How to get your smell back after COVID

Speech language therapist Hannah Eskridge, MSP, was sure she smelled something burning.

“I was in the clinic, and it smelled like someone had left a floor heater on,” she says, recalling a moment in early 2021.

No one else smelled it. Eskridge was experiencing the first disruption to her sense of smell caused by COVID-19, which she had been infected with eight months before, back in June 2020. She doesn’t recall whether she lost her ability to smell during her initial illness because her other symptoms were worse.

“I was pretty sick for about a week,” she says. “I wasn’t eating. Then, throughout the fall and winter, I experienced a variety of long COVID symptoms.”

Her headaches, brain fog and sharp pains in her hands, legs and feet were more concerning than changes to her ability to smell. But soon after she started smelling smoke, she began to taste ashes.

“I felt like I was eating an ashtray,” she says. “It was really quite a difficult symptom.”

A loss or disruption of the sense of smell is a well-known symptom of COVID-19, says UNC Health rhinologist Brent Senior, MD. As many as half of all people who had earlier variants of COVID-19 lost their sense of smell. With omicron and its subvariants, about 1 in 5 people lost their sense of smell.

“The good news is that people do recover,” Dr. Senior says. “But it can be quite disturbing for patients, especially since it’s unclear what the time frame is for improvement.”

Disruption to the sense of smell can happen to both vaccinated and unvaccinated people with COVID-19, but vaccinated people tend to have milder symptoms overall and are much less susceptible to serious illness.

COVID-19 Can Make It Harder to Taste Food

People with COVID-19 also report being unable to taste food, Dr. Senior says, but that problem may be caused by the inability to smell.

“Taste goes hand in hand with the sense of smell,” he says. “We haven’t found any damage to cells that directly support the sense of taste. But to really appreciate flavors, you need to be able to smell.”

On average, patients report losing their sense of smell for two or three months after they have recovered from other COVID-19 symptoms, Dr. Senior says. However, doctors don’t know yet how long it will take people infected with omicron variants to recover, though it appears to be shorter.

How COVID-19 Affects the Sense of Smell

Dr. Senior says that the virus that causes COVID-19 seems to affect cells that support the olfactory nerve, the nerve that transmits messages about smell to the brain. This nerve is found high in the nose. When the supporting cells are unable to remove toxins and provide nutrition to the olfactory nerve, then the messages about smell don’t get to the brain.

It’s not unusual for a viral infection to disrupt a person’s sense of smell, Dr. Senior says, but that’s typically because of nasal congestion, and less commonly from involvement of the cells around the olfactory nerve or damage to the nerve itself.

“The thing that is unusual here is the degree of loss of the sense of smell,” he says. “It’s almost complete loss and occurring in a large percentage of COVID-infected people and for a long time.”

Often, people with long COVID (symptoms continuing for months after the virus is gone), continue to experience a loss of taste and smell.

Some people recover their sense of smell only to lose it again or have it return with distortions, a condition called parosmia.

“It’s not infrequent that I hear of this from a patient,” Dr. Senior says. “Things that normally smell good seem to smell very bad to them. We don’t hear of parosmia with patients who lose smell from a cold or the flu.”

Eskridge said the ashtray taste in her mouth wrecked her appetite, “but at least when I ate, the food tasted like it was supposed to,” she says. “I read about a lot of people whose favorite foods started tasting awful.”

Children with COVID-19 Sometimes Lose Their Sense of Smell, Too

About a third of children who get COVID-19 lose their sense of smell, says UNC Health pediatric rhinologist Austin Rose, MD. Fortunately, “most children have a complete resolution of their symptoms within six months,” he says.

Typically, teens and children 10 and older notice a change in smell more than younger children who may have a harder time explaining these symptoms.

“Primarily what I hear from my patients is that they have an alteration instead of loss of smell,” Dr. Rose says. “They’ll say that things smell or taste unusual—maybe foods they normally like don’t taste good anymore. Fortunately, these symptoms usually improve over time.”

