What is the treatment for loss of taste (hypogeusia)?

Treatment of Loss of Taste (Hypogeusia)

For patients with loss of taste, referral to a registered dietitian for dietary counseling is the primary recommended treatment approach, focusing on additional seasoning of food, avoiding unpleasant food, and expanding dietary options.

Initial Assessment and Diagnosis

• Obtain a detailed history focusing on onset, duration, and potential causes such as viral infections (particularly COVID-19), medications, or underlying conditions 1
• Perform a thorough nasal and oral examination to identify potential obstructions or inflammatory conditions 1
• Consider objective taste testing using standardized methods to quantify the degree of taste loss 1
• Evaluate for COVID-19 in cases of sudden taste loss, as 44-73% of affected patients report improvement within the first month 1

Treatment Approaches

Primary Treatment Recommendations

• Refer patients with altered or loss of taste to a registered dietitian for dietary counseling focusing on:
  • Additional seasoning of food
  • Avoiding unpleasant food
  • Expanding dietary options 2

Cause-Specific Interventions

• Treat underlying causes when identified:
  • Address sinonasal inflammatory disease 1
  • Manage systemic conditions such as diabetes mellitus, chronic kidney disease 3
  • Consider medication review and possible adjustments if medication-induced 3, 4

Supportive Interventions

• Implement olfactory training for persistent taste/smell loss, continuing for at least 3-6 months 1
• Consider zinc supplementation, particularly for patients undergoing head and neck radiotherapy 5
• Improve oral hygiene, which may promote taste ability 5

Special Considerations

• For taste loss following dental procedures or nerve damage:

  • Monitor for potential spontaneous recovery 4
  • Consider referral to specialists if no improvement occurs 1

• For COVID-19-related taste loss:

  • Reassure patients about potential spontaneous recovery within 1-3 months 1
  • Implement olfactory training early 1

• For taste loss following viral upper respiratory infections:

  • Provide reassurance that the problem may resolve if damaged sensory cells regenerate 6
  • Consider follow-up at 1 month, 3 months, and 6 months 1

Experimental Treatments

• Various interventions have been studied with limited evidence:
  • Alpha-lipoic acid, Ginkgo biloba, artificial saliva, pilocarpine 5
  • Oral glutamine, delta-9-tetrahydrocannabinol 5

Safety Considerations

• Address potential safety concerns related to inability to detect spoiled food or gas leaks 1, 6
• Consider referral to an otolaryngologist or specialized smell and taste clinic if no improvement after 3-6 months 1

Common Pitfalls

• Avoid overlooking COVID-19 as a potential cause, especially when taste/smell loss is the primary symptom 1
• Don't order unnecessary neuroimaging when there is a clear temporal relationship to viral infection 1
• Recognize that flavor enhancers should not be routinely used to promote food intake, though they may help in individual cases 2