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Loss of Smell...medical consulting

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Key Points about Loss of Smell










A loss of smell may be part of normal aging.




Common causes include upper respiratory infection sinusitis and head injury.




An imaging test such as CT or MRI is typically needed unless the cause is obvious to the doctor.





Evaluation of Loss of Smell











The following information can help people decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation.

Warning signs

The following findings are of particular concern:





Recent head injury




Symptoms of nervous system dysfunction such as weakness trouble with balance or difficulty seeing speaking or swallowing




Sudden start of symptoms




Local or global outbreak of COVID-19




When to see a doctor

People who have warning signs should see a doctor right away. Other people should see a doctor when possible.

What the doctor does

Doctors first ask questions about the person's symptoms and medical history and then do a physical examination. What doctors find during the history and physical examination often suggests a cause and the tests that may need to be done (see table Some Causes and Features of Anosmia).



Doctors ask about onset and duration of anosmia and its relation to any cold bout of flu or head injury. They note other symptoms such as a runny or stuffy nose and whether any nasal discharge is watery bloody thick or foul-smelling. Doctors seek out any neurologic symptoms especially those that involve a change in mental status (for example difficulty with short-term memory) or the cranial nerves (for example double vision or difficulty speaking or swallowing). Questions about the person's medical history involve sinus disorders head injury or surgery allergies drugs used and exposure to chemicals or fumes.



During the physical examination doctors inspect the nasal passages for swelling inflammation discharge and polyps. Doctors also do a complete neurologic examination that is particularly focused on mental status and the cranial nerves.




Table










Some Causes and Features of Anosmia






Cause




Common Features*




Tests








Blockage within the nose






Nasal allergies




In people who have chronic allergy symptoms (such as nasal congestion and a clear discharge)



No pain



Symptoms that often occur during certain seasons or after exposure to specific substances




A doctor's examination






Nasal polyps




Polyps that are usually seen during the examination




A doctor's examination






Destruction of smell receptors






Chronic sinusitis




A thick foul-smelling nasal discharge most or all of the time



Previous sinus infections




A doctor's examination



Usually computed tomography (CT)






Coronavirus disease 2019 (COVID-19)†




Loss of smell is often followed by other symptoms of infection (for example fever or cough)




Viral testing when available






Some viral upper respiratory infections (such as influenza)




Loss of smell that occurs after an infection




A doctor's examination






Tumors (a rare cause)




Possibly vision problems or only loss of smell




CT



Magnetic resonance imaging (MRI)






Drugs (such as amphetamines enalapril estrogen naphazoline phenothiazines and reserpine or use of decongestants for a long time)




Usually in people who report taking such drugs




A doctor's examination






Toxins (such as cadmium and manganese)




Usually in people who report exposure to such toxins




A doctor's examination






Destruction of olfactory pathways in the brain






Alzheimer disease




Progressive confusion and loss of recent memory




MRI



Sequential memory tests






Head injuries




In people who have had a head injury




CT or MRI






Degenerative neurologic disorders (such as multiple sclerosis)




Intermittent episodes of other symptoms of nervous system dysfunction such as weakness numbness or difficulty speaking seeing or swallowing




MRI



Sometimes a spinal tap






Brain surgery or infection




In people who have had brain surgery or a brain infection




CT or MRI






Brain tumors




Sometimes headache and/or symptoms of nervous system dysfunction




CT or MRI








* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.






† Destruction of smell receptors has not yet been confirmed as the mechanism for anosmia.















Testing

To test smell doctors hold common fragrant substances (such as soap a vanilla bean coffee and cloves) under the person's nose one nostril at a time. The person is then asked to identify the smell. Smell can also be tested more formally using standardized commercial smell test kits. One kit requires the person to scratch and sniff many different smell samples and try to identify them. Another kit contains diluted samples of a smelly chemical. Doctors see how dilute the sample can be before the person can no longer smell the chemical.



If COVID-19 is suspected viral testing is done and the person is managed according to local protocols including quarantine guidelines.



If there is no clear cause of anosmia computed tomography (CT) or magnetic resonance imaging (MRI) of the head (including the sinuses) is done to look for structural abnormalities (such as a tumor an abscess or a fracture).



Treatment of Loss of Smell











Doctors treat the cause of the anosmia. For example people with sinus infections and irritation may be treated with steam inhalation nasal sprays antibiotics and sometimes surgery. However the sense of smell does not always return even after successful treatment of sinusitis. Tumors are surgically removed or treated with radiation but such treatment usually does not restore the sense of smell. Polyps in the nose are removed sometimes restoring the ability to smell. People who smoke tobacco should stop.



