Novel Protocol Using a Comprehensive Training ‘N’ Treatment (TNT) Approach Rapidly Reverses Olfactory and Gustatory Dysfunction in Patients with Acute Loss of Taste and Smell Induced by SARS-CoV-2 Infection

DOI record: { "DOI": "10.21203/rs.3.rs-2702282/v1", "URL": "http://dx.doi.org/10.21203/rs.3.rs-2702282/v1", "abstract": "<jats:title>Abstract</jats:title>\n <jats:p>Infection with SARS-CoV-2 causes COVID-19 and has a well-established set of clinical symptoms. Olfactory and gustatory dysfunction are among the non-life threatening sequalae observed with both acute and chronic SARS-CoV-2 infection. This can lead to the loss of taste and smell and has been observed in large subsets of COVID-19 patients. Although non-life threatening, loss of taste and smell can contribute to decreased quality of life and prevent sufficient nutrient intake, which may negatively affect prognosis and recovery. Despite progress in the treatment of other symptoms caused by COVID-19, there are currently no standardized treatment protocols to mitigate loss of taste and smell caused by SARS-CoV-2 infection and most approaches thus far have evaluated sensory training and regimen-based treatment strategies independently. In this retrospective case series, we demonstrate the effectiveness of a comprehensive, combined treatment protocol for COVID-19-induced taste and smell dysfunction using olfactory and gustatory training in combination with vitamins and supplements, nasal irrigations, nerve stimulation exercises, and anti-inflammatory prophylaxis. Acutely infected patients with COVID-19-related loss of taste and smell were given a daily regimen of zinc, vitamin A, B-complex, vitamin D, and alpha lipoic acid in addition to saline nasal irrigation, fluticasone spray, nerve stimulation exercises, and repeated olfactory-gustatory training. Triamcinalone paste, theophylline, and prednisone were included daily with the observation of partial recovery. At two timepoints over approximately 20–37 days of treatment, taste and smell scores were quantified based on detection of agents included on each sensory training panel. Following this novel and comprehensive “Training ‘N’ Treatment” (TNT) protocol, every patient exhibited a complete recovery of taste and smell. Given the potential to provide relief to the many people with olfactory and gustatory dysfunction following SARS-CoV-2 infection, the effectiveness of this protocol warrants validation in a larger study.</jats:p>", "accepted": { "date-parts": [ [ 2023, 3, 16 ] ] }, "author": [ { "ORCID": "http://orcid.org/0000-0002-9323-9437", "affiliation": [ { "name": "Private Health Management" } ], "authenticated-orcid": false, "family": "Young", "given": "Nicholas A.", "sequence": "first" }, { "ORCID": "http://orcid.org/0000-0002-9165-0804", "affiliation": [ { "name": "Private Health Management" } ], "authenticated-orcid": false, "family": "Skaggs", "given": "Caralee", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0003-2426-4281", "affiliation": [ { "name": "Private Health Management" } ], "authenticated-orcid": false, "family": "Tran", "given": "Frances", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-9503-9199", "affiliation": [ { "name": "Private Health Management" } ], "authenticated-orcid": false, "family": "Murray", "given": "Sara", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0001-5810-4425", "affiliation": [ { "name": "Private Health Management" } ], "authenticated-orcid": false, "family": "Lara", "given": "Montana Kay", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0001-7501-3322", "affiliation": [ { "name": "Private Health Management" } ], "authenticated-orcid": false, "family": "Wolf", "given": "Trevor H.", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0003-4438-2314", "affiliation": [ { "name": "Private Health Management" } ], "authenticated-orcid": false, "family": "Popal", "given": "Tamiem", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0003-0067-5684", "affiliation": [ { "name": "Private Health Management" } ], "authenticated-orcid": false, "family": "Reisenauer", "given": "Keighley", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0001-6588-313X", "affiliation": [ { "name": "Simon Medical Services" } ], "authenticated-orcid": false, "family": "Osgood", "given": "Nikki", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0003-1762-1914", "affiliation": [ { "name": "Simon Medical Services" } ], "authenticated-orcid": false, "family": "Betzner", "given": "Ikeca", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0002-6484-6633", "affiliation": [ { "name": "Private Health Management" } ], "authenticated-orcid": false, "family": "Britt", "given": "Gregg", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0003-2362-3641", "affiliation": [ { "name": "Private Health Management" } ], "authenticated-orcid": false, "family": "Pena", "given": "Jennifer", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0003-4478-6490", "affiliation": [ { "name": "Private Health Management" } ], "authenticated-orcid": false, "family": "Gordon", "given": "Eva", "sequence": "additional" }, { "ORCID": "http://orcid.org/0000-0003-1090-6626", "affiliation": [ { "name": "Private Health Management, Simon Medical Services, Rush University Medical Center" } ], "authenticated-orcid": false, "family": "Simon", "given": "Robert", "sequence": "additional" } ], "container-title": [], "content-domain": { "crossmark-restriction": false, "domain": [] }, "created": { "date-parts": [ [ 2023, 3, 21 ] ], "date-time": "2023-03-21T14:12:18Z", "timestamp": 1679407938000 }, "deposited": { "date-parts": [ [ 2023, 3, 21 ] ], "date-time": "2023-03-21T14:16:56Z", "timestamp": 1679408216000 }, "group-title": "In Review", "indexed": { "date-parts": [ [ 2023, 3, 22 ] ], "date-time": "2023-03-22T05:14:37Z", "timestamp": 1679462077877 }, "institution": [ { "name": "Research Square" } ], "is-referenced-by-count": 0, "issued": { "date-parts": [ [ 2023, 3, 21 ] ] }, "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0/", "content-version": "unspecified", "delay-in-days": 0, "start": { "date-parts": [ [ 2023, 3, 21 ] ], "date-time": "2023-03-21T00:00:00Z", "timestamp": 1679356800000 } } ], "link": [ { "URL": "https://www.researchsquare.com/article/rs-2702282/v1", "content-type": "text/html", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://www.researchsquare.com/article/rs-2702282/v1.html", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "8761", "original-title": [], "posted": { "date-parts": [ [ 2023, 3, 21 ] ] }, "prefix": "10.21203", "published": { "date-parts": [ [ 2023, 3, 21 ] ] }, "publisher": "Research Square Platform LLC", "reference": [ { "article-title": "Olfactory dysfunction as a post-infectious symptom of SARS-CoV-2 infection", "author": "Othman BA", "first-page": "103352", "journal-title": "Ann Med Surg (Lond)", "key": "ref1", "unstructured": "Othman, B.A., et al., Olfactory dysfunction as a post-infectious symptom of SARS-CoV-2 infection. 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