Loss of Sense of Smell due to Covid-19

The Spread of the Virus

Late December 2019, an outbreak of a mysterious virus characterized by fever, dry cough, and fatigue, and occasional gastrointestinal symptoms happened in a seafood wholesale wet market, the Huanan Seafood Wholesale Market, in Wuhan, Hubei, China.1 And before we knew what was happening we were in the middle of a terrible worldwide pandemic that caused massive shut downs and quarantine that has shaken everyone in many different ways.  Many of us have lost loved ones and friends to the virus, suicide and loneliness from being isolated and in quarantine. Many people lost their jobs, homes and every sense of normalcy.  For me, my best friend for over 50 years, Toni, came down with the virus and was hospitalized.  Luckily, she is recovering, however Toni no longer have a sense of smell nearly six months later.

Psychology and Smell

Smell is an important sense as it can alert us to danger like gas leak, fire or rotten food but also is closely linked to parts of the brain that process emotion and memory. Smell is vital for survival of most humans and animals as it enables them to track food and water, find a mate and even communicate. When you lose your sense of smell you can also lose some important memories that are triggered by aroma. Given that our sense of smell clearly plays an important part in our psychological make-up, in addition to it being one of the five ways in which we connect with the world around us, its absence can have a profound impact. Many people feel isolated and can lead to depression.11

I consider myself a wine enthusiast and have obtained a WSET Certificate with distinction in blind tastings.  Through this study I have found our sense of smell has a profound affect on the way our brain processes flavor.  Once you smell something the flavor is much stronger. This is why smell is so important when it comes to tasting a wine.  It is also the way that you can describe a wine. Common aromas associated with wines include fruit, herbs, flowers, earth, grass, tobacco, mocha and chocolate. So in order to be proficient in identifying the aromas, I had to do a lot of “smell training” from little bottles of aromas and then identify these smells in the wine.  It is from this training that I decided I’d love to learn more about aromatherapy.

Loss of Smell

Early in the COVID-19 pandemic, it emerged that many people infected with the SARS-CoV-2 virus were losing their sense of smell — even without displaying other symptoms. Almost a year later, some still haven’t recovered these senses, and for a proportion of people who have, odours are now warped: unpleasant scents have taken the place of normally delightful ones.  Through my research I found one review, published last June3, compiled data from 8,438 people with COVID-19, and found that 41% had reported experiencing smell loss. In another study, published in August4, a team led by researcher Shima T. Moein at the Institute for Research in Fundamental Sciences in Tehran, Iran, administered a smell-identification test to 100 people with COVID-19 in which the patients sniffed odors and identified them on a multiple-choice basis. Ninety-six per cent of the participants had some olfactory friend is in the 18% with total loss of smell. So, since I have been studying aromatherapy, I started researching the possibility of essential oils and their ability to help her regain this very important function.  Firstly, I had to know the scientific reasons for the loss of smell.  Were the cells in the nose damaged or was it a neurological issue, something in the brain?

Why, why, why

Although the mechanisms are not fully understood, A team led by Sandeep Robert Datta, a neurobiologist at Harvard Medical School in Boston, Massachusetts, has instead found5 that cells that support sensory neurons in the nose — known as sustentacular cells — are probably what the virus is infecting. The study suggests that the coronavirus infects the support cells, leaving the neurons vulnerable and deprived of nutrients.  But there are many other conflicting studies.  And no one really knows for certain why people who have had Covid 19 are losing their sense of smell.  It’s just too early in the studies to have a definitive answer.

Claire Hopkins, an ear, nose and throat consultant at Guy’s and St Thomas’ Hospital in London, and her colleagues similarly observed6 as a person regains their sense of smell, odours often register as unpleasant and different from how they remembered them, a phenomenon called parosmia. “Everything smells rancid” to these people, says Hopkins, and the effect can last for months. This might be because the olfactory sensory neurons are rewiring as they recover, she says. Other patients remain fully anosmic for months, and it isn’t clear why. Hopkins suggests that, in these cases, the coronavirus infection might have killed the olfactory sensory neurons.  Which left me wondering what is the possibility of regaining the sense of smell.  Is it that the neurons simply had to remember how to smell or were they killed?  Since I had no way of knowing I decided to try to retrain Toni’s sense of smell to relearn them.  I found that I was not alone in my thinking.

