Case Study Series

Pain Medicine — Post-COVID Anosmia & Dysgeusia

Restoring smell and taste after COVID with ultrasound-guided stellate ganglion block

A case study exploring how a sequenced bilateral stellate ganglion block led to rapid and meaningful recovery of smell and taste in a patient with persistent post-COVID anosmia.

The Presentation

Eighteen months without smell or taste — despite every standard treatment

James, a 40-year-old working professional, presented to PainSpa with persistent loss of smell and taste following COVID-19 infection approximately 18 months earlier. Although he had recovered well from the acute viral illness, the sensory loss had remained near-complete and showed no meaningful sign of improvement with time.

He described near-complete anosmia and markedly impaired taste. Food had become joyless and bland, his appetite had dropped, and the subtle pleasures of cooking, coffee, perfume and familiar everyday smells had all disappeared. He also raised concerns about safety — being unable to detect smoke, gas or spoiled food — and described a low-grade but persistent psychological toll on his mood and wellbeing.

He had already engaged actively with conventional care: review by an ENT specialist, a structured course of olfactory (smell) training, topical intranasal steroids and a trial of oral steroids. Despite this commendable engagement, there had been no meaningful clinical improvement.

He was referred for specialist pain medicine input with Dr Murli Krishna at PainSpa, where ultrasound-guided stellate ganglion block (SGB) was discussed as a possible next step.

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Clinical Background

Post-COVID anosmia — more than just an ENT problem

Loss of smell (anosmia) and altered taste (dysgeusia) emerged as defining symptoms of COVID-19. For most people they resolve within weeks — but a significant minority go on to develop persistent, often profoundly distressing, long-term sensory loss. Altered smell (parosmia) can be particularly disruptive, affecting food, intimacy and relationships.

Increasingly, the medical literature suggests that persistent post-COVID anosmia is not a purely nasal or ENT problem. It is now recognised as part of a broader pattern of post-viral neurological and autonomic dysfunction — with dysregulation of the sympathetic nervous system playing a likely role. This is the rationale for using interventions such as stellate ganglion block, which directly modulates the cervical sympathetic chain.

Symptom Assessment

A picture of persistent, life-narrowing sensory loss

James’s symptom profile was consistent with persistent post-COVID anosmia and dysgeusia with significant quality-of-life impact — a pattern in which sensory loss erodes daily enjoyment, nutrition, safety and emotional wellbeing.

The Treatment Journey

A structured, stepwise approach to recovery

Dr Krishna’s approach was grounded in thorough assessment, transparent discussion of options and a carefully sequenced bilateral protocol — with careful counselling about the current evidence base for SGB in post-COVID anosmia.

The PainSpa Approach

Four pillars of post-COVID SGB practice at PainSpa

Stellate ganglion block for post-COVID anosmia is a developing area of practice. Dr Krishna’s approach combines precise technique, careful patient selection and honest counselling about an evidence base that is still maturing.

The Specialist Perspective

Evidence, expectations and selecting the right patients

The evidence base for stellate ganglion block in post-COVID anosmia and dysgeusia is still developing. Current literature consists mainly of case reports and small case series, with no large randomised controlled trials. The exact mechanism of action also remains incompletely understood — though sympathetic modulation, improved olfactory blood flow and reduction in neuroinflammation are all biologically plausible contributors.

At PainSpa, clinical experience suggests that approximately 60% of patients experience meaningful improvement from a bilateral SGB protocol. Some patients experience partial benefit, and a proportion may not respond. This makes careful counselling and shared decision-making essential — SGB should be offered as a considered option, not as a guarantee.

In Dr Krishna’s practice, this precision is paired with continued support for olfactory training, nutrition, mood and overall wellbeing — recognising that recovery in post-COVID sensory loss is rarely the work of a single intervention alone.

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Outcome

What changed for James following bilateral SGB

The response was striking and unusually rapid. For a patient who had spent approximately 18 months unable to smell or fully taste anything, the changes within days of the procedures were both clinically significant and deeply personal.

The rapid onset of Horner’s syndrome during each procedure had confirmed successful sympathetic block, and the speed and depth of clinical recovery in this case were consistent with a meaningful response to sympathetic modulation. Importantly, James was counselled that if symptoms were to recur over time, the protocol can be safely repeated.

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Looking Ahead

The next steps in James’s care

With smell and taste largely restored, the ongoing plan focuses on consolidating gains, monitoring for any return of symptoms and supporting overall wellbeing.

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Your Specialist

About Dr Murli Krishna

Dr Krishna is a highly experienced Consultant in Pain Medicine practising at PainSpa’s clinics in Bristol, including Willow Surgery in Downend and the Chesterfield Nuffield Hospital in Clifton. He has a specialist interest in ultrasound-guided interventional pain medicine, including stellate ganglion block for post-COVID anosmia, long COVID symptoms and complex regional pain syndrome.

His approach is grounded in a thorough understanding of the autonomic, neuropathic and functional contributors to each patient’s condition. He works closely with ENT colleagues, GPs and allied health professionals, recognising that the best outcomes are achieved through coordinated, patient-centred care.

Dr Krishna consults in person and via telephone or videolink. Patients wishing to explore stellate ganglion block for post-COVID smell and taste loss are encouraged to contact PainSpa to arrange an initial assessment.

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References

Further reading

Painspa

Willow Surgery, Downend • Chesterfield Nuffield, Clifton • clinic@painspa.co.uk • www.painspa.co.uk

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