Part 3: Perspectives on Olfactory and Gustatory Dysfunction Pathophysiology, Management and Relevance to COVID-19: Rationale for Auricular Cranial Nerve Stimulation.

The rapid global emergence of distortions of the senses of smell and taste consequential to COVID-19 has provoked an unprecedented demand for investigation into treatments capable of addressing such medical phenomena. While the pandemic's principal focus rests on interventions intended to prevent the infection and its spread, much attention must be devoted to amelioration of these common symptomatic sequelae of it. The medical historical record reveals a shocking paucity of serious consideration of olfactory and gustatory dysfunction (OGD), hardly exclusive to SARS-CoV-2 infection (as discussed in Part 1 of this article series). To date, no treatment approach has ever delivered noteworthy clinical results for chronic cases. Numerous studies and reviews have addressed the epidemiology and hypotheses of OGD pathophysiology. Past and recent studies have produced vague findings and conclusions devoid of practical clinical applications for patients who continue to experience chronic sensory distortions and deficits. It is urgent that focused exploration be aggressively pursued for therapeutic and restorative modalities to ameliorate OGD across all medical disciplines, with no bias towards any one approach. It is imperative that approaches outside the pharmacological realm are studied; no effective medication of any merit exists. Thus, innovative and new approaches potentially capable of supporting natural self-regulation and restoration of healthy neurophysiology must be investigated, post-haste. Specifically, stimulation of cranial nerves via their auricular branches, by means of various modalities, may hold promise. A vast body of evidence exists to support its investigation. Its inclusion as an extremely safe and inexpensive approach to endeavor to resolve chronic OGD (not merely for post-COVID19 infection) is warranted. The 3-phase auricular acupuncture microsystem may be the most precise form of targeting and positively influencing specific neurological structures affected by COVID-19.

Part Two: Perspectives on Olfactory and Gustatory Dysfunction Pathophysiology, Management, and Relevance to COVID-19: Current Approaches.

Context: The phenomena of olfactory and gustatory dysfunction disorders (OGD) are hardly unique to COVID-19. However, the widespread incidence of OGD as sequelae of COVID-19 has provoked rejuvenated interest in these long existing, but poorly studied maladies. Objective: This second of a three-part review discusses past and current approaches for treatment of OGD, not restricted to those that COVID-19 has caused, with the intention to lay a foundation for consideration of new paradigms for evaluation and management of OGD. Design: The researcher performed a narrative review by searching databases including PubMed, Sciencedirect, Google Scholar, Old Dominion University Libraries, and the websites of various medical journals. Searches included numerous combinations of keywords accompanied by the phrases, loss of sense of smell and taste, olfactory and gustatory dysfunction disorders, as well as the terms anosmia, parosmia, ageusia, and parageusia. Such keywords included viruses, bacteria, fungi, protozoa, parasites, infection, COVID-19, treatments, medications, steroids, supplements, nutrients, alternative medicine, acupuncture, olfactory training, clinical trials, cranial nerves, pathogenesis, pathophysiology, and etiology. Setting: The Liebell Clinic, Virginia Beach, VA, USA. Conclusions: The epidemiology and hypotheses of pathophysiology of post-COVID OGD has been addressed via numerous studies and reviews. However, extremely limited evidence of effective treatment for chronic OGD, in general, exists, Global demand for any treatment capable of reducing or resolving it is unprecedented. Past and present treatment approaches and recently initiated clinical trials, since the onset of the pandemic, have yet to yield any significant results.

Perspectives on the Pathophysiology, Management, and Relevance of Olfactory and Gustatory Dysfunction to COVID-19, Part One.

Context: Amelioration of olfactory and gustatory dysfunction (OGD) disorders has become a common requirement due to COVID-19. Although it's hardly exclusive to COVID-19, OGD's prevalence requires exploration of therapeutic and restorative modalities, on the broadest scale possible. No specific medication or treatment of any noteworthy efficacy exists for OGD. Objective: As Part 1 of a three-part article, a narrative review intended to examine the known causes of OGD, not restricted to COVID-19, and frame their relevance for development of new treatments or the repurposing of existing ones. Design: The researcher performed a narrative review by searching databases including PubMed, Sciencedirect, Google Scholar, Old Dominion University Libraries, and the websites of various medical journals. Searches included numerous combinations of keywords accompanied by the phrases, loss of sense of smell and taste, olfactory and gustatory dysfunction disorders, as well as the terms anosmia, parosmia, ageusia, and parageusia. Such keywords included viruses, bacteria, fungi, protozoa, parasites, infection, COVID-19, treatments, medications, steroids, supplements, nutrients, alternative medicine, acupuncture, olfactory training, clinical trials, cranial nerves, pathogenesis, pathophysiology, and etiology. Setting: The Liebell Clinic, Virginia Beach, VA, USA. Results: Scientific investigation into mechanisms and treatment of OGD appears to be historically limited and unremarkable. Medical literature spanning decades reports a bleak clinical outlook with an abundance of speculation and hypotheses. Limited evidence of effective or reliable treatment exists, especially for chronic cases. Conclusions: With a dismal lack of medical support for a suddenly prevalent, but hardly novel set of maladies of taste and smell perception; the imperative for multifaceted and broad investigations across all medical disciplines is without question. Global urgency for the development of any treatment capable of reducing or resolving OGD triggered by COVID-19 is unprecedented. Part 2 of the current author's three-part series will address the details of current and past treatment approaches and clinical trials.

The Science of Auricular Microsystem Acupuncture: Amygdala Function in Psychiatric, Neuromusculoskeletal, and Functional Disorders.

Addressing dysfunction of the amygdala via the auricular acupuncture microsystem has vast potential. Widespread medical consequences of amygdala dysregulation have been well-defined scientifically. Clinical results and a significant quantity of existing amygdala research support the rationale for addressing amygdala function through auricular-acupuncture techniques. Further scientific inquiry into their mechanisms of action, clinical applications, and expansion of both professional and public education of the merits of these techniques is warranted.

Waking Up and Literally Smelling the Coffee: Inducing Olfactory Function with 3-Phase Auricular Therapy.

Background: Loss of the sense of smell, from both known and unknown causes, can be refractory to medical intervention. Cases unrelated to head trauma or infection might be ignored or assumed to be untreatable. Case: A 20-year-old male had lifelong anosmia. This patient received a single session of 3-phase auricular therapy (3PAT), including electrical stimulation and insertion of 3-mm, semipermanent ear acupuncture needles, covered by surgical tape and adhesive. Results: Approximately 1 month following insertion of the acupuncture needles, the patient acquired a sense of smell, which had always been absent. He acquired and maintained his sustained sense of smell naturally in response to the 3PAT. Conclusions: For cases of loss of sense of smell, particularly those of unknown etiology, 3PAT and its required evaluation techniques should be considered.