Question: I haven’t been able to taste or smell for about a year and a half. I recently (May 14) had sinus surgery to remove polyps. The question nobody can answer is that when I am on steroids for a sinus infection my smell and taste return and once done with the steroid or as it tapers off I lose them again. Do you recommend steroids for loss of smell?
Answer:
While we tend not to think of smell and taste as important as our other senses, clearly its loss can interfere with the enjoyment of life-and our safety. We use the senses of smell and taste to help us avoid spoiled foods as well as to alert us to noxious/unsafe chemicals and fire.
Taste fibers are on the bottom of our tongue, and not really affected by nasal and sinus disease. But since smell is such a large part of what we perceive as taste, we perceive the loss of taste as well.
Smell fibers are located in the top of the nose- and extend directly into the brain from there. We lose the ability to smell if there is a damage to these fibers (often from an infection or trauma) or if air doesn’t get there. We all have noticed the loss of the ability to smell when we are congested with a cold or bad allergies. Nerve damage is often permanent. Loss from nasal obstruction may be transient.
If the sense of smell returns at times, this is not a permanent loss. In your case, it is likely the congestion of the nasal lining around the smell fibers that obstructs your sense of smell. When we remove polyps from the nose, we usually cannot remove all of the swelling around the smell fibers as they are quite close to the thin wall separating the nose from the brain (cribiform plate). In any case, whatever causes the polyps in the first place, is likely to continue to cause the nasal and sinus lining to be swollen after surgery. Oral steroids, such as medrol or prednisone, are the most effective medications we have in shrinking down polyps and in your case are effective enough to bring back your sense of smell. However, because of the side effects of prolonged use, we try to minimize the use of oral steroids for loss of smell. We prefer to use other medications that are less likely to cause side effects- but these also are often less effective. We use nasal steroids- sprays, rinses and/or nebulizers that are less likely enter the blood stream. We use oral and nasal antihistamines if one is allergic- we would suggest other medications such as singulair- and allergy desensitization if you are allergic.
There is the possibility that there are further polyps to be removed surgically- and this should be evaluated. Lastly, some patients and their sinus doctors will use the smallest dose of oral prednisone from time to time that works judiciously- balancing against the potential for long term side effects. I have one such patient who chooses to take a small dose of steroids once or twice a year, before his vacations. In your case, I would try to use all of the more conservative measures on a regular basis first before relying on steroids for loss of smell. We have found Budesinide rinses and nasal nebulizer treatments to be two of the more promising topical treatments that are often overlooked. I would speak to your sinus specialist and explain your concerns and come up with a regimen that works for you and your life style. We of course would be willing to see you if you’re in the NYC area.
I hope this helps.
Robert Pincus MD
co-Director NY Sinus Center
Frequently Asked Questions
Nasal polyps and inflammation cause swelling around the smell fibers in the nose, obstructing airflow to these fibers located at the top of the nose. This blockage prevents proper smell detection, which also affects taste perception since smell significantly contributes to the flavor experience. Damage to the smell fibers from infection or trauma can also cause loss, but often nasal obstruction is the cause when smell returns with steroid use.
Oral steroids like prednisone can effectively reduce inflammation and shrink polyps, which may temporarily restore smell and taste. However, because of potential side effects from long-term steroid use, other treatments such as nasal steroid sprays, rinses, and antihistamines are usually recommended first. Steroids are used cautiously and typically in the smallest effective doses.
Not necessarily. If the loss is due to obstruction and swelling around the smell fibers, it is often reversible, especially if smell returns with steroid treatment. However, if the smell fibers are damaged due to infection or trauma, the loss may be permanent. Persistent inflammation means the condition can recur, requiring ongoing management.
Alternatives include nasal steroid sprays, rinses, nebulizer treatments like Budesonide, oral and nasal antihistamines for allergies, allergy desensitization, and medications like singulair. These treatments are less likely to cause systemic side effects compared to oral steroids and aim to reduce local inflammation and polyp size.
Yes. Surgery may remove visible polyps, but it usually cannot remove all inflammation or swelling near the sensitive smell fibers. The underlying cause of polyps often continues, so recurrent or residual polyps can still obstruct the nasal passages and contribute to loss of smell, requiring ongoing evaluation and treatment.
Discuss your concerns about steroid side effects and the intermittent return and loss of your smell with your sinus specialist. Work together to develop a treatment plan that prioritizes conservative measures such as nasal rinses and sprays, uses the smallest effective steroid doses if needed, and balances treatment benefits with potential risks and your lifestyle.