A concern for doctors and parents is that children won’t eat enough while their sense of smell is altered, Dr. Rose says, but none of his patients have had serious nutritional problems due to this symptom of COVID-19.

Getting Your Sense of Smell Back After COVID-19

If you lost your ability to smell normally because of a COVID-19 infection, your doctor might suggest nasal sprays or steroid pills that help the cells supporting the olfactory bulb recover faster.

“We don’t have a way of preventing it just yet,” Dr. Senior says, “so we are trying to find treatments that might bring the sense of smell back sooner.”

One strategy that doctors around the world are trying is “sense of smell retraining.” This method was in use for other illnesses before COVID-19, Dr. Senior says, and helps your brain associate smells with objects.

Here’s how it typically works: Patients choose four odors that are distinct, strong, pleasant and familiar, such as a rose, a lemon, coffee or cinnamon. They smell these odors, one at a time, for a minute or two each, a couple of times a day.

“We’ve had encouraging results with sense of smell retraining,” Dr. Senior says. “The more often patients are able to do that kind of treatment, the more likely they are to regain their sense of smell. However, it can take months and patients have to be persistent.”

Because of the need for time and patience, sense of smell retraining is used less often with children, Dr. Rose says.

Dr. Senior recommended that Eskridge use sense of smell retraining. He also prescribed irrigation of her sinuses with a steroid solution twice a day for a month, she says. She did sense of smell retraining twice a day, too.

“I don’t know if it was the smell therapy or irrigation or both,” she says, “but the problems seem to have gone away.”

A Sense of Smell Is Important to Health and Safety

Dr. Senior says that losing your sense of smell can have a huge impact on your quality of life.

“It’s the impact on the individual that’s concerning,” he says. “Your sense of smell is so important to daily life. It’s not only an enjoyable sense, but it also helps keep us safe. We smell food to know if it’s safe to eat. We smell a gas leak and know to get out. It’s hard to enjoy a meal if you don’t have a sense of smell.”

Eskridge agrees.

“When you go through something like this,” she says, “it makes you appreciate the things you took for granted.”

If your sense of smell is not as strong as it used to be, or things have started to smell different from what you expect, speak with your doctor, or find one near you. If you think you may have long COVID-19, talk to your doctor or contact the UNC COVID Recovery Clinic at (984) 974-9747.

We’re told that SARS-CoV-2, like its cousin the common cold virus, will be with us for a long time (forever?) How odd that it remains the “new” coronavirus, two years on.

And that means that, for certain persons, its symptoms will occur for a long time, too. For the cook, the most telling symptom is the way COVID-19 sometimes wipes out a person’s sense of taste or smell, sometimes both.

This came home to me because, over the past two years, both my son, Colin, and one of his closest friends, Dan Murray, a Denver small business owner, both suffered total losses to their senses of smell and taste. In both cases, they also attempted to “retrain” those senses by using strongly-flavored and -scented food.

“After about two weeks,” said Murray, “I got back around 25 percent. In probably six weeks, 80 percent. At first, all I could feel on my tongue was texture—no taste. It was like wearing a surgical glove on my tongue.”

Read other great articles and recipes by Bill St. John.

“I did two things,” said Murray. “I ate (the candy) Hot Tamales and, every morning for weeks, I went to an organic juice shop near work and got a shot of their ginger-apple cider vinegar juice. It was daily training.” He used it as a test, he said, “until I made a ‘bitter beer face,’ a kind of ‘squinty tart face.’”

For his part, Colin, who quarantined in a hotel room in Philadelphia for more than a week, just happened to purchase “a loaf of bread and a jar of peanut butter at a nearby CVS,” he said. “I stuck my nose in the jar all the time to see if I could smell something. In time, it got faint, like someone eating peanuts 10 rows behind you at a ballgame.”

Colin’s taste wasn’t merely gone “for a good ten days”; it also was skewed when it crawled back. “A Miller Lite at the airport tasted really bad,” he said, “acrid, just bitterness and alcohol; no malt, no floral notes. It wasn’t beer.”

