Question: Is it typical to lose all sense of smell after endoscopic sinus surgery? It’s been 3 months and I still can’t smell anything. I can only taste salt and something bitter. I have had a ten day course of steroids and antibiotics and still no results. Thoughts? Thank you!! AK
Answer:
Many of us don’t realize how important the sense of smell is. Loss of smell can interfere with every day satisfaction but also can be a health issue. We use smell to help determine what foods have spoiled, whether there is a fire as well as it being an important part of our enjoyment of food and other daily personal interactions.
The smell fibers, unfortunately, are quite exposed in the nasal cavity. They are located at the very top of the inside of the nasal cavity- and send their fibers directly into the brain by small perforations through the “cribiform plate” The sense of smell can be lost if air particles do not reach the roof of the nose, as when we have a cold, or from actual damage to these exposed fibers. The first is rather treatable, but our success in treating nerve damage is much less. When endoscopic sinus surgery is done for sinus disease or other nasal complaints, we usually try to avoid the area of the cribiform plate, as it is quite easily damaged- possibly causing a leak of brain fluid.
A wonderful article by an old friend, Dr. Charles Kimmelman, showed that about 2/3 of patients have an improvement in the sense of smell from endoscopic sinus surgery, 1/3 have some diminshed sense of smell, but in his study he found 1% may lose their sense of smell from surgery. It seems to be independent of the kind of surgery, the age, gender and anesthetic used. You can find this article in an ENT journal- Laryngoscope Volume 104, issue 8 pages 981-988. That is, we still don’t know what causes the “olfactory” or smell nerve damage in those rare instances.
After surgery, one gets some swelling in the nasal and sinus passages that can hinder flow of air to the smell fibers, by far the most common reason to have diminished smell after surgery. We would commonly treat with steroids and antibiotics for any potential infectionand to bring down swelling so that air can get to the top of the nose. Additionally, one would often treat with oral steroids to try to reverse any potential nerve damage. One can monitor smell function simply- we use the University of Pennsylvania Smell and Taste Center booklets.
It is difficult for me to tell which kind of loss you have. But don’t give up…. If the loss is from obstruction, hopefully this will resolve as post-operative swelling diminishes- and finally, there is some possibility of regeneration of nerves that may be damaged- up to a year. I would ask your surgeon about what type of loss he or she thinks you have.
We take care of many such problems here at the NY Sinus Center- but a regional center of excellence for this problem is at the University of Pennsylvania Smell and Taste Center in Philadelphia.
Robert L. Pincus MD
Ask the ENT Doctor
Associate Professor Otolaryngology
NY Otolaryngology Group/ NY Sinus Center
Frequently Asked Questions
Complete loss of smell after endoscopic sinus surgery is rare, occurring in about 1% of patients according to research. Most patients experience either an improvement or some degree of diminished smell, often due to swelling that blocks air flow to the smell fibers during recovery.
Persistent loss of smell could be due to either ongoing swelling obstructing airflow to the olfactory fibers or potential nerve damage from the surgery. While steroids and antibiotics help reduce swelling and infection, nerve regeneration may take up to a year, making recovery a gradual process.
Swelling in the nasal and sinus passages can block air from reaching the olfactory fibers located at the roof of the nasal cavity, which is essential for detecting odors. This obstruction is the most common reason for diminished smell following surgery and typically improves as swelling subsides.
The olfactory fibers are located at the top inside of the nasal cavity near the cribiform plate, a delicate area that surgeons try to avoid. Damage to this area can lead to loss of smell and even complications like cerebrospinal fluid leaks, though such damage is uncommon.
Treatment usually involves steroids and antibiotics to reduce swelling and infection. Oral steroids may also be used in an attempt to reverse nerve damage. Monitoring smell function over time can help assess recovery, and nerve regeneration may occur up to a year post-surgery.
Smell function can be monitored using standardized tools like the University of Pennsylvania Smell and Taste Center booklets, which provide a structured way to assess changes in olfactory ability over time.
Specialized centers such as the University of Pennsylvania Smell and Taste Center offer expert evaluation and treatment for olfactory disorders, providing comprehensive care for patients with ongoing smell loss after sinus surgery.