Smell Training

A charity called AbScent in Andover, UK, has been offering a program to retrain the sense of smell. There is evidence7 from before the pandemic that it can improve smell function in some people with such impairments, but it doesn’t seem to work for everyone.  So I visited their website (https://abscent.org/learn-us/smell-training) and found “If you’ve lost your sense of smell for two weeks or more, smell training can help recovery. Smell training is actively sniffing the same four scents every day, spending around 20 seconds on each scent and really concentrating on what you’re doing. It’s that easy. It’s safe, it’s recommended by doctors, and anyone can do it.”

With this in mind, I knew I was not doing anything ground breaking, but decided to go along with this theory of regular stimulation of their olfactory “brain” and prepare smell training for Toni with the intension of helping her recover hermsense of smell.

Case Study in Smell Training

Following the guidelines in the AbScent smell training website, I did a complete assessment of what she could smell taking notes so that we can measure any improvements. You can find the assessment here: https://abscent.org/application/files/5515/7532/6861/Self_assessment.pdf.

Instead of using jars as they used for the Abscent study, I put together these inhalers (below) for Toni which was inspired from the original Abscent 2009 study.  My information in reference to the oils used is from the Data Sheets is from Aromahead Aromatherapy Certification Course and also from Aromatics International website where I purchased the oils.

Lemon Essential Oil (Citrus limonum) is cold pressed from the lemon peel and it is known to flight exhaustion and is also very uplifting. This is because the olfactory gland in our sinuses helps turn smells into chemical responses for our brain to process. Toni is still struggling from exhaustion while recovering from the virus so I am sure this will benefit her in an emotional way as well as the smell training.
Rose Absolute Oil (Rosa x centifolia) is an anti-depressant, calmative and also just smells great and I know Toni loves Roses. For a long time, I thought all oils were basically created equally. While that may be the case for true essential oils, some organic material cannot be subjected to the same processes that are used to create essential oil. It’s important to note that essential oil is created through a method known as steam distillation, wherein heat (steam) is used to extract the various vitamins and minerals from the organic matter through evaporation. However, certain types of organic material are too sensitive for steam distillation and cannot withstand these high levels of heat. Because of this, a process involving the use of various chemical solvents is sometimes used to extract the phytochemicals, vitamins, nutrients, and other bioactive compounds from organic matter. The end result of this process is known as an ‘absolute’ and it’s important for me to stress that it is not an essential oil.
Clove Bud Essential Oil (Syzygium aromaticum) is steam distilled from the flowering buds of the clove tree and is great for easing respiratory conditions. I also find it invigorating and mentally stimulating.  Clove Bud Oil (rather than leaf which is distilled from the leaf) is a much stronger scent and is usually used in aromatherapy. Clove Bud Essential Oil generally contains up to 85% Eugenol, a phenol that dramatically contributes to the oil’s aroma, therapeutic properties, and safety precautions (which can be irritating to the skin). Clove Bud Essential Oil is also comprised of a number of other constituents, particularly the sesquiterpene B-caryophyllene and the ester Eugenyl acetate. American College of Healthcare Sciences principal Dorene Petersen has undertaken research regarding cognitive and brain health. She presents that Clove Bud Essential Oil shows promise for assisting in the management of neurodegenerative diseases.9   So now I understand that this oil may also assist in the memory of the smells and is an excellent choice for this smell training case study.
EucalyptusEssential Oil (Eucalyptus citriodora) is distilled from the leaf of the tree and is used for its soothing effects when inhaled, for example during a cold or cough and is an immune-boosting oil.  Which is also perfect for the inhaler for smell training after a virus.  Eucalyptus should not be used on children as it can irritate their respiratory track and if not used correctly can cause poisoning. The main constituents of Eucalyptus Oil are: α-Terpineol, 1,8-cineole (Eucalyptol), α-pinene, β-pinene, Sabinene, Camphene, Limonene, p-Cymene, Camphor, Globulol, Citronellal, α-phellandrene, Aromadendrene, and Piperitone.

