COVID-19—The loss of smell, with or without changes in taste, related to COVID-19 infection typically occurs without the nasal congestion or runny nose that is typically seen with a cold. Associated symptoms may also include headache, a dry cough, shortness of breath, high fever, stomach problems, and a persistent sore throat. More severe symptoms such as these often point to COVID-19 or the flu. During the pandemic, anyone who has a new loss of smell or taste, even without any of those other symptoms, should be suspected of having COVID-19 and be tested, whether or not they have been previously vaccinated. Polymerase chain reaction (PCR) testing for COVID-19 can be easily obtained and will identify those patients with COVID-19.
Patients that experience a loss of smell from COVID-19 that does not get better after several months may benefit from, smell retraining therapy. This treatment, which can be done at home by sniffing four different scents twice a day for four to six months, has proven to improve the smell for some, but not all patients. An ENT specialist may advise additional therapies, such as sinus rinses with topical nasal steroids. Parosmia, or altered sense of smell, may occur weeks or months after loss of smell with COVID-19.
URI (Upper Respiratory Infection)—Nasal obstruction and thick nasal drainage with or without the loss of smell commonly occur with a cold (viral URI). These self-confined symptoms are usually limited to the nasal and sinus areas and most times go away in five to seven days. These URIs are often associated with a mild fever. Initial treatment of URIs often benefits from symptomatic care alone without the need for an antibiotic, and they usually clear without the need for a physician visit. If the symptoms do not go away or get worse after five to seven days, a physician visit might be needed. Occasionally, a viral URI will have a lingering effect on your sense of smell, and you should see an ENT (ear, nose, and throat) specialist, or otolaryngologist, for further evaluation if it persists after your nasal breathing returns to normal.
Allergic Rhinitis—Environmental allergies can result in acute or chronic symptoms that can be mistaken for a viral URI or sinus issues. Depending on where you live, allergic rhinitis is usually seasonal. Allergic patients have a clear nasal discharge and nasal congestion with post-nasal drainage or drip as well as runny eyes, sneezing, and itching. Some patients will only experience congestion or obstruction.
Over the counter (OTC) allergy medications or prescription medications that your primary care physician provides usually control the symptoms well. Those who are still suffering from allergies after trying medications can benefit from an evaluation by an ENT specialist to identify your allergies and other related problems that prevent improvement. They will be able to offer additional medical treatments, drops, or shots.
Acute Rhinosinusitis (commonly known as Acute Sinusitis)—Although less common, an URI, bad dental infection of the upper teeth, or severe allergy disease can lead to acute bacterial sinusitis. Symptoms include nasal congestion, which can lead to changes in smell and taste, facial pain and pressure, fever, foul nasal discharge, and occasionally swelling. It often hurts to just touch your face. Antibiotics are sometimes needed and can be obtained from your primary care physician or an ENT specialist.
Many healthy people can get well from acute bacterial rhinosinusitis without antibiotics using supportive therapy such as saltwater rinsing. If the sinus infection is caused by tooth infections, then they often improve when the tooth infection is addressed by your dentist. If not, the patient should see an ENT specialist for further treatment.
Chronic Rhinosinusitis (commonly known as Chronic Sinusitis or CRS)—Once sinus infections last more than three months, they are considered “chronic.” Patients with chronic rhinosinusitis usually complain of nasal blockage and thick nasal drainage with or without loss of smell, facial pain or tenderness and sometimes headaches. Chronic rhinosinusitis can occur with or without nasal polyps, and the presence of polyps often will require more individualized care An evaluation by an ENT specialist is recommended for proper diagnosis and treatment.
Allergy, Nose & Sinus February 10, 2020
Smell or olfaction, is one of the five human senses that is often overlooked. It plays an important role in the appreciation of food flavors and pleasant odorants (e.g. perfumes and flowers), detection of potential hazardous situations or materials (e.g. fire smoke and spoiled food) and is integral in a person’s daily social interactions and awareness of his or her surroundings. In this short blog, Dr Gan explains why we can’t smell when we have a cold and discuss some of the common causes of loss of smell and taste, an area that is often neglected not only by patients but also by some Family Physicians and Ear, Nose & Throat (ENT) Specialists.
Figure 1– The location of the olfactory nerves in the nose. When smell is detected by the olfactory nerves, the smell information is carried by signals that are transmitted by the olfactory bulb and olfactory tract to the brain.
