Smell - impaired

Alternative names 
Loss of smell; Anosmia

Definition
Impaired smell is the partial or total loss of the sense of smell.

Considerations
The loss of smell is usually an insignificant result of nasal congestion or obstruction, but it can sometimes indicate a neurological disorder. Loss of the sense of smell may be idiopathic (without any identifiable cause).

Some loss of smell occurs normally with aging. In most cases, there is no obvious or immediate cause, and there is no treatment.

Temporary loss of the sense of smell is common with colds and nasal allergies, such as hay fever (allergic rhinitis). It may occur following a viral illness.

The sense of smell is often lost with disorders that prevent air from reaching the part of the nose where smell receptors are located (the cribriform plate, located high in the nose). These disorders may include Nasal polyps, nasal septal deformities, and nasal tumors.

Other disorders that may cause a loss of the sense of smell include tumors of the head or brain, head trauma, and a wide variety of endocrine, nutritional, Alzheimer’s dementia, and nervous disorders.

Many medications may change or decrease the ability to detect odors.

Most people who lose the sense of smell can still differentiate salty, sweet, sour, and bitter tastes, which are sensed on the tongue. They may not be able to distinguish other flavors. Some spices (such as pepper) may stimulate facial nerves and may be felt rather than smelled.

Common Causes

     
  • Natural aging process  
  • Recent viral upper respiratory infection  
  • Nasal decongestants  
  • Lead poisoning  
  • Drugs (such as amphetamines, estrogen, naphazoline, phenothiazines, prolonged use of nasal decongestants, reserpine)  
  • Radiation therapy  
  • Nasal or sinus surgery  
  • Tracheostomy  
  • Nasal or brain tumors

Home Care
Treatment of underlying disorders may correct loss of the sense of smell. This can include antihistamines (if the condition is related to allergy), surgical correction of physical blockages, treatment of other disorders, changes in medication, and so on. Avoid excessive use of nasal decongestants, which can lead to recurring nasal congestion.

If loss of the sense of smell is permanent, dietary counseling may include use of highly seasoned foods and stimulation of taste sensations that remain.

Caution should be taken to ensure safety around the home with smoke detectors and use of electric appliances rather than gas appliances or technologies that detect the presence of gas fumes in the home.

For loss of smell due to aging, there is no treatment.

For loss of smell caused by a recent viral upper respiratory infection, be patient. The symptoms return to normal without treatment. Sometimes zinc supplements are recommended.

Note: Loss of the sense of smell may be temporary, and ability to smell may return spontaneously, especially after colds or viral infections.

Call your health care provider if

If the loss of smell is persistent, is getting worse, or is accompanied by other unexplained symptoms, call your health care provider.

What to expect at your health care provider’s office
The medical history will be obtained and a physical examination performed.

Medical history questions documenting impaired sense of smell in detail may include:

     
  • Time pattern       o When did this problem develop?       o Have you always had problems with your sense of smell?       o Is it getting worse?  
  • Quality       o Are all odors affected or only certain types?       o Can you taste food?  
  • Aggravating factors       o Do you have a cold or other upper respiratory infection?       o Do you have allergies?       o Do you have chronic sinusitis?       o What medications are being taken?  
  • Other       o What other symptoms are also present?

The physical examination will include a physical examination of nasal structures.

Diagnostic tests that may be performed include:

     
  • CT scan  
  • Olfactory nerve testing  
  • Nasal endoscopy  
  • X-rays of the skull  
  • MRI scan

Intervention:
If possible, the cause will be treated. If the loss of sense of smell is caused by nasal congestion, local decongestants or antihistamines may be prescribed. A vaporizer or humidifier may be recommended to prevent mucosal drying and improve nasal discharge.

Vitamin A may be given orally or by injection. In some cases, a biopsy of the olfactory epithelium (cells responsible for smell) may be required to make a diagnosis.

Johns Hopkins patient information

Last revised: December 7, 2012
by Mamikon Bozoyan, M.D.

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All ArmMed Media material is provided for information only and is neither advice nor a substitute for proper medical care. Consult a qualified healthcare professional who understands your particular history for individual concerns.