Restoring smell and taste with acupuncture

This is Dawn's story from chapter 15, which was published in the journal 'Acupuncture in Medicine'.

(Our article posted here courtesy of SAGE Publishing for educational purposes only and must not be reproduced.)

Post-viral olfactory dysfunction treated with acupuncture

Jane EB Hunter, M Elizabeth Phillips, F David L Walker, Dawn Busby

First published 20 July 2021

Background

Anosmia (complete loss of smell) and hyposmia (partial loss), accompanied by loss of taste, can have several causes, most commonly post-viral olfactory dysfunction (PVOD). Walker et al.1 summarized diagnostic and treatment steps including the ENTUK flowchart for UK patients with loss of smell during the COVID-19 pandemic. Here, we report the case of a 55-year-old nurse (D.B.) with anosmia and PVOD for 18 months with no improvement despite steps. She reported a 95% improvement after acupuncture (treated pre-COVID-19 pandemic). Acupuncture may be a treatment option for similarly affected patients and worthy of research.

Safety and protocol considerations

J.E.B.H. (British Medical Acupuncture Society (BMAS) diploma holder with over 20 years’ experience) carried out six acupuncture treatments 2–4 weeks apart over 3 months. Treatment was commenced after discussion with M.E.P. (general practitioner (GP) with acupuncture experience). Ten 0.18 × 13 mm needles (Styla) were placed superficially at bilateral BL2 and LI20, CV24, GV20/22/24/26 and Yintang for approximately 10 min (Figure 1). The treatment sites were a combination of local traditional acupuncture points from different papers and added to those reported by Michael.2 While some acupuncture point locations including LI20 are in the area of the angular vein with connection to the cavernous sinus, the risk of infection is believed to be minimal with standard hygiene precautions.

Figure 1. Position of needles.
Source: Image kindly provided
by Dr Michael Cummings
British Medical Acupuncture Society

Case report

The patient had been fully investigated and treated by the Ear, Nose and Throat (ENT) service and diagnosed with PVOD. The loss of smell and taste followed an upper respiratory viral infection with other stressors. She sensed either unusual and putrid smells (dysosmia) or none, and a “hopeless” taste meant little enjoyment in eating. Olfactory retraining as recommended by the Fifth Sense charity was also carried out. She reported faint detection of eucalyptus and lemon but was unable to identify rose and cloves. These represent the four oils Fifth Sense recommends.

The patient reported most improvement with the first acupuncture treatment. She was able to smell cooking the same day, and baking the next, and began enjoying the taste and smell of meals. She experienced new smells after each of the first four treatments, was able to smell all four training oils and described some “fine-tuning” after the third and fourth treatments. There were no more changes after the fifth and sixth treatments, so acupuncture was stopped. She assessed a 95% return in her ability to smell and taste. At the time of writing, this had been maintained for 2 years. The patient also reported that she had no appreciation of the adverse effect it would have on everyday life. She stated that the time involved with no prospect of recovery was soul destroying, and the almost instantaneous level of recovery with the acupuncture was a pure joy.

Comment

Dai et al.3 found 11 of 25 PVOD patients refractory to medical management improved after treatment with acupuncture compared to 4 of 25 in a control group. Selection of needling targets varies between workers. Fewer point locations or needle insertions may be sufficient. Michael2 described an anosmic patient recovering after one treatment using four needles left in situ for 5 min at bilateral LI20, Yintang and GV23.

It is suggested that acupuncture stimulates neural pathways, leading to recovery.4 Most taste comes from smell, with only salt, sweet, sour and umami from the tongue. This case supports previous work2,3 suggesting that acupuncture is a simple treatment that may be worth considering in cases of anosmia or hyposmia.

While we appreciate more objective assessments of sense of smell, as discussed by Joseph et al.,5 we feel a patient’s own assessment allows for clinical monitoring of treatment. Further work should be undertaken to assess this.

Conclusion

Walker et al.1 have reported that an estimated half of COVID-19 patients in the United Kingdom may lose sense of smell. Although most should improve substantially, it may mean that, for around 5% of COVID-19 patients, loss may persist for longer. In addition, anosmia is a relatively common problem in the general population. It is possible acupuncture for patients with PVOD could be cost-effective for the UK National Health Service (NHS) and represent a relatively simple, quick and safe treatment option that could be offered in a GP practice by suitably trained staff. However, adequately powered randomized controlled trials are ultimately required to verify the apparent effect of acupuncture demonstrated in this case.

Acknowledgements

The outline of the head diagram from the British Medical Acupuncture Society (BMAS) website was reproduced with kind permission.

Declaration of conflicting interests
The authors declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Funding
The authors received no financial support for the research, authorship and/or publication of this article.

ORCID iD
Jane EB Hunter https://orcid.org/0000-0002-8314-1399

References

1. Walker, A, Pottinger, G, Scott, A, et al. Anosmia and loss of smell during the COVID-19 pandemic. BMJ 2020; 370: m2808.
Google Scholar

2. Michael, W. Anosmia treated with acupuncture. Acupunct Med 2003; 21(4): 153–154.
Google Scholar | SAGE Journals

3. Dai, Q, Pang, Z, Yu, H. Recovery of olfactory function in postviral olfactory dysfunction patients after acupuncture treatment. Evid Based Compl Alternat Med 2016; 2016: 4986034.
Google Scholar | Crossref | Medline

4. Dhond, RP, Kettner, N, Napadow, V. Neuroimaging acupuncture effects in the human brain. J Altern Complement Med 2007; 13(6): 603–616.
Google Scholar | Crossref | Medline

5. Joseph, T, Auger, SD, Peress, L, et al. Screening performance of abbreviated versions of the UPSIT smell test. J Neurol 2019; 266(8): 1897–1906.
Google Scholar | Crossref | Medline

Restoring smell and taste with acupuncture

Post-viral olfactory dysfunction treated with acupuncture

Figure 1. Position of needles. Source: Image kindly provided by Dr Michael Cummings British Medical Acupuncture Society

Case report

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Comment

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While we appreciate more objective assessments of sense of smell, as discussed by Joseph et al.,5 we feel a patient’s own assessment allows for clinical monitoring of treatment. Further work should be undertaken to assess this.

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Conclusion

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Acknowledgements

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The outline of the head diagram from the British Medical Acupuncture Society (BMAS) website was reproduced with kind permission.

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Declaration of conflicting interestsThe authors declare no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

FundingThe authors received no financial support for the research, authorship and/or publication of this article.

ORCID iDJane EB Hunter https://orcid.org/0000-0002-8314-1399

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References

1. Walker, A, Pottinger, G, Scott, A, et al. Anosmia and loss of smell during the COVID-19 pandemic. BMJ 2020; 370: m2808.Google Scholar

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2. Michael, W. Anosmia treated with acupuncture. Acupunct Med 2003; 21(4): 153–154.Google Scholar | SAGE Journals

​

3. Dai, Q, Pang, Z, Yu, H. Recovery of olfactory function in postviral olfactory dysfunction patients after acupuncture treatment. Evid Based Compl Alternat Med 2016; 2016: 4986034.Google Scholar | Crossref | Medline

​

4. Dhond, RP, Kettner, N, Napadow, V. Neuroimaging acupuncture effects in the human brain. J Altern Complement Med 2007; 13(6): 603–616.Google Scholar | Crossref | Medline

​

5. Joseph, T, Auger, SD, Peress, L, et al. Screening performance of abbreviated versions of the UPSIT smell test. J Neurol 2019; 266(8): 1897–1906.Google Scholar | Crossref | Medline