What is the treatment for loss of taste and smell after a concussion?

Treatment for Loss of Taste and Smell After Concussion

Olfactory training combined with intranasal corticosteroids is the first-line treatment for loss of taste and smell after concussion, with treatment beginning as soon as possible after the acute injury phase. 1

Diagnostic Approach

Before initiating treatment, proper diagnosis is essential:

1. Objective smell testing using validated tests:

   • North American UPSIT (University of Pennsylvania Smell Identification Test)
   • Sniffin' Sticks (European standard)
   • Brief versions like SIT or B-SIT for screening 1

2. Nasal endoscopy to rule out structural abnormalities or inflammatory conditions

3. Imaging when indicated:

   • CT Maxillofacial: For suspected structural abnormalities, inflammatory disease, or history of trauma
   • MRI Brain/Olfactory Bulbs: When intracranial pathology is suspected or no obvious cause is found on endoscopy and CT 1

Treatment Protocol

First-Line Treatment

1. Olfactory Training:

   • Involves repeated exposure to different odors (typically 4 distinct scents)
   • Performed twice daily for at least 12 weeks
   • Patient should sniff each odor for 10-15 seconds while focusing on memory of the scent 1

2. Intranasal Corticosteroids:

   • Mometasone furoate nasal spray is recommended
   • Dosage: 2 sprays in each nostril once daily for at least 3 weeks 2, 1
   • Studies show combination with olfactory training may improve outcomes compared to olfactory training alone 2

Second-Line Options

1. Systemic Corticosteroids (for severe cases):

   • Short course of oral prednisolone (0.25-0.5 mg/kg) for 1-3 weeks with tapering
   • Consider only when significant inflammation is suspected and no contraindications exist 2

2. Zinc Supplementation:

   • May be beneficial as post-traumatic taste and smell disorders have been associated with decreased serum zinc levels 3
   • Dosage: 30-50 mg elemental zinc daily for 3 months

Special Considerations

Monitoring and Follow-up

• Reassess olfactory function using objective testing at 6-8 weeks after initiating treatment
• If no improvement, consider MRI to rule out olfactory groove meningioma or other intracranial pathologies 4
• Continue treatment for at least 3-6 months as recovery can be slow

Important Caveats

• Post-traumatic smell and taste disorders can develop even after minimal head trauma and may begin months after the injury 3
• Approximately 19% of patients with post-traumatic olfactory dysfunction also experience taste deficits 5
• Recent research suggests that smell impairment following concussion is not associated with concussion severity or recovery time 6, but it significantly impacts quality of life

Safety Precautions

Patients with persistent anosmia should be advised to:

• Install gas and smoke alarms
• Check food expiration dates carefully
• Be cautious with gas appliances 1

Prognosis

Recovery from post-traumatic olfactory dysfunction is variable:

• Approximately 30% of patients show improvement within 6 months
• Recovery can continue for up to 2 years post-injury
• Complete recovery is less common with more severe initial dysfunction

The combination of olfactory training and intranasal corticosteroids offers the best chance for improvement based on current evidence, though some patients may have permanent deficits despite treatment.