Management of Covid-19 anosmia

A summary of the current guidance for patients and GPs

This information is sourced from ENT UK, Your Covid Recovery, NHS UK and the RCGP :

Guidance for the public

Your Covid Recovery advises patients that loss of smell following Covid infection may take weeks or months to resolve and is associated with an altered sense of taste. The advice given is limited to techniques to improve the taste of food (oral hygiene, experimenting with different flavours and avoiding metal cutlery)

NHS UK advises patients that rinsing the inside of your nose with saline may help but that you should see a GP if your sense of smell does not go back to normal in a few weeks. Steroid nasal sprays or drops might help if sinusitis or nasal polyps are diagnosed. NHS UK also direct patients to smell testing and training resources from AbScent and Fifth Sense and highlight safety advice from Fifth Sense as people with anosmia may not be able to smell things like gas leaks, fires and food that’s gone off

Guidance for GPs:

The RCGP advises GPs to:

Take a history (in appropriate PPE) and look for red flags; neurological impairment, unilateral nasal congestion, persistent headache, weight loss
Perform a head, neck and basic neurological examination
Treat acute cold symptoms with nasal irrigation advice
Advise patients who have had persistent anosmia for more than 3 months to complete olfactory training at home over a 12-week period and to refer to ENT after this if there is no improvement
Consider a short course of steroids in selected patients as a diagnostic aid
Counsel patients with anosmia on the hazards of smell disturbance (see NHS UK advice above)

The British Rhinological Society advises GPs:

Isolated Loss of smell (ILOS)

Patients with ILOS for less than 3 months following Covid infection should be directed to AbScent and Fifth Sense for olfactory training
Patients with ILOS for more than 3 months following Covid infection should be referred to ENT
Patients with no Covid infection and ILOS for more than 4-6 weeks need an ENT referral

Loss of smell (LOS) associated with nasal symptoms (blockage/congestion)

Intranasal corticosteroid sprays are recommended in patients with LOS more than 2 weeks associated with nasal symptoms
All patients with LOS more than 4-6 weeks associated with nasal symptoms should be referred to ENT

Loss of smell (LOS) associated with neurological symptoms (including persistent gustatory dysfunction)