Question:
I have a question for Dr. Robert Pincus. I was prescribed oral steroids (methylprednisolone 4mg) due to loss of smell. I took the 7 day regime of oral steroids. About 10 days after completing this treatment I again lost my sense of smell. My doctor said this could not be treated. I am seeking a second opinion from you. Thank you for any information you can provide.
Answer:
Thank you for your question. It is not hopeless when you have lost your sense of smell. There are two main reasons that we lose the sense of smell. The first and most common is that there is congestion in the nose at the area of the cribriform plate (the top of the nasal cavity) where the smell fibers are located. This happens when we have a cold or often from a sinus infection or nasal polyps. Obviously, these are not only treatable, but will almost always get better.
Damage to the smell fibers themselves, either after a viral infection, trauma, breathing in certain toxins, or other causes are more difficult to treat.
At the NY Sinus Center we believe it is important to find out what has caused your loss of smell and aim our treatments at the particular cause of your problem.
The fact that your smell improved temporarily with oral steroids is an EXCELLENT sign that your sense of smell is both treatable and more likely to be regained. We would be happy to try to help.
I hope this helps clear things up.
Robert Pincus MD
Co-Director NY Sinus Center
NY Otolaryngology Group ” Care beyond excellence”
Question:
I haven’t been able to smell my entire life (I put my birthday as the onset date). A doctor I went to diagnosed it as “congenital anosmia” but couldn’t do anything more for me. He prescribed an oral corticosteroid plan but I had no change in my ability to smell, so he said there’s nothing else he can do. I’m hoping there are more resources out there. I put severe migraines as a symptom because as a young child I used to get terrible migraines so bad I would randomly fall over. I got tests done though, and there was nothing out of the ordinary, and they no longer occur, so I’m not sure if that’s relevant, but I wanted to put it regardless. I’ve tried taste testing because I know that smell greatly affects taste. When I did a blind taste test, I had absolutely no idea what I was eating. However, I have favorite foods, and there are things I don’t like so I know I have a sense of taste, but I just can’t recognize any specific flavors.
I’m not from New York, I’m from Pennsylvania, but I’m just hoping for some answers or some other resources or some clinical trial somewhere, or basically anything. Nobody else I’ve seen has been able to help.
Answer:
First of all, thank you for your question. As you obviously realize, the loss of smell can cause many problems. We use the sense of smell to detect danger—varying from a gas leak to rotting food. The loss of smell interferes with our enjoyment of food and our daily activities. While about 1/5 of cases of loss of smell have an unknown cause, most can be related to a viral infection, head trauma or infection. A small group is born without a sense of smell. This is called congenital anosmia.
While this can be due to a mutation on chromosome 18, the most common syndrome causing congenital anosmia is Kallmann’s Syndrome. Kallmann’s Syndrome’s two most common findings are the congenital absence of smell and delayed puberty. While we are still not able to find a way to help with the lack of the sense of smell, once diagnosed, hormonal therapy will be successful in treating the delay or absence of sexual maturation.
One can usually differentiate congenital anosmia from the loss of smell that may have occurred in infancy by an MRI of the olfactory bulb. The olfactory bulb is an area in the brain, just above the sinuses, where the smell nerves are located. The olfactory bulb may be absent in people born without the sense of smell.
While we have therapies that have been shown to help for acquired anosmia, so far we do not have a good therapy for its congenital absence. Work, though, is being done. A study at the University of Michigan a few years back showed good results in treating mice with congenital anosmia.
One of the nations leading centers for the study of the sense of smell is at the University of Pennsylvania Smell and Taste Center. While we’d be happy to see you at the NY Sinus Center for this, you might start by going there for an evaluation and to see whether you may be a candidate for one of their studies.
I hope this helps clear things up.
Robert Pincus MD
Co-Director NY Sinus Center
NY Smell and Taste Center
Question: Hi, I had sinus surgery on all four sinuses along with septoplasty and turbinectomy about a month ago. I completely lost all sense of smell and taste. Maybe once or twice a day I will get it back but very slightly and it only lasts a couple of minutes. My surgeon said it should come back in around 2 weeks and I cannot get an appointment to see him for another 6 weeks. It has now been a month and I am starting to worry. Is this normal?
