Hi everyone. I'm Dr. Pracha Eamranond, chief medical officer at Doctorpedia,
and today I have the pleasure of welcoming Dr. Michael Bergstein,
assistant clinical professor of Otolaryngology at the Icahn Mount
Sinai School of Medicine. Mike, welcome.
Thanks for having me.
So, today we're gonna talk about a topic that
many of my patients have had, which is loss of smell with
COVID infection. And we know from multiple research studies that it's variable.
Some people have mild loss of smell,
and some people have
loss of smell that's lasted for months now. So,
wanted to get your expert opinion as a ENT
specialist. And I know you deal with this often.
Can you just tell us a bit about what you see in your practice?
Yeah.
The focus in COVID especially in the media has been,
what are the number of deaths that have been occurring.
We're now 525,000 people are, unfortunately have died,
but that's not what we see. What we see are the walking wounded. Okay.
And those are the patients who've been adversely affected with COVID on a day
to day basis, who survived COVID,
but in fact are now suffering the lingering effects of COVID and what people are
calling long haulers.
And one subset of those patients are patients who've lost their sense of smell,
and uncommonly this happens.
But what happens is that they don't get it back.
Or worse than that, they get something -- so that's called anosmia.
And what's worse than that is there are patients who have what we call parosmia,
where in fact, it's not just they lost their smell initially,
but when the smell is returned, they have these smells
that are awful. In other words, for instance,
their coffee might smell like metal or might smell like something that's rancid.
And those patients are extremely distressed. There's no wound, so to speak,
right? That you can see, but their quality of life has been adversely affected.
And what happens is a consequence of that,
is that the rest of their lives in terms of their quality has been adversely
Right. So for me as a primary care doc,
I see it quite often.
What are the things that I should be telling my patients who are going through
this experience? I'll be honest with you,
I'm not sure what are the treatment options for
these patients? I would assume, and I know this is true, cause we talk about it,
I talk about with my fellow physicians,
but it's not immediately clear what is actually the way we
should be managing these things from a general medicine perspective?
Well, first of all, you wanna explain to the patient, I think,
"This is what's going on pathophysiologically." Meaning that,
here your smell nerves sit at the base of your skull. That's the olfactory bulb,
the olfactory nerves. And in a typical cold,
those patients who lose from a virus like a cold, the smell nerves die,
and that's the end of the story and they don't get it back. Here,
there are these sustentacular cells.
These are cells that feed the smell nerves.
And that communication between the feeding nerves and the smell
nerves themselves becomes disrupted.
And so what we're trying to do is in enhance that connection back.
Now in some cases, right, that returns,
we'd say 95% of patients at six months will get their smell back
intact, but 5% don't.
So the way we address that is we have them use a particular kind of steroid
nasal spray and we need to deliver it all the way up here.
So it's not just your over the counter nasal spray that we use.
We have them through a pharmaceutical company deliver the
steroid smell,
or deliver the steroid spray all the way up into here.
Second portion of in terms of getting them better is,
you wanna work out those smell nerves, you wanna challenge them.
And we do that through smell therapy.
And we have them smell different smells which help to stimulate
the smell nerves, work them out.
Stimulate them so that they will rehabilitate them and that the patient
will get their smell back much sooner.
Well, that's fascinating. And thank you for teaching us. I
wanna take us on a different path. How did you... I've seen some of your videos,
and how you've been able to help so many patients with smell disorders,
anosmia, how did you even become interested in this field?
Well, as a -- particularly with regards to COVID, right,
when you see the patients coming in,
one after the other with this lost look or this stressed look,
and they're just unable to breathe, right, or to smell, it's
incumbent upon me to get them better. So we've been doing this for a long time.
Patients who have chronic sinusitis, chronic nasal polyps,
I've been treating sinus patients who have polyps for many, many years.
And over the years with the advent of different medications,
we've been able to get them better.
Certainly there are those patients who don't respond to medications and those
patients we
have surgery on and we deliver the smell back to them,
but with advents of different ancillary procedures and instrumentation,
I've been delivering smell back to my patients for many years.
That has enhanced my ability to improve patients' quality of life who lost their
smell with COVID cause we've been doing this for quite some time.
Well thank you for shedding a light into this world that we hadn't addressed
so far at Doctorpedia. Do you have any final words to our audience,
before we adjourn?
In terms of, if you have a loss of smell,
if you've been adversely affected from COVID,
I'd encourage you to see your otolaryngologist, your ear, nose,
and throat surgeon.
If in fact you suffer with chronic sinusitis and you've lost the ability to
smell, this can be insidious,
but your ear and throat surgeon can help you. If not medically, then surgically,
but what we always try to do first prior to recommending any intervention,
any procedures, is work with the patient,
deliver medications to them and improve their ability to smell
without surgery. If in fact surgery is required,
we certainly can do that as well. And
I will tell you that our patients are satisfied and quite happy,
and I feel great about having improved their quality of life.
Great. Thank you, Dr. Michael Bergstein. Thank you everyone for listening in.
Please stay safe out there,
and thank you for joining us again on Doctors on the Frontlines, COVID-19
pandemic webcast.