Reduced sense of smell (hyposmia/anosmia)
GGC - Primary Care
Background: This section refers to reduction or complete loss of smell as a solitary symptom. When combined with nasal obstruction, discharge or sneezing, consider chronic rhinosinusitis or rhinitis.
Common causes of isolated anosmia / hyposmia include:
- Viral URTI
- Trauma
- Cocaine use
- Smoking
- Age-related loss of smell
- Previous nasal surgery
- Idiopathic anosmia/hyposmia
How to manage
Patients should be given safety advice regarding ensuring fire alarms are working in the household and checking use-by dates on food rather than relying on their sense of smell
Avoid cocaine use – its use is more prevalent than you might think
Stop smoking
Advice olfactory retraining and signpost to the FifthSense (https://www.fifthsense.org.uk/) and AbScent (https://abscent.org/) websites. Advise they do not need to buy any equipment but can simply use familiar smells from the kitchen cupboard e.g. coffee, cinnamon, vanilla.
Topical nasal steroid sprays may improve recovery, particularly if a viral trigger
Referral guidance
If the above has been tried for 3 months without success, refer to ENT on a routine basis for consideration of an MRI to investigate for an underlying cause. Counsel the patient that underlying causes are rarely found and occasionally MRI scans can pick up incidental findings that may prompt further investigations and anxiety for the patient.