Olfactory disturbance

The olfactory ability is extremely important for humans: it performs both a protective and a signaling function. Olfactory impairment is a really serious problem, because at the same time we lose the ability to determine the quality of food products, the presence of foreign substances in the air (for example, gas). In addition, the sense of smell plays one of the main roles in the perception of taste sensations, and in general affects well-being and performance.

Olfactory impairment can manifest itself in the form of a distorted perception of aromas, complete or partial loss of olfactory ability. This pathology often becomes one of the symptoms of viral infections - in particular, coronavirus infection COVID-19, as well as ENT pathologies, mental disorders, injuries, tumors, etc. However, it happens that the cause of the problem cannot be determined: in such cases, they talk about idiopathic olfactory impairment.

Epidemiology

Olfactory impairment is a fairly common complaint of patients who seek medical attention. Overall, the global prevalence of the problem is estimated at more than 19%: decreased olfactory sensitivity is more common (approximately 13%), while anosmia occurs less frequently (almost 6% of cases).

The disorder is more common in older people, but can also occur much earlier. The prevalence of the problem in people over 50 is approximately 30%, and among people over 80 years old – more than 60%.

The overwhelming majority of disorders are caused by pathologies of the nasal cavity (upper respiratory tract) – about 70%. Both men and women are equally affected. [ 1 ]

It is known that the olfactory function appeared one of the first in the process of phylogenesis, because it is the ability to determine aromas that helps animals detect food, find potentially dangerous objects, perceive pheromones and find partners. The most important direction of the "smell" is the warning of possible danger (smoke, toxic gases, fumes) and the search for food.

Scientists also highlight such important features of the olfactory function as participation in the social sphere: largely due to smells, contact is established between a woman and a newborn child, between young people when choosing a partner. Aromas also play a role in the processes of memorization and recollection.

Loss of olfactory ability deprives people of the opportunity to enjoy food and life in general: according to statistics, patients with long-term anosmia often suffer from depressive disorders.

Causes olfactory disorders

The loss of the ability to detect and identify odors may be associated with disorders of peripheral and central genesis.

Peripheral pathology is caused by problems with the nasal receptors, such as:

• ENT diseases (polyposis, adenoid growths, sinusitis, rhinitis);
• infectious diseases (ARI, COVID-19);
• post-infectious complications (consequences of influenza, coronavirus infection, measles, etc.);
• foreign bodies in the nasal passages;
• allergic processes;
• diabetes mellitus;
• hypothyroidism;
• traumatic injuries to the nose;
• exposure of the nasal mucosa to high temperatures or chemicals;
• regular smoking, drug addiction;
• frequent use of local medications (nasal drops, aerosols).

Olfactory disorder of central genesis is associated with dysfunction of the central nervous system, which occurs with the following pathologies:

• traumatic brain injury;
• hypovitaminosis A;
• brain tumor processes;
• Alzheimer's disease, Parkinson's disease;
• schizophrenia, deep depressive states.

In addition, olfactory impairment may be caused by taking neurotoxic drugs, complications of meningeal infection, unsuccessful neurosurgical interventions. The "culprits" are often congenital defects of the olfactory receptors and nasal cavity, as well as regular inhalation of dusty and polluted air, which may be associated with a person's professional activities.

Among the numerous medications, amphetamines, thiazides, and levodopa can cause olfactory disturbances.

Olfactory impairment after coronavirus

At the stage when the COVID-19 coronavirus infection was still being studied, olfactory impairment in patients was associated with the direct cytotoxic effect of the pathogen on nerve cells. However, the relatively rapid restoration of function cast doubt on the reliability of this assumption.

Over time, neurologists from Harvard concluded that the problem is caused by damage to the auxiliary cellular structures surrounding sensitive nerve cells. Such structures include the ACE2 protein, which is actively used by the coronavirus to enter cells, which leads to the development of cytotoxic manifestations. It turns out that the coronavirus infection has an indirect effect on the nervous system, inhibiting the function of the auxiliary cell material, which subsequently leads to a disorder in the functioning of the olfactory nerves.