Guidelines and Instructions for Smell Training

I packaged up the inhalers and typed up some instructions for use which included:

Keep the inhalers beside your bed so that you can use them when you wake and before you go to sleep.
Take a short breath and gently inhale the lemon scent (for instance) for about 20 seconds. (There is a snif app that will help time you and also offer visuals. This is located on the Absent website as mentioned previously and is in the bibliography.)
Block out any intrusive thoughts.
Try to remember everything you know about lemons both smell and tasting.
Next move on to the next inhaler and repeat this process.
Continue doing this twice a day for four months. It is not a quick process but the earlier you start the quicker the process.
Remember to Record your progress in a journal. Your smell training results may be better or worse on any given day so it is best to record your progress every 3 weeks. Download this handy diary or try AbScent’s Snif App to help with the routine of smell training and record your results on your mobile device or desktop.E

Conclusion

While the study is ongoing, we have seen some promising results. Nerves take time to heal.  Depending on the damage, this could be two months or it could be two years or even longer.  No one can predict how long recovery will take or how completely anyone will recover.  But we do have evidence that smell training helps 10 .  These studies have shown that smell training may help recover smell performance (identifying and distinguishing smells) caused by parosmia in patients with smell loss caused by a viral infection. Although speculative, these findings stress the importance for future efforts in experimental and clinical research regarding olfactory neuron regeneration in different types of olfactory loss.  I will keep you updated on the results from my case study with which is still in the early stages and hopefully will have a positive conclusion.

Aromatherapy is an amazing recourse, with the ability to stimulate cognition and memory, enhance mood, and curb cravings. Of course, smells are indisputably a very strong link to the past. The benefits of aromatherapy are the proof of the efficiency of our sense of smell in the present; therefore, if olfaction is a window into the past as well as a supportive and healing tool in the present, with this knowledge how can we change our future?   I leave you with an important quote: “Knowledge without application is simply knowledge. Applying the knowledge to one’s life is wisdom — and that is the ultimate virtue.” ― Author Kasi Kaye Iliopoulos.

Bibliography

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet2020DOI: 10.1016/S0140-6736(20)30183-5
World Health Organization Novel Coronavirus (2019-nCoV)Available athttps://www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed February 7, 2020
Agyeman, A. A.,Chin, K. L., Landersdorfer, C. B., Liew, D. & Ofori-Asenso, R. Mayo Clin. Proc. 95, 1621–1631 (2020).
Moein, S. T., Hashemian, S. M., Tabarsi, P. & Doty, R. L. Forum Allergy Rhinol. 10, 1127–1135 (2020).
Brann, D. H. et al. Adv. 6, eabc5801 (2020).
Boscolo-Rizzo, P. et al.JAMA Otolaryngol. Head Neck Surg. 146, 729–732 (2020). https://doi.org/10.1001%2Fjamaoto.2020.1379
Boesveldt, S. et al. Senses 42, 513–523 (2017). https://academic.oup.com/chemse/article/42/7/513/3844730
https://abscent.org/learn-us/smell-training
[Dorene Petersen,Presentation: Clinical Use of Aromatherapy for Brain Health: 7 Essential Oils. August 9, 2017, New Brunswick, NJ. Alliance of International
https://abscent.org/learn-us/latest-research

