Published online May 9, 2023. doi: 10.5319/wjo.v10.i2.4
Peer-review started: January 20, 2023
First decision: March 28, 2023
Revised: March 28, 2023
Accepted: April 18, 2023
Article in press: April 18, 2023
Published online: May 9, 2023
Core Tip: Smell loss is the most frequent acute manifestation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Persistent smell disorders (deficits and distortions) are the most frequent viral complications. Taste and flavor disorders are also complications of SARS-CoV-2 infection but at lower frequencies compared to smell disorders. It has been found that SARS-CoV-2 has a 4 times more affinity to infect the olfactory epithelium compared to other human coronaviruses. The mechanisms of these disorders have been explored mainly based on animal models of anosmia due to SARS-CoV-2 infection. It has been suggested that the post-coronavirus disease 2019 transient smell loss might be due to viral infection to the olfactory non-neuronal epithelial cells (particularly the susentacular cells) which are important for the health of olfactory sensory neurons (OSNs). These cells rapidly regenerate after injury, within 1-3 wk, and restore smell function. Persistent smell disorders have been suggested to be due to injury of OSNs, disorganization of the olfactory epithelium, altered expression of olfactory receptors, and impaired olfactory neurogenesis. These cells require ≥ 3 mo to regenerate and restore function depending on the severity and type of injury. Taste disorders have been suggested to be due to viral infection of taste buds, disruption of the activity of the salivary glands, inflammation of the gustatory epithelium, and injury to the taste sensory cells. Treatment of these disorders is a medical challenge, and none of the available pharmacotherapies or interventions which are used to treat similar disorders due to other causes, showed curative effect.