There are no treatments for anosmia itself. People who retain some sense of smell may find that adding concentrated flavoring agents to food improves their enjoyment of eating. Smoke alarms important in all homes are even more essential for people with anosmia because they cannot smell smoke. Doctors recommend that people with anosmia use caution before consuming stored food and using natural gas for cooking or heating because they may have difficulty detecting food spoilage or gas leaks.


Causes of Loss of Smell











Anosmia that is not the result of aging occurs when swelling or another blockage of the nasal passages prevents odors from reaching the olfactory area or when parts of the olfactory area or its connections to the brain are destroyed (see table Some Causes and Features of Anosmia). The olfactory area where odors are detected is located high in the nose (see How People Sense Flavors).

Common causes

The most common causes include





Head injury (young adults)




Viral infections and Alzheimer disease (older adults)






A common cause of permanent loss of smell is a head injury as may occur in a car accident. Head injury can damage or destroy fibers of the olfactory nerves (the pair of cranial nerves that connect smell receptors to the brain) where they pass through the roof of the nasal cavity. Sometimes the injury involves a fracture of the bone (cribriform plate) that separates the brain from the nasal cavity. Damage to the olfactory nerves can also result from infections (such as abscesses) or tumors near the cribriform plate.



Another common cause is an upper respiratory infection especially influenza (flu). Flu may be the cause in up to one quarter of people with hyposmia or anosmia. Alzheimer disease and some other degenerative brain disorders (such as multiple sclerosis) can damage the olfactory nerves commonly causing loss of smell.

Less common causes

Drugs can contribute to anosmia in susceptible people. Polyps tumors other infections in the nose and seasonal allergies (allergic rhinitis) may interfere with the ability to smell. Occasionally serious infections of the nasal sinuses or radiation therapy for cancer causes a loss of smell or taste that lasts for months or even becomes permanent. These conditions can damage or destroy smell receptors. The role of tobacco is uncertain. A very few people are born without a sense of smell.



Anosmia or hyposmia may be an early symptom of COVID-19 an acute respiratory illness that can be severe and is caused by a newly identified coronavirus officially named SARS-CoV2.



simple explanation



Anosmia is complete loss of smell. Hyposmia is partial loss of smell. Most people with anosmia can taste salty sweet sour and bitter substances but cannot tell the difference between specific flavors. The ability to tell the difference between flavors actually depends on smell not the taste receptors on the tongue. Therefore people with anosmia often complain of losing their sense of taste and of not enjoying food.


A loss of smell receptors due to aging causes a decreased ability to smell in older people. People typically notice changes in smell by age 60. After age 70 changes are substantial.


Anosmia that is not the result of aging occurs when swelling or another blockage of the nasal passages prevents odors from reaching the olfactory area or when parts of the olfactory area or its connections to the brain are destroyed (see table Some Causes and Features of Anosmia). The olfactory area where odors are detected is located high in the nose (see How People Sense Flavors).


The most common causes include


Head injury (young adults)


Viral infections and Alzheimer disease (older adults)


A common cause of permanent loss of smell is a head injury as may occur in a car accident. Head injury can damage or destroy fibers of the olfactory nerves (the pair of cranial nerves that connect smell receptors to the brain) where they pass through the roof of the nasal cavity. Sometimes the injury involves a fracture of the bone (cribriform plate) that separates the brain from the nasal cavity. Damage to the olfactory nerves can also result from infections (such as abscesses) or tumors near the cribriform plate.


Another common cause is an upper respiratory infection especially influenza (flu). Flu may be the cause in up to one quarter of people with hyposmia or anosmia. Alzheimer disease and some other degenerative brain disorders (such as multiple sclerosis) can damage the olfactory nerves commonly causing loss of smell.


Drugs can contribute to anosmia in susceptible people. Polyps tumors other infections in the nose and seasonal allergies (allergic rhinitis) may interfere with the ability to smell. Occasionally serious infections of the nasal sinuses or radiation therapy for cancer causes a loss of smell or taste that lasts for months or even becomes permanent. These conditions can damage or destroy smell receptors. The role of tobacco is uncertain. A very few people are born without a sense of smell.


Anosmia or hyposmia may be an early symptom of COVID-19 an acute respiratory illness that can be severe and is caused by a newly identified coronavirus officially named SARS-CoV2.


The following information can help people decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation.


The following findings are of particular concern:


Recent head injury


Symptoms of nervous system dysfunction such as weakness trouble with balance or difficulty seeing speaking or swallowing


Sudden start of symptoms


Local or global outbreak of COVID-19


People who have warning signs should see a doctor right away. Other people should see a doctor when possible.


