March 19, 2022

Stellate Ganglion Block to Resolve Long COVID Symptoms Including Smell/Taste Loss

There has been a smattering of anecdotal research (with slightly more media coverage) that even a single stellate ganglion block (SGB) may resolve long COVID symptoms afflicting the central nervous system (CNS) including any smell or taste loss within minutes. Long COVID CNS symptoms include brain fog, poor memory, inability to focus, fatigue, etc. Repeat SGB injections typically do not appear to be necessary as the improvement appears to be durable. However, because there is no clear explanation in exactly how this improvement occurs, there has only been limited broad acceptance of SGB as a valid treatment.

Anecdotal research supporting SGB in treating long COVID:

• Stellate ganglion block reduces symptoms of Long COVID: A case series

• Regulation of acute reflectory hyperinflammation in viral and other diseases by means of stellate ganglion block. A conceptual view with a focus on Covid-19

• Long-term Results of Stellate Ganglion Block in Patients with Olfactory Dysfunction

More recently, larger pilot trials support SGB to help with long COVID:

• Stellate Ganglion Block for the Treatment of COVID-19-Induced Olfactory Dysfunction: A Prospective Pilot Study. Otolaryngol Head Neck Surg. 2023 Sep 26. doi: 10.1002/ohn.530.

Media reports supporting SGB:

• ‘I’m amazed that it worked.’ Local woman receives injection that reset her taste, smell after COVID

• Nebraska teen gets sense of smell back after COVID, thanks to shots ‘rebooting’ nerve system

• Pain specialist working to help reduce long term symptoms in COVID-19 patients

• Pain Syndromes Common in Patients With Long COVID

• Some long haulers still dealing with severe taste, smell issues due to COVID; North Texas clinic working on experimental treatment

The mechanism behind how injecting numbing medicine into a nerve plexus in the bottom of the neck near the cervical spine accomplishes this improvement is unclear, but is hypothesized to "reset" the autonomic nervous system which provides complex bidirectional communication between the immune system and the nervous system. Feedforward loops allow rapid response to infection, while feedback loops prevent damaging levels of inflammation. 

Please note that SGB does not appear to help ALL patients suffering from long COVID. Only some. At this time, it is unknown who would benefit. 

As such, it may be worthwhile to consider SGB only for those desperate patients suffering from long COVID CNS symptoms if more traditional and conservative management fail to help (nasal sprays, supplements, anti-histamines, smell therapy, etc). Those who perform SGB include interventional radiology and pain specialists under XR or US guidance.

SGB has notable side effects (which must happen to ensure the injection worked) which encompasses Horner's syndrome (decreased pupil size, a drooping upper eyelid, sunken appearance of the eye, slight elevation of the lower eyelid, and decreased sweating on the affected side of your face).

Here is a nice video explaining how SGB injections are performed, though geared more towards pain control.

Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids.

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