While quarantined in her bedroom with the coronavirus, 16-year-old Ellie Jotte stuck her nose in her sweetest-smelling candles, bottles of perfume and all kinds of fruit- and flower-scented lotions.
Nearly four months later, the teenager’s senses of smell and taste are still messed up. Some days, Ellie smells nothing at all, and others, she gets a whiff of scent or a burst of taste, but often, it’s not quite right.
Chomping on peanut butter pretzels the other day, she tasted the salt but not the peanut butter. But then, “I was eating a carrot and it literally tasted like peanut butter,” she said.
A recent order of french fries tasted the exact same as the chicken, which is to say, not good. “One main flavor: bitter,” said Ellie, who is a sophomore at Regis Jesuit High School in Aurora.
The fact that COVID-19 has disrupted people’s ability to smell, for days or months, has been well-documented at this point in the pandemic, but researchers aren’t sure yet why. Even less is known about the long-term effects on children who have not regained their sense of smell months after recovering from the coronavirus, a phenomenon that doctors believe is vastly underreported. Kids are less likely to articulate to a doctor — or even to their parents — that they cannot smell or taste normally.
A new “olfaction training” clinic and study opening at Children’s Hospital Colorado in early March will focus on helping teens and children age 5 and older regain their sense of smell. The theory is that through repeated exposure to certain odors, children can increase their sensitivity and retrain their nose to communicate with their brain.
Various pre-pandemic studies have found positive results from olfaction training in adults, but only one study involved children, said Dr. Kenny Chan, a professor at the University of Colorado School of Medicine and chair of the otolaryngology department at Children’s Hospital.
Previous research has found that “if you keep exposing known odorants to patents, that somehow it would get the connection going,” he said.
The clinic will use four essential oils: orange, lavender, eucalyptus and peppermint. Children and teens will smell each oil for 20 seconds, twice per day, for three months. Parents, after receiving training from a nurse practitioner who will check in regularly via telehealth appointments, will record their responses, noting whether their kids can distinguish between the oils or smell any of them at all.
Chan is well aware that a 5-year-old child is unlikely to spit out the word “eucalyptus.”
“No, they won’t,” he said. “If they say, ‘This smells like a plant, this smells like a forest,’ it will be good enough.”
And Chan has doubts that children will specifically name lavender or peppermint, either. He’s hoping for “flower” to identify lavender, and probably “candy” or “toothpaste” if they can smell the peppermint oil. If they get a whiff of citrus while smelling the orange essential oil, that’s considered progress.
“We have to be very generous when we train these kids,” he said, noting that coaxing is allowed. “For example, ‘This smells like a fruit that you know.’”
The study is for 5-year-olds and up because preschoolers and toddlers likely could not answer questions about the four scents. Chan won’t know how well the participants could discern those scents before joining the study, only whether they improved during the three months.
Kids who attend the clinic and whose parents decide to enroll them in the accompanying study will take a 40-scent smell test that’s been in use for decades, the University of Pennsylvania Smell Identification Test, or the UPSIT. After three months, they’ll take the test again to see whether their olfactory senses have improved.
Virus likely attacks cells around nerve endings, damaging smell
Chan is particularly interested in finding out if losing sense of smell for longer makes it harder for a child to get it back. He’s hoping to study a broad range of kids, including those who haven’t been able to smell for a few weeks and those who caught COVID-19 early on in the pandemic but still have trouble smelling and tasting.
Research during the past year has found that about 45-50% of adults with coronavirus experience a loss of smell or taste for some length of time, and a fraction of those people still can’t smell several months later. Doctors, including one at Children’s Hospital Colorado, have reported that 5-10% of children with coronavirus lose their sense of smell, but many doctors believe the true numbers are much higher.
Chan suspects that many young children with COVID-19 who were otherwise asymptomatic still have trouble with smell and taste, and that their parents are unaware. He suggests parents regularly ask their kids if they can smell certain odors, and if they can’t, to go get a coronavirus or antibody test.
Humans have a sense of smell not only to enjoy food and other pleasant fragrances, but to survive, Chan said. “If you think about it, if a house is on fire and you can’t smell the smoke? That’s a survival sensory organ that we need,” he said.
Nerve endings at the top of the nose are connected to olfactory bulbs, which are in the front of the brain. Odors dissolve in the liquid surrounding the lining of the cells in the top of the nose, allowing nerve fibers to fire and elicit smell. Sense of smell is linked to taste, which begins with receptor cells on the tongue.
Long before COVID-19, researchers studied cases of post-viral loss of smell, but it took a worldwide communal disease to bring the peripheral-neurological side effect to common conversation.
The known causes of “olfaction dysfunction” include being born without olfactory bulbs, and whiplash from a traumatic event — such as a vehicle crash — that shears off the nerve endings that connect the nose and the olfactory bulbs. Less is understood about how viral infections, including the coronavirus, destroy the sense of smell long term, but researchers are finding that viruses could damage the support cells surrounding those nerve endings, Chan said.
Olfactory research was revived by the pandemic, and similar smell-training clinics involving children are in the works around the country, including in Seattle.
“I can taste my Taco Bell!”
Ellie hasn’t enrolled in the clinic, but has been smelling the four essential oils in her room at home. On Dr. Chan’s advice, Ellie’s mom, Sonia Jotte, picked up the collection of oils at Costco.
So far, Ellie has had mixed results, much like her daily attempts to taste and smell her favorite foods, including Taco Bell and Bad Daddy’s burgers.
She can always detect the citrus scent of the orange, and the peppermint usually has a distinct smell. But she regularly mixes up the eucalyptus and the lavender, and has realized she has a better chance of getting lavender correct if she smells that one first.
The Greenwood Village teen first got sick in late October and complained of a sore throat coming on. The sore throat didn’t worsen, but soon came a runny nose, what sounded to her mom like horrible congestion (though Ellie said she could breathe just fine), and the loss of smell and taste.
Sonia Jotte believes her daughter was exposed at a dance class the week before the symptoms arrived. Ellie went in for a COVID-19 test the same day the dance studio called and told Sonia that the dance teacher had tested positive.
Ellie quarantined in her bedroom, where her mom delivered her food. The precautions worked: no one else in the family, including Ellie’s dad and younger sister, got sick. Ellie kept requesting apples. She couldn’t taste them, but her tongue could tell they were sweet, and she liked that they were juicy.
Sonia, a pediatrician who is not currently practicing, began researching why her daughter couldn’t smell. When she read that COVID-19 was causing inflammation in the nose at the neurological level, she asked Ellie’s doctor for a steroid prescription. It didn’t have much effect.
Now, after about four months, the fact that Ellie can smell or taste intermittently makes them believe she will eventually regain her sense of smell.
“Some days are really good and she can walk in the house and smell a candle, and other days she can’t smell anything at all,” Sonia said. “The other day she said, ‘I can taste my Taco Bell today!’”
Ellie said that even when she can taste, it’s not how it was before. It’s not like she can taste the whole taco or burger — more like a burst of taste shoots through for a second, like the flavor of hot sauce or salt. Sometimes she concentrates hard, willing herself to taste, and there is no sensation, only bland nothing.
And some scents she used to love are now foul in her nose. She walked into a room a few days ago and was affronted by the sickeningly sweet smell of a burning candle, one that she used to like.
“I couldn’t stand it. I hated it,” she said. “I had to blow it out.”
Still, Ellie has faith that her nose is making progress. “If I keep trying new things and working toward it,” she said, “I know it will come back.”