What Can I Do About My Post-COVID Ear, Nose, and Throat Symptoms?

Loss of taste and smell. Persistent cough. Nagging throat clearing. Hearing loss. These are just some of the symptoms experienced by those who were infected with and have since recovered from COVID-19.  Researchers estimate that nearly 10 percent of all patients who have recovered from COVID-19 suffer from prolonged symptoms. Often called post-COVID-19 syndrome, this condition can cause a range of health problems including fatigue, headache, shortness of breath, confusion, forgetfulness, and cardiac complications.

Every day, Sam Huh, MD, Chair of Otolaryngology-Head and Neck Surgery at Mount Sinai Brooklyn, sees at least two of these patients with long COVID for persistent ear, nose, and throat symptoms.

“There are many of these patients suffering from a variety of symptoms that last approximately three months or longer after infection,” explains Dr. Huh. “They can be quite debilitating and have a significant impact on their quality of life and ability to return to normal.”

While some of Dr. Huh’s patients had severe COVID-19 infection, others were asymptomatic. “Many patients who come to me were never officially diagnosed with the virus but have symptoms of post-COVID syndrome. However, when I run an antibody test, it often comes back positive for a prior infection,” he says.

Fortunately, many of the ear, nose, and throat symptoms experienced by those with long COVID are reversible.

Loss of smell and taste may return organically, or with training

One of the most common post-COVID symptoms is the loss of smell and taste, also known as anosmia and ageusia. Additionally, on their way to recovery, some patients develop an altered sense of smell and taste called parosmia and dysgeusia. For these patients, nothing smells or tastes like what it should. It is not clear why this happens, but it can cause much distress among the sufferers.

“Smell and taste are linked together,” says Dr. Huh. “If you lose smell, taste often goes with it. Most of these patients get better on their own in a month or so, but others may have issues for up to eight months.”

There are two potential culprits for these altered senses. In some patients, post-infection inflammation and swelling in the nasal tissues prevents odor from reaching the olfactory nerve, which is instrumental for the sense of smell. For others, the COVID-19  virus has damaged the area surrounding the nerve, affecting their sense of smell and taste.

To address this problem, it is important to identify anything in the patient’s medical history that is contributing to the problem, such as abnormal nasal anatomy or allergies. When inflammation is the contributing factor, Dr. Huh recommends using saline rinses to irrigate the nasal passageways, topical or oral steroids, and antihistamines. If the problem is damage around the nerve, Dr. Huh advises olfactory smell training. Research shows that patients can retrain the nose by smelling five strong scents—such as cinnamon, citrus, garlic, rose, or lavender—three times a day.

Your post-COVID cough might be post-nasal drip

Many people who have long COVID struggle with a prolonged cough that lasts for months.

Lung damage is one of the more serious causes of this symptom. Patients experiencing shortness of breath or who are becoming winded when walking up the stairs should seek medical attention immediately. Consult a lung specialist if your symptoms are mild and, if they are severe, head to the emergency room.

The majority of post-COVID patients with chronic cough do not have shortness of breath. Instead, they experience an irritating, nagging tickle in their throat from post-nasal drip caused by post-viral inflammation of the nasal passages. This causes them to cough incessantly. For these patients, Dr. Huh usually prescribes saline rinses, topical or oral steroids, and antihistamines.

A dietary change may help with chronic throat clearing

Post-COVID patients often describe that they feel as though something is stuck in their throat. This feeling causes them to repeatedly try to open their airway by coughing and throat clearing.

“These individuals typically had an awful cough during the symptomatic period when they had COVID-19,” explains Dr. Huh. “The constant coughing caused pressure to rise in their stomach, acid to build up, and reflux to occur.”

Known as laryngopharyngeal reflux, this condition occurs when stomach acid and an enzyme called pepsin travel up to the throat. Thankfully, once the reflux is addressed, patients tend to feel better.

Unlike with the more common gastroesophageal reflux disease, antacids typically do not alleviate these symptoms. However, Dr. Huh has had success with low-protein, plant-based diets, which reduce stomach acid. He also advises that patients drink at least eight cups of water a day.

Extreme post-COVID pain is rare, but treatable

An uncommon post-COVID complication is neuralgia, a severe stabbing pain that can develop after being infected with a virus. This debilitating condition is caused by an inflamed or damaged nerve. Dr. Huh has seen a handful of patients with neuralgia in the throat who experience extreme pain or even incontinence when they cough. These patients are typically treated with neuroleptics, a class of medication normally used to treat psychosis, which research has shown to be beneficial in the treatment of nerve pain.

Post-COVID hearing loss is an unusual side effect that is not fully understood

Another unusual ear, nose, and throat complication is post-viral hearing loss. Dr. Huh estimates seeing one of these patients approximately every month. Physicians are not entirely sure what causes this symptom to develop. They suspect the virus triggers an immune response that may be damaging the tiny vessels inside the ear. Since COVID-19 is associated with blood clots, it is also possible that these vessels become clogged. These patients are typically treated with steroids. However, Dr. Huh says the medication is not always effective in restoring hearing loss. But, some patients can recover their hearing spontaneously.

“Most people recover fairly well when we give them these supportive treatments,” says Dr. Huh. “So, if you are suffering, please know there is hope. I encourage anyone with symptoms to make an appointment because there is probably something we can do to make you feel better.”

Dr. Huh and his colleagues evaluate and treat patients who have symptoms related to the ear, nose, and throat at Mount Sinai Brooklyn. For complications that affect vital organs including the lung, heart, or brain, he advises patients to visit the Center for Post-COVID Care at Mount Sinai.