Doctors first ask questions about the person's symptoms and medical history and then do a physical examination. What doctors find during the history and physical examination often suggests a cause and the tests that may need to be done (see table Some Causes and Features of Anosmia).


Doctors ask about onset and duration of anosmia and its relation to any cold bout of flu or head injury. They note other symptoms such as a runny or stuffy nose and whether any nasal discharge is watery bloody thick or foul-smelling. Doctors seek out any neurologic symptoms especially those that involve a change in mental status (for example difficulty with short-term memory) or the cranial nerves (for example double vision or difficulty speaking or swallowing). Questions about the person's medical history involve sinus disorders head injury or surgery allergies drugs used and exposure to chemicals or fumes.


During the physical examination doctors inspect the nasal passages for swelling inflammation discharge and polyps. Doctors also do a complete neurologic examination that is particularly focused on mental status and the cranial nerves.


Cause


Common Features*


Tests


Blockage within the nose


Nasal allergies


In people who have chronic allergy symptoms (such as nasal congestion and a clear discharge)


No pain


Symptoms that often occur during certain seasons or after exposure to specific substances


A doctor's examination


Nasal polyps


Polyps that are usually seen during the examination


A doctor's examination


Destruction of smell receptors


Chronic sinusitis


A thick foul-smelling nasal discharge most or all of the time


Previous sinus infections


A doctor's examination


Usually computed tomography (CT)


Coronavirus disease 2019 (COVID-19)†


Loss of smell is often followed by other symptoms of infection (for example fever or cough)


Viral testing when available


Some viral upper respiratory infections (such as influenza)


Loss of smell that occurs after an infection


A doctor's examination


Tumors (a rare cause)


Possibly vision problems or only loss of smell


CT


Magnetic resonance imaging (MRI)


Drugs (such as amphetamines enalapril estrogen naphazoline phenothiazines and reserpine or use of decongestants for a long time)


Usually in people who report taking such drugs


A doctor's examination


Toxins (such as cadmium and manganese)


Usually in people who report exposure to such toxins


A doctor's examination


Destruction of olfactory pathways in the brain


Alzheimer disease


Progressive confusion and loss of recent memory


MRI


Sequential memory tests


Head injuries


In people who have had a head injury


CT or MRI


Degenerative neurologic disorders (such as multiple sclerosis)


Intermittent episodes of other symptoms of nervous system dysfunction such as weakness numbness or difficulty speaking seeing or swallowing


MRI


Sometimes a spinal tap


Brain surgery or infection


In people who have had brain surgery or a brain infection


CT or MRI


Brain tumors


Sometimes headache and/or symptoms of nervous system dysfunction


CT or MRI


* Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.


† Destruction of smell receptors has not yet been confirmed as the mechanism for anosmia.


To test smell doctors hold common fragrant substances (such as soap a vanilla bean coffee and cloves) under the person's nose one nostril at a time. The person is then asked to identify the smell. Smell can also be tested more formally using standardized commercial smell test kits. One kit requires the person to scratch and sniff many different smell samples and try to identify them. Another kit contains diluted samples of a smelly chemical. Doctors see how dilute the sample can be before the person can no longer smell the chemical.


If COVID-19 is suspected viral testing is done and the person is managed according to local protocols including quarantine guidelines.


If there is no clear cause of anosmia computed tomography (CT) or magnetic resonance imaging (MRI) of the head (including the sinuses) is done to look for structural abnormalities (such as a tumor an abscess or a fracture).


Doctors treat the cause of the anosmia. For example people with sinus infections and irritation may be treated with steam inhalation nasal sprays antibiotics and sometimes surgery. However the sense of smell does not always return even after successful treatment of sinusitis. Tumors are surgically removed or treated with radiation but such treatment usually does not restore the sense of smell. Polyps in the nose are removed sometimes restoring the ability to smell. People who smoke tobacco should stop.


There are no treatments for anosmia itself. People who retain some sense of smell may find that adding concentrated flavoring agents to food improves their enjoyment of eating. Smoke alarms important in all homes are even more essential for people with anosmia because they cannot smell smoke. Doctors recommend that people with anosmia use caution before consuming stored food and using natural gas for cooking or heating because they may have difficulty detecting food spoilage or gas leaks.


A loss of smell may be part of normal aging.


Common causes include upper respiratory infection sinusitis and head injury.


An imaging test such as CT or MRI is typically needed unless the cause is obvious to the doctor.
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