Psychology and Smell

Recovering Anosmia for people experiencing loss of smell after Covid-19

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The Spread of the Virus

Late December 2019, an outbreak of a mysterious virus characterized by fever, dry cough, and fatigue, and occasional gastrointestinal symptoms happened in a seafood wholesale wet market, the Huanan Seafood Wholesale Market, in Wuhan, Hubei, China.1 And before we knew what was happening we were in the middle of a terrible worldwide pandemic that caused massive shut downs and quarantine that has shaken everyone in many different ways.  Many of us have lost loved ones and friends to the virus, suicide and loneliness from being isolated and in quarantine. Many people lost their jobs, homes and every sense of normalcy.  For me, my best friend for over 50 years, Toni, came down with the virus and was hospitalized.  Luckily, she is recovering, however Toni no longer have a sense of smell nearly six months later.

Psychology and Smell

Smell is an important sense as it can alert us to danger like gas leak, fire or rotten food but also is closely linked to parts of the brain that process emotion and memory. Smell is vital for survival of most humans and animals as it enables them to track food and water, find a mate and even communicate. When you lose your sense of smell you can also lose some important memories that are triggered by aroma. Given that our sense of smell clearly plays an important part in our psychological make-up, in addition to it being one of the five ways in which we connect with the world around us, its absence can have a profound impact. Many people feel isolated and can lead to depression.11

I consider myself a wine enthusiast and have obtained a WSET Certificate with distinction in blind tastings.  Through this study I have found our sense of smell has a profound affect on the way our brain processes flavor.  Once you smell something the flavor is much stronger. This is why smell is so important when it comes to tasting a wine.  It is also the way that you can describe a wine. Common aromas associated with wines include fruit, herbs, flowers, earth, grass, tobacco, mocha and chocolate. So in order to be proficient in identifying the aromas, I had to do a lot of “smell training” from little bottles of aromas and then identify these smells in the wine.  It is from this training that I decided I’d love to learn more about aromatherapy.

Loss of Smell

Early in the COVID-19 pandemic, it emerged that many people infected with the SARS-CoV-2 virus were losing their sense of smell — even without displaying other symptoms. Almost a year later, some still haven’t recovered these senses, and for a proportion of people who have, odours are now warped: unpleasant scents have taken the place of normally delightful ones.  Through my research I found one review, published last June3, compiled data from 8,438 people with COVID-19, and found that 41% had reported experiencing smell loss. In another study, published in August4, a team led by researcher Shima T. Moein at the Institute for Research in Fundamental Sciences in Tehran, Iran, administered a smell-identification test to 100 people with COVID-19 in which the patients sniffed odors and identified them on a multiple-choice basis. Ninety-six per cent of the participants had some olfactory friend is in the 18% with total loss of smell. So, since I have been studying aromatherapy, I started researching the possibility of essential oils and their ability to help her regain this very important function.  Firstly, I had to know the scientific reasons for the loss of smell.  Were the cells in the nose damaged or was it a neurological issue, something in the brain?

Why, why, why

Although the mechanisms are not fully understood, A team led by Sandeep Robert Datta, a neurobiologist at Harvard Medical School in Boston, Massachusetts, has instead found5 that cells that support sensory neurons in the nose — known as sustentacular cells — are probably what the virus is infecting. The study suggests that the coronavirus infects the support cells, leaving the neurons vulnerable and deprived of nutrients.  But there are many other conflicting studies.  And no one really knows for certain why people who have had Covid 19 are losing their sense of smell.  It’s just too early in the studies to have a definitive answer.

Claire Hopkins, an ear, nose and throat consultant at Guy’s and St Thomas’ Hospital in London, and her colleagues similarly observed6 as a person regains their sense of smell, odours often register as unpleasant and different from how they remembered them, a phenomenon called parosmia. “Everything smells rancid” to these people, says Hopkins, and the effect can last for months. This might be because the olfactory sensory neurons are rewiring as they recover, she says. Other patients remain fully anosmic for months, and it isn’t clear why. Hopkins suggests that, in these cases, the coronavirus infection might have killed the olfactory sensory neurons.  Which left me wondering what is the possibility of regaining the sense of smell.  Is it that the neurons simply had to remember how to smell or were they killed?  Since I had no way of knowing I decided to try to retrain Toni’s sense of smell to relearn them.  I found that I was not alone in my thinking.

