The cervical sympathetic chain is involved in sensory processing, such as perception of taste and smell. Parosmia is a distorted sense of smell and dysgeusia is a distorted sense of taste. It is now well established that patients can develop parosmia and/or dysgeusia symptoms after COVID-19. Furthermore, this distortion in taste and smell may be the first sign of a COVID-19 infection or linger for years, affecting the patient’s quality of life. In this case report, we perform a stellate ganglion block (SGB) to block the cervical sympathetic chain to temporarily interrupt positive feedback loops. This disturbance allows the nerves in the sympathetic chain to autoregulate, increasing blood flow.
Patient was placed in the supine position. The anterior cervical area was prepped with 4% Chlorhexidine Gluconate solution and draped in sterile fashion. Using fluoroscopic guidance, the target area on the right side was identified and marked. A 25 gauge 3 ½ inch needle was advanced to the lateral aspect of C6 at the anterior tubercle. A total of 5mL of bupivacaine 0.25% was injected with dexamethasone 10mg/mL. Intermittent aspiration was negative. Horner’s syndrome was present. The same procedure was performed on the left side.
A 25-year-old female who recovered from a course of COVID-19 but developed persistent parosmia and dysgeusia. She presented to our clinic two years after her COVID-19 diagnosis. The patient did not respond to any previous treatment. Because taste and smell is a sympathetically mediated process, a stellate ganglion block procedure was suggested to restore regional autonomic nervous system activity, specifically olfactory and gustatory processes. This patient had two blocks done, first on the right side that she stated provided 45% improvement in her taste and smell and second block done on the left side that provided further improvement in both senses. This improvement was described by reversal of her taste and smell to common foods and smells.
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