Answer:
Permanent loss of smell is an uncommon risk from any nasal or sinus surgery. Taste is actually not really involved, but since so much of “flavor” is determined by smell we feel that we have lost taste as well.
It is not unusual for there to be a temporarily diminished sense of smell after sinus surgery as the nasal airways can be congested and there are frequently crusts that keep the flow of air away from the smell fibers, at the roof of the nose. It is likely that is what you have as there are times when the sense of smell returns. Loss of smell from obstruction should resolve and in fact many patients who have diminished smell before surgery will note improvement in their abilitiy to smell afterwards. The much less common loss of smell from nerve damage is best treated earlier, rather than later.
However, most sinus specialists, including us at the NY Sinus Center believe that comprehensive post operative care (including cleanings) is an important part of successful sinus surgery- and will help insure the best results.
I hope this clears things up.
Robert L. Pincus MD
Co-Director NY Sinus Center
Question: I am experiencing a lost sense of smell after surgery. I had an upper left molar tooth extracted last month. The extraction was painful, for more than 20 min. the dentist pushed my head, pulled and twisted the molar. I had a sinus perforation which later was confirmed through a dental x-ray (not panoramic or whole head).
Please can someone tell me whether my anosmia is going to be permanent (one month already) and whether I might have had the CSF leak due to the blunt trauma of the tooth extraction and sinus perforation? The liquid did not resemble any mucus, it was watery and sudden gush. I am still waiting for the day where a surgery will be done to close the sinus communication via cutting and stitching on my gums (it will be after 3 weeks).
Is anosmia typical for sinus perforation? I have a burning sensation in the base of my left nostril and a feeling of excessive dryness. For a week or so I started having a mucous liquid running down to my throat, I am sure that this is from the sinus.
Answer:
First of all, thank you for your question. This obviously has been a difficult time for you. I will try to answer your question(s) as best as possible, without having examined you.
It is not rare for someone experience a lost sense of smell after surgery. Typically because they develop a sinus infection after an upper molar infection or extraction. The roots of the upper molars are very close to and sometimes in the maxillary sinus. The bacteria that we have in our mouth can then spread into the sinus easily causing infection. The bacteria of the oral cavity, in particular, tend to be worse than those we have living normally in our nose and sinuses, and can cause quite significant infections.
It seems likely, that you had a sinus infection from your dental problem. This needs to be treated aggressively, with antibiotics based on a culture of your sinus discharge- and sometimes by drainage- surgically or with a balloon sinuplasty (balloon dilating of the normal opening of the sinus – done in the office.
You can certainly have a temporary- or even permanent loss of the sense of smell (anosmia) from infection. One needn’t postulate a break in the roof of the sinus (cribiform plate)- Although your description of the mucous drainage is consistent with a leak of brain fluid (CSF)- the best way to diagnose this would be to collect the fluid and to have it tested – (Beta Transferin is used as a marker)- Even less likely would be a leak of fracture of the petrous apex (inner ear)- as this usually will cause a hearing loss from fluid collecting in the middle ear- and will not often cause drainage through the nose.
Certainly, I would suggest CT scanning of the sinuses to make sure you do not have a persistent infection- and to look at the area where one could find a tear causing a leak of brain fluid into the nose. I am not sure how a dental extraction could cause a fracture of the roof of the sinuses, however.
Lastly, one needs to find out the cause of your loss of smell to give you the best idea of how to treat this and whether the lost sense of smell after surgery will eventually disappear.
If there is a persistent infection of the sinuses, it certainly can cause loss of smell and your sense of smell will usually (not always) return once the infection has resolved.
If you have a leak of brain fluid, (CSF Rhinorrhea)- that needs to be treated-
Traumatic anosmia- loss of smell from head trauma- has a less favorable outlook than other causes.
In any case- you should really be seen and evaluated by an Ear Nose and Throat doctor- or sinus specialist (rhinologist) who deals with smell and taste problems to see what you should do next.
