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CME / ABIM MOC / CE

Can Olfactory Training With Essential Oils Restore Sense of Smell After COVID?

  • Authors: News Author: Lisa O’Mary; CME Author: Laurie Barclay, MD
  • CME / ABIM MOC / CE Released: 2/24/2023
  • Valid for credit through: 2/24/2024, 11:59 PM EST
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  • Credits Available

    Physicians - maximum of 0.25 AMA PRA Category 1 Credit(s)™

    ABIM Diplomates - maximum of 0.25 ABIM MOC points

    Nurses - 0.25 ANCC Contact Hour(s) (0 contact hours are in the area of pharmacology)

    Pharmacists - 0.25 Knowledge-based ACPE (0.025 CEUs)

    Physician Assistant - 0.25 AAPA hour(s) of Category I credit

    IPCE - 0.25 Interprofessional Continuing Education (IPCE) credit

    You Are Eligible For

    • Letter of Completion
    • ABIM MOC points

Target Audience and Goal Statement

This activity is intended for infectious disease clinicians, family medicine/primary care clinicians, internists, nurses, pharmacists, physician’s assistants, and other members of the health care team for patients with loss of sense of smell from COVID-19.

The goal of this activity is for learners to be better able to describe the efficacy of bimodal visual-olfactory training and patient-preferred scents compared with unimodal olfactory training and physician-assigned scents in COVID-19 olfactory loss measured with the University of Pennsylvania Smell Identification Test, based on a randomized, single-blinded trial.

Upon completion of this activity, participants will:

  • Assess the efficacy of bimodal visual-olfactory training and patient-preferred scents compared with unimodal olfactory training and physician-assigned scents in COVID-19 olfactory loss, based on a randomized, single-blinded trial
  • Determine the clinical implications of the efficacy of bimodal visual-olfactory training and patient-preferred scents compared with unimodal olfactory training and physician-assigned scents in COVID-19 olfactory loss, based on a randomized, single-blinded trial
  • Outline implications for the healthcare team


Disclosures

Medscape, LLC requires every individual in a position to control educational content to disclose all financial relationships with ineligible companies that have occurred within the past 24 months. Ineligible companies are organizations whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

All relevant financial relationships for anyone with the ability to control the content of this educational activity are listed below and have been mitigated. Others involved in the planning of this activity have no relevant financial relationships.


News Author

  • Lisa O’Mary

    Freelance writer, Medscape

    Disclosures

    Lisa O’Mary has no relevant financial relationships.

CME Author

  • Laurie Barclay, MD

    Freelance writer and reviewer
    Medscape, LLC

    Disclosures

    Laurie Barclay, MD, has no relevant financial relationships.

Editor/Compliance Reviewer

  • Amanda Jett, PharmD, BCACP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Amanda Jett, PharmD, BCACP, has no relevant financial relationships.

Nurse Planner

  • Leigh Schmidt, MSN, RN, CNE, CHCP

    Associate Director, Accreditation and Compliance, Medscape, LLC

    Disclosures

    Leigh Schmidt, MSN, RN, CNE, CHCP, has no relevant financial relationships.

Peer Reviewer

This activity has been peer reviewed and the reviewer has no relevant financial relationships.


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Medscape

Interprofessional Continuing Education

In support of improving patient care, Medscape, LLC is jointly accredited with commendation by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

IPCE

This activity was planned by and for the healthcare team, and learners will receive 0.25 Interprofessional Continuing Education (IPCE) credit for learning and change.

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  • Medscape, LLC designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

    Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.25 MOC points in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

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  • Awarded 0.25 contact hour(s) of nursing continuing professional development for RNs and APNs; 0.00 contact hours are in the area of pharmacology.

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    For Pharmacists

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    Medscape, LLC has been authorized by the American Academy of PAs (AAPA) to award AAPA Category 1 CME credit for activities planned in accordance with AAPA CME Criteria. This activity is designated for 0.25 AAPA Category 1 CME credits. Approval is valid until 02/24/2024. PAs should only claim credit commensurate with the extent of their participation.

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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

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You may now view or print the certificate from your CME/CE Tracker. You may print the certificate but you cannot alter it. Credits will be tallied in your CME/CE Tracker and archived for 6 years; at any point within this time period you can print out the tally as well as the certificates from the CME/CE Tracker.

