Olfactory Disorder

Q My smell disorder has lasted for two years. Is it worth starting treatment even now?

A. It is still meaningful to start treatment for a smell disorder that has lasted more than two years. Complete recovery may be difficult, but maintaining the remaining sense of smell and preventing further deterioration are realistic goals. There are reported cases of partial recovery even years later when olfactory training and mucosal care are continued consistently.

Q Since I cannot smell, food tastes bland and I have become more depressed. Is there a connection between smell disorders and depression?

A. Yes, about 40 to 50% of patients with smell disorders also experience symptoms of depression or anxiety. Smell is directly connected to the amygdala and hippocampus, which process memory and emotion, so when smell declines, emotional responses and appetite can also become dulled. It is important to combine psychological support with smell recovery.

Q I heard that smell disorders can be an early sign of Parkinson's disease or dementia. Should I be worried?

A. Smell disorder is known to be one of the early signs that can appear years before Parkinson's disease and Alzheimer's disease. However, most smell disorders are due to other causes such as rhinitis or COVID-19 and do not immediately indicate a neurodegenerative disease. If gradual smell decline of unknown cause appears after the age of 50 along with accompanying symptoms such as hand tremor or memory decline, a neurology evaluation is recommended.

Q I heard about something called olfactory training. How can I do it at home?

A. Olfactory training involves smelling four scents - rose, lemon, eucalyptus, and clove - for 30 seconds each, twice a day, while concentrating. The key is to actively recall the memory and image of each scent as you smell it. Doing it consistently for at least 12 weeks promotes regeneration of the olfactory epithelium and neural plasticity, speeding recovery.

Q Please tell me about lifestyle habits that help with smell disorder recovery.

A. Saline nasal irrigation, sufficient sleep, not smoking, and keeping indoor humidity at 50 to 60% are key. Drink plenty of fluids so the nasal mucosa does not dry out, and reduce exposure to fine dust and chemicals. Doing olfactory training every day without missing a day boosts the recovery rate the most.

Q I heard that nasal bloodletting is also used for smell disorders. Is it safe? Are there any side effects?

A. Nasal bloodletting is a procedure that uses sterile instruments to release a small amount of blood from congested areas of the nasal mucosa, and it is safe when performed by an experienced Korean medicine doctor. There may be temporary discomfort or minor bleeding after the procedure, but it usually resolves within a few minutes. If you have a bleeding disorder or are taking anticoagulants, you must inform us in advance.

Q Can herbal medicine be used safely for smell disorders? Is there any burden on the liver or kidneys?

A. Herbal medicine is prescribed under a Korean medicine doctor's diagnosis according to individual constitution and underlying conditions, so it is safe when taken correctly. If you have concerns about liver values or kidney function while taking herbal medicine, you can bring your blood test results so they can be reflected in the prescription. If you already have liver or kidney disease, please be sure to tell us at the first visit.

Q My ENT doctor prescribed oral steroids. Is it okay to take them together with herbal medicine?

A. Oral steroids are effective for quickly suppressing inflammation of the olfactory epithelium, and no major interactions with short-term herbal medicine use have generally been reported. However, since steroids can place a burden on the digestive system, it is safest to be sure to tell your Korean medicine doctor that you are taking them so the prescription can be adjusted.

Q I am worried that the smell disorder caused by COVID-19 might never come back. What is the prognosis?

A. About 85% of post-COVID smell disorders recover naturally within a few months. Recovery within one month is most common, and most improve within 3 to 6 months. Cases lasting more than a year account for about 5 to 10%, and the earlier olfactory training and treatment are started, the better the prognosis.

Q Can a smell disorder caused by head trauma recover? It has been three months since my accident and I still cannot smell anything.

A. The recovery rate for smell disorders after head trauma is about 30 to 40%, lower than for other causes. Three months after an accident is still a time when recovery remains possible, so it is important not to give up on active treatment and olfactory training. Because nerve regeneration occurs very slowly, the course should be observed over 1 to 2 years.

Q After recovering from COVID-19, I have barely been able to smell anything for two months now. Why does COVID-19 cause loss of smell as a lingering symptom?

A. The COVID-19 virus enters through the ACE2 receptors on the supporting cells of the nasal lining. When these supporting cells are damaged, the olfactory receptor neurons cannot function properly and regeneration of the entire olfactory epithelium slows, resulting in loss of smell. About 85% of post-COVID smell disorders recover naturally within a few months.

Q I have severe chronic rhinitis and sinusitis, and lately I can barely smell anything. Can rhinitis and sinusitis also cause loss of smell?

A. Yes, chronic rhinitis and sinusitis (rhinosinusitis) are among the common causes of smell disorders. When mucosal swelling and purulent discharge block the path for air to reach the olfactory epithelium, odor molecules cannot reach the receptors and the sense of smell declines. Repeated inflammation can also damage the olfactory epithelium itself.

Q I am a smoker and my sense of smell seems to be gradually dulling. Does smoking affect the sense of smell?

A. Yes, smoking is an independent risk factor for olfactory damage. Toxic substances in cigarette smoke directly damage the cells of the olfactory epithelium, and long-term smoking reduces the number of olfactory receptors, raising the smell threshold. In many cases, the sense of smell gradually recovers over several months after quitting.

Q I heard that zinc is good for smell recovery. Would it help to get it through food or supplements?

A. Zinc is a trace element needed for olfactory receptor proteins and mucosal regeneration. Supplementing it is effective when there is a deficiency, but taking too much when levels are already normal can actually damage the olfactory nerve. The safest approach is to eat a balanced amount of zinc-rich foods such as oysters, red meat, and pumpkin seeds.

Q What happens on the first visit if I come to Dongjedang for a smell disorder? How often do I need to come?

A. On the first visit, we take a detailed history of when the loss of smell began, the cause, COVID-19 history, current medications, and any past history of rhinitis or sinusitis. We then establish a treatment plan according to the cause; in the first 1 to 2 months we recommend visiting 1 to 2 times a week, then adjusting to once every two weeks once the condition stabilizes.

Q What stages does Korean medicine use to treat post-COVID smell disorder?

A. Post-COVID conditions proceed in three stages: removing heat toxin, restoring vital energy, and regenerating the mucosa. For the first 1 to 2 weeks, heat-clearing detoxifying prescriptions address remaining heat toxin; then lung- and qi-tonifying prescriptions restore the depleted vital energy while creating an environment for nasal mucosal regeneration. Olfactory training is combined throughout this entire process.

Q With Korean medicine treatment, how long do I usually need to come before my sense of smell returns? Please tell me by stage.

A. It varies depending on the cause and how long the condition has lasted. For cases caused by rhinitis or sinusitis, improvement often begins after 1 to 2 months of treatment. When there is an underlying qi deficiency (giheo) background, as in post-COVID conditions, at least 3 months is recommended. The sooner you start after onset, the faster the recovery.

Q I heard that Western medicine doesn't really have much they can do. Is Korean traditional medicine effective for olfactory disorders?

A. While Western medicine uses steroids and antivirals depending on the cause, established drug therapies for chronic olfactory disorders are limited. Korean traditional medicine approaches treatment by improving the mucosal regeneration environment and promoting blood circulation in the nasal cavity to aid nerve recovery. In particular, prescriptions that tonify Qi and open the orifices are helpful when a state of Qi deficiency is present, such as in the aftereffects of COVID-19.