I hope this clears things up.
Robert Pincus MD
Associate Professor Otolaryngology NY Medical College
Co-Director NY Sinus Center
Question: I fell and I hit head on radiator, blacked out, hospital was vague and unhelpful, found that I have loss of smell and taste from trauma. Can you help? I have some taste of salt. It depresses me. Nobody seems to know anything about this, have any serious ideas. Everybody wants to meet me and charge for consultations. Stupid I am not. But tired of USA doctors. In other countries they will at least say “nothing known about cures for this” but here I get “buy this, eat that” – trivia, as if it were a minor issue.
Answer: Loss of the sense of smell (anosmia) is a major problem, as you well know. It is important for our safety (spoiled foods, smoke, gas) and for our enjoyment of every day life. Loss of smell can be a predictor of neurologic diseases, such as Parkison’s and early dementia.
We at the NY Sinus Center, take the loss of smell as a serious problem and are working to help people like you with the loss of smell and taste.
It is important to find the cause of one’s loss of smell- in this case it seems likely to be the head trauma.
Recent research has shown that early treatment may be beneficial. Studies have shown that in some cases, treatment of sinus disease may help and prednisone early in the loss may be effective. Some newer therapies that we are using include theophylline nasal sprays and smell therapy. They may be effective in later stages, but as time goes on, any treatment is less likely to help.
I wish we could say that a particular therapy will be effective in any individual- specifically in your problem.
I am attaching a power point of a recent continuing medical education lecture I gave to Ear Nose and Throat specialists on this problem.
I hope this clears things up.
Robert Pincus MD
Co-Director NY Sinus Center.
Question: I have been suffering from anosmia since approximately July 2012. I had no illness around that time (have not had the flu since 2002), and had no injury of any kind. I do have strong hay fever allergies, but those have been present all my life. I have had an MRI done, and no one has ever identified anything wrong with it, nor has looking up my nose with an endoscope revealed anything. The reason for my email is this: All the doctors I have seen so far, once they are up to speed on the above information, have given up surprisingly quickly on the idea of trying anything. Are there any anosmia treatment options available?
Answer:
The loss of the sense of smell can be quite debilitating. The sense of smell is important for our day to day safety (to determine if food has gone bad or if there is a gas leak), for our enjoyment of life in general, and can be a precursor or indicator of other neurologic problems.
Evaluation includes a thorough history, quantification by smell testing, ear nose, and throat evaluation and nasal endoscopy, and imaging studies such as an MRI.
Many times, but not always, the loss of smell can be reversed or improved. Obstructing polyps can be shrunken or removed, inflammation- such as after a viral infection may be treated with steroids, orally or in the nose. Infection can be treated with appropriate antibiotics if needed.
More recently, several studies have shown that in those people whose loss of smell persists, other newer therapies may be helpful.
Theophylline has been used orally and often can be of help.
Smell therapy- also has been shown to be a benefit in many people as well.
Unfortunately, oral theophylline has many side effects. We have been using a topical nasal spray with theophylline for such patients. The study results have been promising.
We’d be happy to see you at the NY Sinus Center to review your previous studies and treatments to see if we could suggest other therapies- such as intranasal theophylline or smell therapy- and to make sure that no other treatable cause has been missed.
Robert Pincus MD Associate Professor Otolaryngology
Co-Director NY Sinus Center
Question: Is it normal for an increased amount of nasal mucus and drainage into the back of my throat 2 months after turbinid reduction surgery? I also have no sense of smell in the morning with my ability to smell increasing during the day. Even at it’s best, my ability to smell is greatly diminished.
Thank You
Answer : Thanks for your question.
Turbinates are tubes on the side of the inside of the nose that help the nose serve its role as a humidifier and filter. At times these structures can become quite swollen and interfere with breathing. There are different procedures to shrink them, if other treatment fails, but today one almost never would remove them as their role is essential to the nose doing its job.
Anything that causes congestion in the nose can temporarily limit your ability to smell.
Typically turbinate surgery causes swelling and crusting and dried mucus in the nose- for a short term.
Usually, this lasts a month or two, but can last longer.