Smell Training

A charity called AbScent in Andover, UK, has been offering a program to retrain the sense of smell. There is evidence7 from before the pandemic that it can improve smell function in some people with such impairments, but it doesn’t seem to work for everyone.  So I visited their website (https://abscent.org/learn-us/smell-training) and found “If you’ve lost your sense of smell for two weeks or more, smell training can help recovery. Smell training is actively sniffing the same four scents every day, spending around 20 seconds on each scent and really concentrating on what you’re doing. It’s that easy. It’s safe, it’s recommended by doctors, and anyone can do it.”

With this in mind, I knew I was not doing anything ground breaking, but decided to go along with this theory of regular stimulation of their olfactory “brain” and prepare smell training for Toni with the intension of helping her recover hermsense of smell.

Case Study in Smell Training

Following the guidelines in the AbScent smell training website, I did a complete assessment of what she could smell taking notes so that we can measure any improvements. You can find the assessment here: https://abscent.org/application/files/5515/7532/6861/Self_assessment.pdf.

Instead of using jars as they used for the Abscent study, I put together these inhalers (below) for Toni which was inspired from the original Abscent 2009 study.  My information in reference to the oils used is from the Data Sheets is from Aromahead Aromatherapy Certification Course and also from Aromatics International website where I purchased the oils.

  • Lemon Essential Oil (Citrus limonum) is cold pressed from the lemon peel and it is known to flight exhaustion and is also very uplifting. This is because the olfactory gland in our sinuses helps turn smells into chemical responses for our brain to process. Toni is still struggling from exhaustion while recovering from the virus so I am sure this will benefit her in an emotional way as well as the smell training.
  • Rose Absolute Oil (Rosa x centifolia) is an anti-depressant, calmative and also just smells great and I know Toni loves Roses. For a long time, I thought all oils were basically created equally. While that may be the case for true essential oils, some organic material cannot be subjected to the same processes that are used to create essential oil. It’s important to note that essential oil is created through a method known as steam distillation, wherein heat (steam) is used to extract the various vitamins and minerals from the organic matter through evaporation. However, certain types of organic material are too sensitive for steam distillation and cannot withstand these high levels of heat. Because of this, a process involving the use of various chemical solvents is sometimes used to extract the phytochemicals, vitamins, nutrients, and other bioactive compounds from organic matter. The end result of this process is known as an ‘absolute’ and it’s important for me to stress that it is not an essential oil.
  • Clove Bud Essential Oil (Syzygium aromaticum) is steam distilled from the flowering buds of the clove tree and is great for easing respiratory conditions. I also find it invigorating and mentally stimulating.  Clove Bud Oil (rather than leaf which is distilled from the leaf) is a much stronger scent and is usually used in aromatherapy. Clove Bud Essential Oil generally contains up to 85% Eugenol, a phenol that dramatically contributes to the oil’s aroma, therapeutic properties, and safety precautions (which can be irritating to the skin). Clove Bud Essential Oil is also comprised of a number of other constituents, particularly the sesquiterpene B-caryophyllene and the ester Eugenyl acetate. American College of Healthcare Sciences principal Dorene Petersen has undertaken research regarding cognitive and brain health. She presents that Clove Bud Essential Oil shows promise for assisting in the management of neurodegenerative diseases.9   So now I understand that this oil may also assist in the memory of the smells and is an excellent choice for this smell training case study.
  • EucalyptusEssential Oil (Eucalyptus citriodora) is distilled from the leaf of the tree and is used for its soothing effects when inhaled, for example during a cold or cough and is an immune-boosting oil.  Which is also perfect for the inhaler for smell training after a virus.  Eucalyptus should not be used on children as it can irritate their respiratory track and if not used correctly can cause poisoning. The main constituents of Eucalyptus Oil are: α-Terpineol, 1,8-cineole (Eucalyptol), α-pinene, β-pinene, Sabinene, Camphene, Limonene, p-Cymene, Camphor, Globulol, Citronellal, α-phellandrene, Aromadendrene, and Piperitone.

