Anosmia: Causes, Treatments, and Surgical Options

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Hello Doctor: Last time you mentioned that having no sense of smell should be impossible unless it is due to a congenital deformity.
However, I truly feel like I have never smelled anything.
You mentioned that surgery might be an option.

1.
Nasal passage obstruction such as sinusitis, chronic hypertrophic rhinitis, or a deviated septum can prevent odor molecules from reaching the olfactory region.

2.
Head trauma or tumors pressing on the olfactory nerve can lead to damage and result in loss of smell.

3.
Viral infections affecting the olfactory nerve can also cause loss of smell, which often occurs after a cold.

Since I have not experienced any head trauma, would the doctor still recommend surgery? Is it covered by health insurance? Is there any risk involved? Doctor, I have rarely heard of anyone completely lacking a sense of smell; usually, it is just diminished.
But I truly cannot smell anything! What should I do? Why is this happening to me?

Xiao Mei, 20~29 year old female. Ask Date: 2003/04/11

Dr. Hu Kexin reply Otolaryngology

Dear Miss Hsiao-Mei,
This is the second time I am responding to your inquiry.
If you are truly concerned, I recommend that you visit our Otolaryngology (ENT) department for a thorough examination, after which all your issues should be resolved.
Based on what you have described, the physician may suggest surgery, indicating that your loss of smell could be addressed surgically.
Such issues are often caused by obstructive lesions in the nasal passages, as mentioned earlier.
The most common condition is sinusitis, which is covered by health insurance.
With careful preoperative evaluation (imaging studies) and skilled technique, the risks can be minimized.
I advise you to undergo the following two examinations at the outpatient clinic:
1.
Olfactory testing
2.
Computed tomography (CT) of the sinuses
With this information, we can better assess whether your sense of smell can be restored through surgery.
Wishing you good health, safety, and happiness.
Sincerely,
Dr.
Hu Ke-Hsin
Otolaryngology Department
Taoyuan Hospital
April 18, 2003

Reply Date: 2003/04/11

More Info

Anosmia, or the loss of the sense of smell, can be a perplexing and distressing condition. Understanding its causes, potential treatments, and surgical options is essential for anyone experiencing this issue.

Causes of Anosmia
1. Obstruction of Nasal Passages: Conditions such as chronic sinusitis, nasal polyps, or a deviated septum can block the nasal passages, preventing odor molecules from reaching the olfactory receptors in the nasal cavity. This is one of the most common causes of anosmia.

2. Head Trauma: Injuries to the head can damage the olfactory bulbs or the pathways that transmit smell signals to the brain. This can lead to a permanent loss of smell if the damage is severe.

3. Neurological Conditions: Certain neurological disorders, including tumors that press on the olfactory nerves, can result in anosmia. These conditions may require more complex interventions.

4. Viral Infections: Viral infections, particularly those affecting the upper respiratory tract, can lead to temporary or permanent anosmia. This has been notably observed in cases of COVID-19, where loss of smell is a common symptom.

5. Congenital Conditions: While rare, some individuals are born with anosmia due to genetic factors or developmental issues.

Treatments for Anosmia
The treatment for anosmia largely depends on the underlying cause:
- Medical Management: If the anosmia is due to nasal obstruction, treatments may include nasal corticosteroids, antihistamines, or decongestants to reduce inflammation and clear the nasal passages.

- Surgery: In cases where structural issues such as a deviated septum or nasal polyps are present, surgical intervention may be necessary. Surgery can help restore airflow and allow odor molecules to reach the olfactory receptors.
- Olfactory Training: This is a rehabilitation technique where patients are encouraged to smell specific scents regularly to help retrain their sense of smell.

Surgical Options
If your doctor has suggested surgery, it is likely because they believe there is a physical obstruction or structural issue contributing to your anosmia. Common surgical procedures include:
- Septoplasty: This surgery corrects a deviated septum, allowing for better airflow through the nasal passages.

- Polypectomy: This involves the removal of nasal polyps that may be obstructing the nasal passages.

- Endoscopic Sinus Surgery: This is used to treat chronic sinusitis and involves removing blockages in the sinuses.

Insurance and Risks
Regarding insurance coverage, many health insurance plans do cover surgical procedures for anosmia if they are deemed medically necessary. It is advisable to check with your insurance provider to understand your coverage options.

As for the risks associated with surgery, like any surgical procedure, there are potential complications, including bleeding, infection, or adverse reactions to anesthesia. However, these risks are generally low, and the benefits of restoring your sense of smell often outweigh the potential downsides.

Conclusion
If you feel you have never experienced a sense of smell, it is crucial to discuss this with your healthcare provider. They can conduct a thorough evaluation, including imaging studies if necessary, to determine the cause of your anosmia. Understanding the underlying issue is key to finding the right treatment and potentially restoring your sense of smell. Remember, you are not alone in this experience, and there are options available to help you.

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