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CME / ABIM MOC / CE

Can Olfactory Training With Essential Oils Restore Sense of Smell After COVID?

Authors: News Author: Lisa O’Mary; CME Author: Laurie Barclay, MDFaculty and Disclosures

CME / ABIM MOC / CE Released: 2/24/2023

Valid for credit through: 2/24/2024, 11:59 PM EST

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Note: The information on the coronavirus outbreak is continually evolving. The content within this activity serves as a historical reference to the information that was available at the time of this publication. We continue to add to the collection of activities on this subject as new information becomes available. It is the policy of Medscape Education to avoid the mention of brand names or specific manufacturers in accredited educational activities. However, manufacturer names related to the approved COVID-19 vaccines are provided in this activity in an effort to promote clarity. The use of manufacturer names should not be viewed as an endorsement by Medscape of any specific product or manufacturer.

Clinical Context

Complications of olfactory loss may include initiation of depression, reduced detection of potentially harmful stimuli such as smoke and spoiled foods, weight loss, diminished social well-being, and increased mortality in older adults. Evidence is weak for efficacy of pharmacotherapy COVID-19-associated postviral olfactory dysfunction.

The most effective method for olfactory training delivery is unknown, as is overall olfactory training efficacy in COVID-19 olfactory loss. Multisensory integration by adding a visual component to olfactory training may potentiate olfactory neuroplasticity by stimulating cross-modal sensory transfer. Olfactory training protocols with modifications that increase adherence may also improve efficacy.

Study Synopsis and Perspective

Personalized essential oils may help people recover their sense of smell, lost because of COVID-19, according to a new study.

Called olfactory training, the process involves smelling the oils regularly to “challenge” the nerves responsible for sending smell messages to the brain, according to The Mayo Clinic. Those nerves are known to be able to heal and regrow in a process called neuroplasticity.

The study was published last week in JAMA Otolaryngology-Head & Neck Surgery.[1] It included 275 people aged 18 to 71 years who reported loss of smell as a result of COVID-19. Participants sniffed the oils for 15 seconds with a 30-second rest between odors. The study lasted for 3 months.

The Truth About Essential Oils

Essential oils are becoming popular in recent years, but do they actually have any health benefits?

A traditional olfactory training protocol uses 4 specific scents: rose, lemon, eucalyptus, and clove. One group in the new study used those scents, and another group sniffed 4 scents that they selected themselves from 24 scent options. A third control group did not participate in olfactory training. In addition, a subset of people in the study were shown images of the scents they smelled.

Although there were no “definitive” differences between the individual approaches, the researchers noted that there may be benefits for patients who get to both select their scents and see images of the scents.

In a companion commentary published with the study, Carol Yan, MD, from the University of California San Diego, said that the improvements some patients saw may have been a placebo effect and should be considered for treatment plans of patients who lost their sense of smell as a result of COVID-19.[2]

“Allowing patients to select their own odorants may improve cost-effectiveness and increase adherence, particularly if there was an issue of familiarity with 1 of the classic 4 odorants,” she writes. “The addition of visual cues to [olfactory training] may improve engagement in some patients while increasing the burden on others. Ultimately, patients’ belief and satisfaction in their therapeutic plan can have substantial placebo-effect benefits that are not to be ignored.”

An estimated 700,000 people have lost their sense of smell as a result of COVID-19, the authors said. Most people regain their sense of smell within a year. 

JAMA Otolaryngol Head Neck Surg. Published online December 29, 2022.