 

Guidelines and Instructions for Smell Training

I packaged up the inhalers and typed up some instructions for use which included:

  • Keep the inhalers beside your bed so that you can use them when you wake and before you go to sleep.
  • Take a short breath and gently inhale the lemon scent (for instance) for about 20 seconds. (There is a snif app that will help time you and also offer visuals. This is located on the Absent website as mentioned previously and is in the bibliography.)
  • Block out any intrusive thoughts.
  • Try to remember everything you know about lemons both smell and tasting.
  • Next move on to the next inhaler and repeat this process.
  • Continue doing this twice a day for four months. It is not a quick process but the earlier you start the quicker the process.

Remember to Record your progress in a journal. Your smell training results may be better or worse on any given day so it is best to record your progress every 3 weeks. Download this handy diary or try AbScent’s Snif App to help with the routine of smell training and record your results on your mobile device or desktop.E

Conclusion

While the study is ongoing, we have seen some promising results. Nerves take time to heal.  Depending on the damage, this could be two months or it could be two years or even longer.  No one can predict how long recovery will take or how completely anyone will recover.  But we do have evidence that smell training helps 10 .  These studies have shown that smell training may help recover smell performance (identifying and distinguishing smells) caused by parosmia in patients with smell loss caused by a viral infection. Although speculative, these findings stress the importance for future efforts in experimental and clinical research regarding olfactory neuron regeneration in different types of olfactory loss.  I will keep you updated on the results from my case study with which is still in the early stages and hopefully will have a positive conclusion.

Aromatherapy is an amazing recourse, with the ability to stimulate cognition and memory, enhance mood, and curb cravings. Of course, smells are indisputably a very strong link to the past. The benefits of aromatherapy are the proof of the efficiency of our sense of smell in the present; therefore, if olfaction is a window into the past as well as a supportive and healing tool in the present, with this knowledge how can we change our future?   I leave you with an important quote: “Knowledge without application is simply knowledge. Applying the knowledge to one’s life is wisdom — and that is the ultimate virtue.” ― Author Kasi Kaye Iliopoulos.

 

Bibliography

  1. Huang C, Wang Y, Li X, Ren L, Zhao J, Hu y, et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China.Lancet2020DOI: 10.1016/S0140-6736(20)30183-5
  2. World Health Organization Novel Coronavirus (2019-nCoV)Available athttps://www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed February 7, 2020
  3. Agyeman, A. A.,Chin, K. L., Landersdorfer, C. B., Liew, D. & Ofori-Asenso, R. Mayo Clin. Proc. 95, 1621–1631 (2020).
  4. Moein, S. T., Hashemian, S. M., Tabarsi, P. & Doty, R. L. Forum Allergy Rhinol. 10, 1127–1135 (2020).
  5. Brann, D. H. et al. Adv. 6, eabc5801 (2020).
  6. Boscolo-Rizzo, P. et al.JAMA Otolaryngol. Head Neck Surg. 146, 729–732 (2020). https://doi.org/10.1001%2Fjamaoto.2020.1379
  7. Boesveldt, S. et al. Senses 42, 513–523 (2017). https://academic.oup.com/chemse/article/42/7/513/3844730
  8. https://abscent.org/learn-us/smell-training
  9. [Dorene Petersen,Presentation: Clinical Use of Aromatherapy for Brain Health: 7 Essential Oils. August 9, 2017, New Brunswick, NJ. Alliance of International
  10. https://abscent.org/learn-us/latest-research
  11. https://www.fifthsense.org.uk/psychology-and-smell/

 

 

Categories: Aromatherapy Case Study

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