How is olfactory dysfunction in taste and smell disorders treated?

Updated: Jan 08, 2021
  • Author: Eric H Holbrook, MD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Any treatment of olfactory disorders must first treat the specific causative abnormality if it has been identified from diagnostic tests, history, and physical examination.

Local nasal and/or sinus conditions should be optimally managed with saline lavage, decongestants, antihistamines, antibiotics, and/or nasal and systemic steroids, if applicable. Polyps and sinus disease that are resistant to medical management should be surgically addressed. Care must be exercised during surgery to avoid damage to the olfactory regions.

Aggressive treatment of these disorders, if present, provides a good chance of improvement. In general, conductive olfactory losses are the most amenable to treatment.

A few of the sensorineural olfactory defects also have specific treatments, but these are fewer and have less chance of success. Generally, viral processes that damage the olfactory neuroepithelium, sarcoidosis, and multiple sclerosis do not have specific remedies (although steroids may be administered in an attempt to limit the inflammation). Indeed, a consensus paper pointed out the lack of existing medical therapies to treat most olfactory disorders, outside of dysfunction arising from inflammatory chronic rhinosinusitis. [53]

Endocrine disturbances may be addressed by administration of the deficient hormone, as with hypothyroidism. Control of diabetes mellitus may slow neural degeneration of the olfactory system. However, in a study of 12 males with Kallmann syndrome, Gong and Gao stated that, while the condition can be effectively treated with the administration of human chorionic gonadotropin (hCG), human menopausal gonadotropin (hMG), and testosterone undecanoate, there is currently no effective therapy for the olfactory dysfunction occurring in this disease. [54]

Idiopathic cases of olfactory loss are not amenable to specific treatment, although some unproven remedies have been attempted. The best known of these is zinc sulfate. It has not been proven beneficial and is generally regarded as ineffective.

Other unproven remedies include pharmacologic doses of vitamins, topical steroids, and tricyclic antidepressants (for their effect on CSF catecholamines).

It is now known that olfactory training is safe and effective therapy for olfactory losses. [55] This method involves the patient choosing four known odors and intentionally sniffing these odors twice daily. A randomized, controlled study showed improved olfactory function after 18 weeks, particularly in patients who started training within the first 12 months after olfactory dysfunction began. [56] Eliminating toxins (eg, cigarette smoke, airborne pollutants) may help.

A literature review by Sorokowska et al indicated that olfactory training may be an effective treatment in patients with olfactory loss resulting from multiple etiologies, with improvements reported in discrimination between and identification of smells, although not in thresholds of odor detection. [57]  However, Jiang et al reported improvements in threshold testing with single-odor olfactory training in patients with traumatic anosmia. [58]

Overall, the patient with olfactory disorders needs reassurance that these generally are not life-threatening problems and that many other individuals experience them. In some patients, psychiatric evaluation and treatment may be warranted. Most importantly, the physician is responsible for warning the patient with olfactory disorders of the hazards associated with the inability to smell odors such as smoke, natural gas leaks, and spoiled food. Smoke detectors, as well as natural gas and propane gas detectors, are commercially available to help eliminate such risks.

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