Workup for Loss of Taste Sensation

Initial Assessment

• The American College of Radiology recommends obtaining a detailed history focusing on onset and duration of symptoms, temporal relationship with viral infections, particularly COVID-19, and associated symptoms, in patients with loss of taste sensation 1, 2
• A thorough nasal examination for signs of obstruction or inflammation is recommended, as suggested by the Journal of the American College of Radiology 1

Diagnostic Testing

• The Rhinology society recommends objective taste testing using standardized methods, such as the University of Pennsylvania Smell Identification Test (UPSIT) for olfactory function, in patients with loss of taste sensation 3, 2
• COVID-19 testing should be performed in patients with sudden onset taste/smell loss, especially during pandemic periods, as recommended by the Rhinology society 3

Special Considerations for COVID-19

• The Rhinology society reports that loss of taste and smell is a significant presenting symptom of COVID-19 infection, with 44-73% of patients reporting improvement within the first month 3, 4, 5, 6

Treatment Approach

• The American College of Radiology recommends treating underlying causes, such as sinonasal inflammatory disease, in patients with loss of taste sensation 1
• The Praxis Medical Insights guideline recommends olfactory training as the primary treatment for persistent taste/smell loss, which should be started immediately and continued for at least 3-6 months 2

Follow-up Recommendations

• The Praxis Medical Insights guideline recommends re-evaluating patients at 1 month, 3 months, and 6 months after initiating treatment, and considering referral to an otolaryngologist or specialized smell and taste clinic if no improvement after 3-6 months 2

Common Pitfalls

• The Rhinology society warns against overlooking COVID-19 as a potential cause of loss of taste sensation, especially when taste/smell loss is the primary symptom 3, 4
• The Praxis Medical Insights guideline advises against ordering unnecessary neuroimaging when there is a clear temporal relationship to viral infection, and recommends addressing potential safety concerns related to inability to detect spoiled food or gas leaks 2

Treatment of Loss of Taste (Hypogeusia)

Dietary Counseling

• The American College of Oncology recommends referring patients with altered or loss of taste to a registered dietitian for dietary counseling, focusing on additional seasoning of food, avoiding unpleasant food, and expanding dietary options 7, 8
• The use of flavor enhancers may help in individual cases to promote food intake, according to the American Gastroenterological Association 9