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Possible treatments for anosmia (smell dysfunction) post-Covid

Loss of smell function (anosmia) is recognized as occurring post-Covid-19. 

Two papers offer options. The first was an RCT comparing a topical steroid (50 mcg fluticasone) with an antihistamine (azelastine base) 125 mcg one puff each nostril BD (the only NZ equivalent is Dymista® which is unfunded) versus steroid alone versus antihistamine alone versus placebo.1 At three weeks, improvements in smell tests were greatest for the combination and least for the placebo. The combination was not statistically better than the steroid alone. 

The second treatment option suggested is to identify a sequence of four strong-smelling scents—usually rose, eucalyptus, lemon, and clove—for 15 seconds twice a day over several months.2 Using inhaled nasal steroids was recommended concurrently. It is unclear whether the study is an RCT or case series. Hopefully, better evidence will eventuate.

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