It was late December 2020 when Tricia Wimsatt first realized that something was different. Her husband had put up a Christmas tree in their Los Angeles home, and remarked about how good it smelled. But as much as she tried, Wimsatt could smell nothing.
“That was one of my first clues,” Wimsatt recalls.
She had just returned home after quarantining with a family member who had contracted COVID-19. Although Wimsatt was never diagnosed with COVID, she believes it was the coronavirus that robbed her of her sense of smell and taste—something that she still struggles with today.
“The only thing I can really smell are bad smells—the cat box, putrid odors outside. I really don’t get good aromas. The things that I used to love to smell, I can’t stand the smell of now.” Wimsatt says. “Some days everything tastes like flour.”
Besides missing the fragrance of freshly-cut Christmas trees or home-cooked meals, Wimsatt is also concerned about her inability to detect dangerous odors and fumes from things like natural gas leaks, spoiled food, or a fire.
“Before I lost my taste and smell, we had a little gas leak at my house and I was the only one [in my family] who could smell it,” Wimsatt says. “I would not be able to detect that now—which really bothers me. I used to have phenomenal smell. Now it’s gone.”
Loss of smell has become a worldwide problem
Studies show that millions worldwide suffer from loss of smell and taste after COVID-19 infections. According to a 2022 study published in the peer-reviewed journal of the British Medical Association, “about five percent of people who report initial changes to their sense of smell or taste after COVID-19 still report smell and taste dysfunction six months later.”
The National Institute on Deafness and Other Communication Disorders says that about two percent of Americans have anosmia, which is the complete loss of smell, or hyposmia, which is a partial but significant loss of smell. Many also experience parosmia, which is distorted smell. Although COVID has made these more common issues, other viruses and even head trauma can also cause them. And some people are born without ever being able to smell.
The problem not only prevents people from detecting dangers, like Wimsatt fears, but can also have an impact on their physical and mental health as well as their overall well-being. Not being able to taste food can lead to poor appetite or overeating. Many people who’ve lost their sense of smell also report feeling depressed and uneasy.
Traditionally there have been few treatment options. Some otolaryngologists (aka ear, nose, and throat specialists) have found steroids to be most helpful early in the treatment process. However, smell training is perhaps the most effective option based on existing data. It consists of sniffing a variety of scents, like lemon and clove, and trying to retrain the brain to remember what the fragrance smelled like. But since it’s often difficult to determine if the patient regained their sense of smell organically or because of the treatment, researchers say more studies are needed.
Because the COVID-19 pandemic has negatively impacted the sense of smell in so many people, the medical community has turned its attention to finding new options. And soon, there might be a few more promising treatments for loss of smell and taste.
Blood platelets are being used creatively
Some promising research has been taking place in Philadelphia, where a team of researchers and otolaryngologists at Thomas Jefferson University Hospital have been using topical treatments of a patient’s own platelet-rich plasma in hopes of restoring the sense of smell.
“Patients are absolutely desperate,” says David Rosen, MD, who leads the research. “Sometimes they are in tears because it is really miserable not being able to smell.”
“Sometimes [patients] are in tears because it is really miserable not being able to smell.” —David Rosen, MD
Inspired by smaller PRP studies conducted in Europe and in California, Dr. Rosen began a pilot study in 2019 before COVID hit. For the treatments, blood is drawn from the patient and the platelets containing growth factors are isolated. The platelets are then placed on a small sponge which is inserted in the nose. “It is a way for the blood product to get in contact with the lining of the olfactory neurons that are high in the nose,” says Dr. Rosen. “What you’re trying to do is regenerate more of the olfactory neurons. You’re trying to tell the body that there has been some damage, and it’s time to repair it.”
Dr. Rosen says he has studied more than a hundred patients, many of them receiving three or more monthly PRP topical treatments. And based on a commonly used scratch smell test, about 60 percent have reported some level of improvement.
“Whatever improvement these patients get, in general, they are willing to do whatever they can to regain anything,” says Dr. Rosen.
Nancy Damato, a New York– and Florida-based marketing consultant is among the patients who traveled to Thomas Jefferson University Hospital for monthly PRP treatments for most of 2022. Damato says she believes the PRP treatments helped her regain between 50 and 60 percent of her sense of smell, though her ability to perceive odors can fluctuate at times and occasionally she experiences parosmia, or smell distortion.
“I feel that medically it helped me, and I feel that psychologically it gave me the hope I didn’t have before,” Damato says.
There’s a new bionic nose
At Virginia Commonwealth University, researchers are working on the development of a neuroprosthetic device, which, if implanted in the brains of people who have lost their sense of smell, may help some of them regain the ability to detect odors.
Richard Costanzo, PhD, professor emeritus of physiology and biophysics, and Daniel Coelho, MD, a surgeon and professor of otolaryngology have been conducting research on a “bionic nose” for years now—well before the start of the COVID-19 pandemic. Just like the cochlear implant for the hearing impaired, the “bionic nose” would have an outside part and an inside part: A small device might sit on a pair of glasses, for example, and detect odors in the environment, while an inside part in the brain would interpret them.
“The sensors pick up the vapors, and depending on what the different profile is, say orange versus chocolate, then you would get a different output signal,” Dr. Coelho says.
“Then, through a special [micro]processor, it would send signals into the inside of the skull where the electrodes are and activate the appropriate parts of the brain to reproduce those smells,” Dr. Costanzo adds.
After years of experiments in the lab, Drs. Costanzo and Coelho are now beginning to study humans, working with colleagues at a hospital in Massachusetts who are monitoring the brains of epilepsy patients. “Because these people have all these recording electrodes scattered all throughout the brain…looking and listening for where the epilepsy is occurring…we present them different types of odors to see what parts of the brain are lighting up,” Dr. Coelho explains.
So what’s the status of treatments for loss of smell and taste?
Although some patients are already receiving the platelet-rich plasma treatments, the treatment is costly and not covered by insurance. Meanwhile, researchers at Virginia Commonwealth University say their “bionic nose” may take five to 10 years to be fully developed and approved by the federal government.
In the meantime, ENT specialists like Marc Cohen, MD, at Providence Cedars-Sinai Tarzana Medical Center in Southern California, are awaiting the development of medication that would prevent viruses like COVID from doing extensive damage to the nose in the first place. “Creating something that you could take or spray in your nose that protects the nasal lining from injury is the key,” Dr. Cohen says. Because, as a 2022 Duke University study found, COVID can lead to smelling loss due to an immune assault on tissues surrounding the olfactory nerve cells.
In the meantime…
All that said, a cure is precisely what patients like Tricia Wimsatt and Nancy Damato would like to see as soon as possible. Until then, they have had to make several adjustments to their lives. For example, Wimsatt now makes sure to have extra smoke detectors installed. Damato asks her neighbors to do walk-throughs of her home from time to time to detect any gas leaks. And both women now rely on their husbands and other close family members to let them know if food is fresh or to describe how things smell.
“If we go out to dinner I’ll ask my husband. ‘Does this taste good?’ and he says, ‘This tastes really good.’” Wimsatt says. “I kind of use his [judgment] to test out my sense of what’s okay.”
Damato has joined a support group, and continues to take omega-3 vitamins and practice aroma therapy. Both remain hopeful that maybe someday their smell will be completely restored.
“I don’t know if I’ll get it back,” Wimsatt says. “But I hope I do.”