We tend to recommend nasal saline rinses, a humidifier in the bedroom at night- (if you are able to clean religiously)- and sometimes a nasal steroid spray (such as flonase/fluticason) for 2-3 months after the procedure to help bring down any swelling.
If your problems persist, please check with your surgeon.
I hope this clears things up.
Robert Pincus MD
Co-director NY Sinus Center
Question: A month ago I had oral surgery, I had a frenectomy, tooth extraction, bone graft, and an implant. My jaw bone was shaved and I was not prescribed the standard pre & post-op antibiotics, so, unfortunately, I developed a jaw bone infection. I had severe facial & neck swelling from the infection and was in the hospital for five days. I thought my decreased sense of smell & taste was due to all the medications but now I am off all of them and no smell or taste has returned. I can only taste or smell a little bit of bitter. I can’t even taste salt. Is this nerve damage from all the facial swelling? Do you think my lost sense of smell after oral surgery will ever return? It is absolutely devastating not being able to smell and taste. I had been a person with a hypersensitive sense of smell, I would get headaches if smells were too strong and avoided perfumes and the soap aisle in stores. I can’t imagine living the rest of my life like this.
Thank you.
Answer: I just posted a response to a question about the loss of smell on our web site- www.nyogmd.com – under ask the doctors- and I won’t repeat the whole answer…
Your issue is certainly more specific- We don’t always know what causes the loss of taste and lost sense of smell after oral surgery. Smell makes up much of the sense of taste-
The smell fibers are at the top of the nose and we can lose the sense of smell because of nasal congestion (think a bad cold)- or from nerve damage- which can occur after trauma, infection, surgery, or from an unknown reason.
You should be evaluated to make sure you don’t still have a sinus infection which can be causing the former loss- certainly, that can be improved-
Nerve losses are more difficult to treat. The nerve can re-grow over up to about a year. So there certainly is a good chance your smell and taste will return after an acute loss such as yours. We have been suggesting alpha lipoic acid to help with this process.
You might also consider the use of topical theophylline nasal spray. You would have to be in a study at this point, though, such as at the NY Sinus Center, as it is not yet commercially available.
R Pincus MD
NY Sinus Center
Question: I am a 75-year-old female, and I am losing my sense of smell. I have had sinus and allergy problems all my life, and I always have a tissue with me. In the past 4—5 years I have lost about 95% of my ability to smell. Taste is fine. Since I live alone, losing the sense of smell can be a real hazard. I miss this sense very much. I tried zinc. Nothing happened. Is there anything new that might bring back my ability to smell?? Thank you so much.
Answer:
Finally, there may be something new…
The loss of the sense of smell can be a devastating problem. Smell is important not just for the enjoyment of food and activities of life, but for safety – avoiding fire and spoiled foods. A person’s sense of smell becomes limited because of nasal congestion- in that case, air does not reach the smell fibers, or due to damage to the fibers themselves. Damage can occur after trauma, an upper respiratory infection, or for reasons unknown. We all do lose some sense of smell as we age.
The loss of the sense of smell should, however, get evaluated. One needs to be sure that there is no growth obstructing the smell fibers or damaging them directly. The nasal cavity should be evaluated to make sure there is no unusual congestion (polyps, chronic infection). Most otolaryngologists (ear nose and throat doctors) can do the appropriate evaluations and recommend therapy if indicated.
When these causes are ruled out, the treatment for the loss of smell is limited. We have recommended alpha lipoic acid- a vitamin that may help with nerve regrowth- but its there is no proof of its effectiveness as of yet.
A recent study, however, just published in November of 2012, is quite promising. Revealed in this study, the use of a low dose theophylline nasal spray (an old asthma drug- usually taken by mouth) helped almost all of a small group of patients improve their sense of smell, without reported side effects.
While this clearly needs to be further evaluated, the possible ill effects seem quite small- and the prospects for improvement are encouraging. We plan on doing a study shortly at the NY Sinus Center to see if we can confirm these results. Please call us for an appointment if you would be interested.
Robert Pincus MD
Co-director NY Sinus Center
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