• Post-COVID-19 chemosensory dysfunctions (dysosmia and dysgeusia) are common and

significantly affect quality of life

• Symptoms may persist for months to years and frequently co-occur, suggesting shared

neurological and autonomic mechanisms

•Proposed pathophysiology: autonomic dysregulation, neuroinflammation, and/or

cranial nerve involvement3

•Treatment options are limited, driving interest in neuromodulatory therapies

•Stellate ganglion block (SGB) has been used to modulate sympathetic outflow and

restore autonomic balance

•Emerging data suggests it may improve post-COVID-19 dysosmia and dysgusia1, 2

• 55-year-old female with PMHx hypertension, type 2 diabetes, and confirmed COVID-19

• Had persistent dysosmia and dysgusia >12 months, with significant nutritional and

quality of life impacts

•Symptoms resistant to conventional treatments (olfactory training, acupuncture, and

hyperbaric oxygen)

• Evaluated for SGB due to symptom chronicity

•Post-COVID-19 dysosmia and dysgusia are not currently FDA approved indications for

SGB

• Underwent right-sided SGB with 3mL 0.25% bupivicaine under ultrasound and

fluoroscopic guidance

• Rapid subjective improvement in smell and taste at one-week and one-month follow-

up

Figure 1: Ultrasound image of SGB. Transverse cervical view demonstrabng key anatomical landmarks: thyroid

(Th), trachea (Tr) esophagus (E), carobd artery (CA), internal jugular vein (IJ), and longs colli muscle (LC). Yellow

arrows indicate the stellate ganglion target adjacent to the longs colli, with green arrow showing in-plane needle

advancement technique.5

Figure 2: Fluoroscopic-guided SGB: Sequenbal anteroposterior cervical fluoroscopic images demonstrabng (A) needle

entry at the C6 level (Chassiagnac’s tubercle), (B) advancement of the anterolateral vertebral body, and (C) contrast

spread along the prevertebral fascia overlying the longus colli muscle (★), confirming appropriate injectate

distribubon.6

•Marked improvement in post-COVID-19 dysosmia and

dysgeusia after SGB and failure of conservative

treatments

•Proposed mechanism: sympathetic modulation and

autonomic “reset,” targeting persistent dysautonomia3

• Evidence is mixed

• RCT data show no significant benefit over placebo

• Smaller studies report modest, variable improvement

• Favorable safety profile in literature

• Not all patients respond; structural olfactory damage

may limit efficacy

• SGB may benefit select patients; further controlled

studies are needed to define efficacy and patient

selection4