Study Highlights

  • This randomized, single-blinded trial with 2-by-2 factorial design (bimodal, patient preferred; unimodal, physician assigned; bimodal, physician assigned; unimodal, patient preferred) included an independent control group.
  • From February 1 to May 27, 2021, 275 participants aged 18 to 71 years (mean, 41±12 years; 86% female) were enrolled.
  • Olfactory loss criteria were University of Pennsylvania Smell Identification Test score lower than 34 for men and lower than 35 for women, duration at least 3 months (mean, 6±+3 months), and initially diagnosed within 2 weeks of COVID-19 infection.
  • 68% of participants reported concurrent symptoms of phantosmia or parosmia.
  • Participants sniffed 4 essential oils for 15 seconds, separated by a 30-second rest, for 3 months.
  • Participants in the physician-assigned odor groups trained with rose, lemon, eucalyptus, and clove; those in the patient-preferred groups chose 4 of 24 available scents; and those in the bimodal group viewed digital images of the essential oil they were smelling.
  • The primary end point of change in objective University of Pennsylvania Smell Identification Test scores preintervention to postintervention was similar among the study groups.
  • Marginal mean difference for change in University of Pennsylvania Smell Identification Test scores preintervention to postintervention between participants randomly assigned to patient-preferred vs physician-assigned scents was 0.73, and between participants randomly assigned to bimodal visual-olfactory training vs unimodal olfactory training it was 1.10, both of which were insignificant differences.
  • Five (24%) participants in the control group had clinically important improvement on the University of Pennsylvania Smell Identification Test, as did 18 (53%) in the bimodal, patient-preferred group (difference, 29%; 95% CI, 4%-54%).
  • Self-reported improvement on Clinical Global Impressions-Improvement occurred in 4 control participants (19%) compared with 12 (35%) in the bimodal, patient-preferred group (difference, 16%; 95% CI, −7% to 39%).
  • Mean change in the quality-of-life questionnaire Olfactory Dysfunction Outcomes Rating (ODOR) score preintervention to postintervention was 11.6 points (85% CI, 9.2-13.9), which was not considered clinically important nor significantly different between groups.
  • Reported adverse effects during the intervention included 2 (0.8%) reports of headaches and 1 (0.4%) report of worsening parosmia associated with olfactory training.
  • The investigators concluded that there was improvement over time in olfactory function in the control and intervention groups, with no clinically meaningful improvement in University of Pennsylvania Smell Identification Test score among individuals given olfactory training and no added benefit from bimodal visual-olfactory training or patient-preferred scents.
  • However, when exploring within-patient change in University of Pennsylvania Smell Identification Test and self-reported impression of improvement, active interventions were associated with larger improvement than controls, with a potential advantage of bimodal intervention.
  • The finding of possible benefit of olfactory training is consistent with the published literature.
  • Although the findings are not definitive, they suggest that patients with COVID-19 olfactory loss may benefit from adding a visual component to olfactory training and using patient-preferred scents.
  • Although natural improvement does occur, the low-cost, noninvasive nature and minimal risk for olfactory training suggests that clinicians should recommend this treatment to patients with postviral olfactory dysfunction, as it may provide incremental benefit.
  • Future studies should focus on identifying subgroups for whom olfactory training is likely to benefit, alone or in combination with other potential treatments.
  • Multiple studies suggest that the olfactory pathway has neuroplasticity for peripheral and central recovery.
  • The optimal olfactory training delivery method is unknown, with previous studies assessing total duration of intervention from 3 to 14 months, varying odor concentrations, and supplementing training with adjuvant pharmacotherapy.
  • Dual-sensory stimulation training may enhance auditory adaption and various other sensory and cognitive processes.
  • Study limitations include study cohort comprising mostly White patients, with a large proportion reporting concurrent dysosmia, and significant attrition across all study groups, resulting in a smaller sample with complete data.
  • In addition, the intervention was limited to 3 months, but some data suggest that patients may derive benefit for up to 6 months, and the control group could not be blinded because of the difficulty of administering placebo olfactory training.
  • An accompanying commentary suggests that the improvements in some patients with belief and satisfaction in their therapeutic plan may have been a placebo effect, which should be considered for treatment plans for patients with postviral olfactory dysfunction from COVID-19.
  • Allowing patients to select their own odorants may improve cost-effectiveness and increase adherence, and adding visual cues to olfactory training may improve engagement in some patients while increasing the burden on others.

Clinical Implications

  • There was no clinically meaningful improvement in University of Pennsylvania Smell Identification Test score among individuals given olfactory training, and no added benefit from bimodal visual-olfactory training or patient-preferred scents.
  • However, some patients with COVID-19 olfactory loss may benefit from adding a visual component to olfactory training and using patient-preferred scents.
  • Implications for the Health Care Team: The low-cost, noninvasive nature and minimal risk for olfactory training suggests that members of the healthcare team should consider recommending this treatment to patients with postviral olfactory dysfunction, as it may provide incremental benefit.

 

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