How can I restore my taste buds?

Restoring Taste Buds: Evidence-Based Treatment Approach

Start olfactory training immediately and continue for at least 3-6 months, as this is the primary evidence-based treatment for persistent taste loss, while simultaneously addressing any underlying causes such as viral infections, nutritional deficiencies, or sinonasal disease. 1

Initial Assessment and Diagnosis

History and Physical Examination

• Obtain detailed history focusing on onset timing, duration, and temporal relationship with viral infections (particularly COVID-19, which causes taste loss in 59-86% of infected patients) 2
• Perform thorough nasal examination specifically looking for signs of obstruction, inflammation, or nasal polyposis 1
• Assess for associated symptoms including loss of smell, nasal congestion, recent upper respiratory infections, medication changes, or neurological symptoms 3, 2

Diagnostic Testing

• Perform objective taste testing using standardized methods such as the University of Pennsylvania Smell Identification Test (UPSIT) to quantify dysfunction 1
• Order COVID-19 testing if sudden onset taste/smell loss occurred, especially during pandemic periods 1
• Most patients do not require imaging unless history or physical examination reveals concerning features such as unilateral symptoms, progressive neurological deficits, or lack of clear viral trigger 3

Primary Treatment: Olfactory Training

Olfactory training should be initiated immediately as first-line therapy and continued for a minimum of 3-6 months. 1 This is the only treatment with established efficacy for post-viral taste and smell dysfunction. The training involves systematic exposure to specific scents multiple times daily to promote neural regeneration and sensory recovery.

Treating Underlying Causes

Post-Viral Dysfunction (Including COVID-19)

• Recognize that 44-73% of COVID-19 patients report improvement within the first month, but some require longer recovery 1
• Continue olfactory training as the mainstay of treatment 1
• Reassure patients that taste receptor cells naturally regenerate every 1-2 months, though recovery may take longer after viral damage 4

Sinonasal Inflammatory Disease

• Treat chronic rhinosinusitis and nasal polyposis aggressively, as CT-documented severity correlates directly with worse olfaction 3
• Consider CT maxillofacial imaging to characterize sinonasal inflammatory disease and guide treatment 3
• Address mechanical obstruction that prevents odorants from reaching olfactory epithelium 3

Nutritional Deficiencies

• Check and correct zinc deficiency, which contributes to taste dysfunction 5
• Assess vitamin B12, iron, and ferritin levels, particularly in patients with restrictive diets 6
• Ensure adequate supplementation with 100% Daily Values of essential micronutrients 6

Dietary Management

Enhancing Food Palatability

• Refer to registered dietitian for dietary counseling focusing on additional seasoning of food, avoiding unpleasant foods, and expanding dietary options 1
• Use flavor enhancers including herbs and spices (rather than salt) to promote food intake 1
• Avoid high-salt foods despite temptation to increase palatability, as older adults are at increased risk of hypertension from excess salt intake 3

Preventing Malnutrition

• Monitor for adequate protein and calorie intake, as taste loss can lead to food aversion and malnutrition 7
• Recommend milky drinks for underweight or frail patients to provide energy, protein, and fluid 3
• Address dental health issues that may compound eating difficulties, including reducing frequency of snacking on cariogenic foods 3

Follow-Up Protocol

Re-evaluate at 1 month, 3 months, and 6 months after initiating treatment. 1 If no improvement occurs after 3-6 months of olfactory training, refer to an otolaryngologist or specialized smell and taste clinic for advanced evaluation and management. 1

Critical Pitfalls to Avoid

• Do not overlook COVID-19 as a potential cause, especially when taste/smell loss is the primary symptom without traditional nasal congestion 2
• Do not order unnecessary neuroimaging when there is clear temporal relationship to viral infection 1, 2
• Do not rely on patient self-assessment of severity, as objective testing reveals much higher rates of dysfunction (98.3% by UPSIT versus 35% self-reported) 2
• Do not assume taste loss is purely psychiatric without appropriate workup, as structural lesions can present with taste disturbances 6
• Do not neglect safety counseling regarding inability to detect spoiled food or gas leaks during the recovery period 1

Understanding the Mechanism

Most "taste loss" in viral infections actually reflects loss of retronasal olfaction (flavor perception) rather than true taste dysfunction, as true taste only differentiates sweet, sour, salty, and bitter. 2 This explains why olfactory training is effective—it addresses the primary deficit in smell that patients perceive as taste loss. The sense of taste diminishes with age due to physiological changes, disease, and medication use, making older adults particularly vulnerable. 3