Post-Fever Loss of Smell: Olfactory Dysfunction and Treatment

Loss of smell after fever, with subsequent treatment resulting in hyposmia?

A few months ago, after experiencing a significant fever, I lost my sense of smell and taste.
I consulted an otolaryngologist who suspected that my olfactory nerve was damaged and recommended that I go to a larger hospital for further examination.
At the hospital, they suspected I had sinusitis.
During the first week, I was instructed to get an X-ray and was prescribed antibiotics.
After that, I was able to smell food, but the sensation was somewhat dull.

In the second week, during my follow-up appointment, the doctor noted only slight inflammation in my nasal passages.
I then underwent a CT scan and was prescribed a nasal spray.
After using the spray, I found that I needed to inhale deeply or bring things very close to my nose to detect any scent, and the smells I could perceive were not the same as what I used to smell before.
Two weeks later, during my third visit, the doctor reviewed the CT scan results and stated that there were no issues with my nasal passages.
He prescribed another nasal spray but did not recommend any further follow-up appointments.
Currently, I do not have a fever, I am not experiencing a runny nose, and any nasal discharge is clear.
However, the scents of products like body wash and perfume smell different from what I remember.
Could you please advise me on what my current issue might be?

Mr. Zhan, 20~29 year old female. Ask Date: 2017/04/10

Dr. Ji Zhaoyun reply Otolaryngology

Hello Mr.
Jan,
Olfactory dysfunction may be caused by inflammation or central nervous system issues.
If it is due to inflammation, conditions such as allergic rhinitis, sinusitis, or nasal tumors could be responsible.
If it is related to the central nervous system, a neurologist should be consulted for evaluation.
Common symptoms of sinusitis include nasal congestion, yellow or green nasal discharge, fever, facial pain, foul smell, and changes in smell; however, not all symptoms may be present.
Diagnostic methods include endoscopy and imaging studies.

If acute sinusitis persists despite antibiotic treatment for more than two weeks, it is advisable to visit an otolaryngologist for bacterial culture.
If a more virulent strain of bacteria is identified, a stronger antibiotic may be necessary.
I recommend purchasing a nasal irrigation device (containing isotonic saline) and performing rinses 1-2 times daily to enhance the treatment of sinusitis.
Additionally, avoid staying up late, refrain from smoking, and if you have diabetes, control your blood sugar levels.

If treatment continues for more than 2-3 months and sinusitis has not resolved, it is likely to be "chronic" sinusitis, which requires further examination.
If necessary, surgical intervention may be needed, and I suggest an evaluation by an otolaryngologist.

Based on your description, if your olfactory dysfunction is due to nasal inflammation, it should gradually improve as the inflammation is controlled.
However, if symptoms persist, it is best to consult an otolaryngologist.

Wishing you peace and good health.

Director of Otolaryngology, Taichung Hospital, Ministry of Health and Welfare,
Chi Chao-Yun

Reply Date: 2017/04/10

More Info

Dear Patient,
Thank you for sharing your experience regarding the loss of smell and taste following a significant fever. It sounds like you have been through a challenging time, and I understand your concerns about your olfactory dysfunction. Let's delve into the potential causes and treatment options for your condition.

The loss of smell, known as anosmia, can occur due to various reasons, particularly following a viral infection such as influenza or COVID-19. In your case, it seems that the fever you experienced may have been a viral infection that affected your olfactory nerves. The olfactory nerve is responsible for transmitting smell information from the nasal cavity to the brain, and any damage or inflammation can lead to a reduced ability to smell.

Your doctor’s suspicion of sinusitis is also valid. Sinusitis can cause inflammation in the nasal passages and sinuses, leading to congestion and a diminished sense of smell. The fact that you were prescribed antibiotics suggests that your doctor was concerned about a bacterial infection, which can sometimes occur following a viral illness. The imaging studies, such as X-rays and CT scans, are useful in assessing the sinuses for any signs of blockage or infection.

It is not uncommon for individuals recovering from a viral infection to experience lingering symptoms, including altered smell and taste. This phenomenon is sometimes referred to as post-viral olfactory dysfunction. The fact that you can smell some things but find that the scents are different from what you remember indicates that your olfactory system is still in the process of healing.

Here are some key points regarding your situation:
1. Olfactory Training: This is a therapeutic approach that involves regularly exposing yourself to a set of distinct scents (such as rose, lemon, clove, and eucalyptus) to help retrain your sense of smell. This method has shown promise in helping individuals recover their olfactory function.

2. Nasal Corticosteroids: If your doctor prescribed nasal sprays, these may help reduce inflammation in your nasal passages, potentially improving your sense of smell. It’s important to use these medications as directed.

3. Time: Recovery from olfactory dysfunction can take time. Some individuals may notice gradual improvement over weeks or even months. It’s essential to be patient with your body as it heals.

4. Follow-Up Care: Since your symptoms have persisted, it may be beneficial to seek a second opinion or follow up with an otolaryngologist (ear, nose, and throat specialist) who has experience in treating olfactory disorders. They can conduct further evaluations and possibly recommend additional treatments.

5. Underlying Conditions: In some cases, other underlying conditions, such as allergies or nasal polyps, can contribute to olfactory dysfunction. A thorough examination can help rule out these possibilities.

In conclusion, while your situation is concerning, there are avenues for treatment and recovery. It’s important to continue working with your healthcare provider to monitor your symptoms and explore potential therapies. If you have any further questions or concerns, do not hesitate to reach out for more guidance.

Wishing you a smooth recovery and the return of your sense of smell.

Best regards.

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