Most of us has had a cold, flu or sinus infection (sinusitis) at some point in our lives (some more frequent than others). During these episodes, sometimes we would have experienced a temporary reduction or a total loss of our sense of smell and taste. The nerves responsible for detecting smell (also called the olfactory nerves) are located at the roof of the nasal cavity (deep and high inside the nose)(Figure 1). When one has a cold, flu or sinusitis, there is swelling and a lot more mucous in the nose. The mucous and swelling in the nose prevents the smell (odorant) from reaching the top of the nasal cavity. Hence the smell never reaches the smell nerves and the nerves are not stimulated. After your nose or sinus infection settles, the swelling and excessive mucous resolves. The odorant is then able to reach the smell nerve fibres again. Hence, you regain your sense of smell. Your sense of taste (ability to detect sweetness, sourness, bitterness and saltiness and umami) is actually normal during your cold or sinus infection. Your food seems “tasteless” during a cold because your appreciation of food flavour and odour comes from your ability to smell! So don’t blame your taste bud for the loss of flavour. It is all due to your stuffed-up nose!
Unfortunately for some, during the cold, flu or sinus infection, the loss of sense of smell is not due to a physical blockage. It is due to the virus, bacteria or inflammation causing damage to the smell nerves during the infection. If the smell nerves are damaged, the loss of smell is often permanent and irreversible. Most often, the cause for prolonged loss of sense of smell is unknown (Idiopathic). Other common causes of prolonged loss of sense of smell include severe head trauma (potentially causing shearing injury to the smell nerve), chronic sinusitis, nasal polyps and rhinitis. In rare instances the loss may be due to a nose or brain tumour!
If your sense of smell has decreased, you should consult a Singapore ENT Specialist for further assessment. A decrease in sense of smell (relative to what is considered normal for the patient’s age-group) is also increasingly recognised as an early marker for neurodegenerative conditions such as Parkinson’s disease and Alzheimer’s disease.
Best wishes,
Dr Gan Eng Cern
ENT Specialist Singapore
When Should You See An ENT Specialist In Singapore?
- Any Ear, Nose or Throat symptoms that you are troubled with or concerned of
- Persistent blocked nose with mouth breathing or snoring
Dr Gan Eng Cern
Dr Gan Eng Cern is a fellowship trained Consultant Ear, Nose & Throat (ENT) Surgeon. He completed his ENT training in Singapore and obtained his subspecialty training in Rhinology and Endoscopic Skull Base Surgery at the world renowned St Paul’s Sinus Centre, University of British Columbia, Vancouver, Canada. He was also a Senior Clinical Lecturer at Yong Loo Lin School of Medicine at the National University of Singapore. Dr Gan was an avid researcher with numerous publications in reputable international ENT journals. He was also an invited speaker and surgical dissection teacher in many ENT conferences and courses.
Awards
- 2020 – Reader’s Choice Gold Award for Best ENT Specialist
(Expat Living Singapore) - 2016 – Best Educator Award (Eastern Health Alliance)
- 2016 – “Wow” Award (Patient Compliment)
- 2014 – Eastern Health Alliance Caring Award – Silver
- 2014 – 19th Yahya Cohen Memorial Lectureship (awarded by the College
of Surgeons, Academy of Medicine Singapore for best scientific surgical
paper) - 2012 – Human Manpower Development Award (Ministry of Health,
Singapore) - 2007 – Singhealth Best Doctor Award
Qualifications
- MBBS - Bachelor of Science, Bachelor of Medicine, Bachelor of Surgery (University of New South Wales, Sydney, Australia)
- MRCS (Edin) - Member of the Royal College of Surgeons Edinburgh, United Kingdom
- MMed (ORL) - Master of Medicine in ENT (National University of Singapore)
- FAMS - Fellow of the Academy of Medicine Singapore
Why Choose Dr Gan Eng Cern
1
Reliable & Reputable ENT Expert
Experienced and patient ENT Specialist who has your best interests at heart. We aim to provide you with accessible and specialized care for any ENT condition in a comfortable setting.
2
Friendly & Helpful Clinic Staff
Our friendly staff will assist you to the best of our ability and we are happy to accept most insurance providers and assist with E-filing with relevant insurance providers or Medisave.
3
Advanced ENT Equipment & Fully Equipped Facility
Our ENT Specialist, Dr Gan Eng Cern, will be able to diagnose and offer personalised treatments for your specific ENT condition. You can expect a high level of ENT care in a spacious setting with in-house minor surgical, endoscopy, allergy testing and microscopy services.
4
Financial Options
There are various financial options available for you to ensure that you are able to receive the most optimal treatment and care. Our ENT clinic staff will be able to assist you with your medical insurance claims and work with your chosen healthcare organization to minimize the hassle and paperwork required. In some cases, you may be able to utilise the funds in your Medisave account to defray part of the costs of your treatment. As our clinic is accredited by the Medisave board, we are able to process your claims from your Medisave for certain clinic procedures.
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