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Clinical Challenges
June 2000

A Perplexing Olfactory Loss

Author Affiliations
 

KAREN H.CALHOUNMDRONALD B.KUPPERSMITHMDNot Available

Arch Otolaryngol Head Neck Surg. 2000;126(6):803. doi:10.1001/archotol.126.6.803

Dr Archer has prepared an excellent review of this clinically perplexing condition. It typically affects young healthy adults in the prime of their life, and strikes quickly, such as over a weekend. The other mysterious aspect is why it affects women twice as often as men. Truly, it is difficult to sit in front of the patient who has just had testing to define the amount of loss and tell him or her that there is no therapy and no return to normalcy is expected.

Donald Leopold, MD

Donald Leopold, MD

Since this condition occurs after a URTI, and since we know that viruses can affect nerve function, there is a temptation to assume that viruses cause this disease. This has not, however, been proven or even implicated by research. It is also possible that an inflammatory product released in fighting the URTI causes the olfactory loss. The higher incidence in women, who also have greater numbers of "autoimmune" diseases like thyroid conditions, also suggests noninfectious causes. This is an area where much research needs to be done.

As Dr Archer has noted, this is the most common cause of olfactory loss after a blocked nose due to nasal infection/inflammation. It is also the most common "neural" reason for olfactory loss. Millions of people are affected by this condition. Its true incidence can only be estimated, since individuals with this condition often do not seek medical evaluation, and it is not in any way obvious that they have a problem.

I agree with the workup (thorough head and neck examination, including nasal endoscopy) and therapy (no effective treatment, avoid harm) that Dr Archer has described. There are 2 small possibilities, however, that need to be mentioned. As was noted, there has been some anecdotal evidence that beta carotene or retinoic acid may be helpful. A carefully prepared, multicenter, randomized trial would be needed to evaluate this therapy, but it should be done. The second possibility is the improvement that has been noted, again anecdotally, with oral steroid therapy.1 Why this should work is unclear, although inflammation of the olfactory nerves has been proposed. Treatment of patients with steroids is a potentially dangerous proposition, and the reason for this therapy must justify the possible complications. Again, if this therapy is used, it should be in the context of a controlled study, such as is conducted with powerful anticancer drugs.

References
1.
Jafek  BWMoran  DTEller  PM  et al.  Steroid-dependent anosmia.  Arch Otolaryngol Head Neck Surg. 1987;113547- 549Google ScholarCrossref
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