Is it possible to ‘retrain’ your nose and get back your sense of taste and smell after COVID-19?

Dr. Jennifer Reavis Decker at the UCHealth Ear, Nose and Throat Clinic, has helped her patients, some of whom are children, to retrain their sense of smell by using strongly-scented essential oils (especially the four of citrus, floral, fruit and spice). It is called “olfactory retraining.”

“The sense of smell is closely linked to memory,” she says, “especially pleasant memories.” That’s why using peanut butter or peppermint candy with children makes more sense than something like the odor of clove or jasmine, of which they typically have little memory or, surely, pleasant ones.

Decker also reminds that many smells are perceived via “the rear nasal pharynx, after a swallow” when the tongue “lifts” air into that passage and onto the olfactory globe where we smell smells. So, attend to the memories that that may evoke for you if you retrain your sense of smell (and the sense of taste that goes with it) after losing it.

Decker also points out two important considerations: first, that “your best shot at improving your sense of smell is during the first 6 weeks after losing it,” and that, second, “the best way to avoid losing your sense of smell (to COVID-19) is to get vaccinated.”

The cookie recipe here is peanut buttery but not overly sweet, so not to distract the palate from tasting sweetness over the nut butter’s aroma. The ginger-based “shot” is powerfully aromatic and flavorful. When swallowing, be sure to push some air up through the rear nasal cavity so that you get a strong smell of it, too.

Healthy Peanut Butter Cookies

From thefirstyearblog.com. Makes 8-12 depending on size. Although the recipe states that “the cookies won’t spread much,” they do.

Ingredients

1 cup quick-cooking oats

3/4 cup peanut butter

1 teaspoon baking soda

1/8 teaspoon salt

1 teaspoon vanilla extract

1/4 cup honey

1 egg

Directions

Preheat the oven to 350 degrees. Place the oats in a blender or food processor and pulverize for 30 seconds to make oat flour. In a large mixing bowl, combine the oat flour, peanut butter, baking soda, salt, vanilla, honey and egg. Use a hand mixer (or heavy wooden spoon) to combine; the mixture will be thick.

Scoop dough balls of about 1 1/2 tablespoons in volume and place on a silicone- or parchment paper-lined baking sheet. Press the dough balls down using the palm of your hand. Create a crisscross pattern on the top of each cookie by pressing a fork into the dough. If the fork sticks to the dough, wipe the fork on a paper towel sprayed with non-stick cooking spray. Because the cookies won’t spread much, you can place them closer together and probably fit all the dough on one baking sheet.

Place the baking sheet in the oven and bake for 10-12 minutes. The cookies will be soft and tender when they come out of the oven; allow them to cool and firm up on the baking sheet for 10 minutes before moving them to a cooling rack.

Store the cookies in an airtight container on the counter for up to 3 days. These cookies can also be frozen. Wrap them in bundles of 3-4 cookies in plastic wrap then place inside a zippered plastic bag and place in the freezer.

Ginger-Lemon-Apple Cider Vinegar Shots

A very healthy tonic, but not for the faint of heart. Makes about 12 ounces (1 1/2 cups).

Ingredients

8 ounces fresh ginger root

1 large lemon, zested and juiced

2/3 cup apple cider vinegar

1 tablespoon honey

1/8 teaspoon fine sea or kosher salt

Directions

Peel the ginger: Using a dull-edged spoon or knife, scrape and rub away the skin on the ginger, getting into the nooks and crannies as best you can. Chop the ginger into 10-12 pieces and pulse, then pulverize, them in a food processor, scraping down the bowl from time to time, until the ginger is nearly a paste.

Add the zest and juice from the lemon, the vinegar, honey and salt and process until the mixture is a thick slurry. Spoon the amount you desire into a small glass and drink down in one “shot.” Stores in the refrigerator for up to 10 days.

This story first appeared in The Denver Post. Reach Bill St. John at