Since COVID-19 does not directly affect the olfactory nerve fibers and bulbs, the function of detecting odors is gradually restored. Complete elimination of olfactory disorders is observed within 14-100 days, sometimes a little longer. According to experts, 2 weeks after recovery, the ability to detect odors returns in about every fourth patient. In general, this period varies, depending on the severity of the coronavirus infection and the presence of background and chronic otolaryngological diseases. There are no special drugs yet that can speed up the restoration of this function. [ 2 ]

Nasal polyposis accompanied by olfactory impairment

A large number of patients experience nasal breathing disorders caused by a chronic inflammatory process, as a result of which polyps appear on the mucous membrane in the nose. This pathology is accompanied by constant nasal congestion and deterioration of aromatic perception. [ 3 ]

The disease progresses in certain stages, depending on how much the airways are blocked. The main symptoms are often:

• difficulty breathing;
• nasal discharge (mucopurulent or watery);
• deterioration of olfactory and taste sensations;
• headaches;
• lacrimation, sometimes coughing (caused by secretions flowing down the back of the throat).

Olfactory impairment due to polyposis is eliminated mainly by surgical method, which can be represented by different techniques of execution. The type of surgical intervention is selected by the surgeon on an individual basis. [ 4 ]

Olfactory impairment in acute respiratory viral infections

Acute respiratory viral infection combines several inflammatory processes at once, which are characterized by the following symptoms:

• viral pathogen;
• airborne infection;
• dominant lesion of the respiratory system;
• acute development of pathology.

When the infection spreads through the upper respiratory tract, the patient experiences swelling of the nasal tissues, mucous discharge, and a fever. Without timely treatment, the sense of smell worsens and may disappear completely for some time.

After a few days, after the temperature has normalized and the catarrhal symptoms have gradually disappeared, the ability to detect aromas is restored.

Since ARVI can be caused by different viruses, it is impossible to say exactly how severe the olfactory impairment will be and how long it will last. In addition, a person's general health, the presence of chronic diseases of the ENT organs and the respiratory system as a whole play a significant role. [ 5 ]

Olfactory disturbances due to a runny nose

The mucous tissue in the nasal cavity is the first protective barrier that protects the human body from infection through the respiratory tract. If bacteria get on the mucous membrane, a runny nose (rhinitis) develops. This situation is typical for hypothermia, viral infections, allergic processes. The main symptoms are nasal discharge and a feeling of congestion.

When you have a runny nose, blood circulation in the nasal cavity is disrupted, and congestion develops. The mucous tissue swells, nasal breathing becomes difficult, which explains the temporary loss of olfactory sensitivity.

If left untreated, a runny nose can become chronic, the main symptoms of which are frequent nasal congestion, thick discharge, decreased sense of smell, headaches. The complication may spread to the organs of vision and hearing.

To fully restore all functions that were disrupted as a result of rhinitis, doctors prescribe, in addition to medications, physical therapy: ultraviolet irradiation, inhalation and warming. As a rule, after some time the sense of smell returns to its previous level. [ 6 ]

Endocrinological causes

One of the reasons for poor perception of smells is considered to be hypothyroidism – decreased function of the thyroid gland. Manifestations of the pathology are varied. The primary form of the disease occurs mainly in women: patients complain of constant fatigue, lethargy, chilliness, memory impairment. Deterioration of the skin, nails, hair is possible. Hypotension, bradycardia, swelling of the face and legs, impaired sense of smell and taste are noted. The temperature is usually low (even during infectious diseases), which is due to a slow metabolism. [ 7 ]

With hypothyroidism, the functioning of the central and peripheral nervous system is disrupted, which can be seen in changes in neuropsychic processes, cranial innervation, and the motor sphere. Patients become slow, apathetic, their speech is slow, and their facial expressions are inexpressive. [ 8 ]

Similar symptoms are also characteristic of diabetes mellitus. In the decompensation stage of the disease, patients may experience severe dry skin, wrinkling and peeling, and decreased turgor. Eight out of ten patients have dermatoses caused by metabolic disorders and deterioration of microcirculation. Deterioration of vision and olfactory impairment are no less common. Joints, the digestive and urinary systems, and the liver are also affected. [ 9 ], [ 10 ]

Olfactory impairment in sinusitis

Sinusitis is diagnosed when there is an acute or chronic inflammatory process in the maxillary sinuses, which are responsible for clearing the inhaled air flow and for the olfactory function. These sinuses have a complex shape, are narrowly connected to the nasal cavity, and are therefore often affected by bacterial and viral agents. [ 11 ]

In most cases, sinusitis develops against the background of acute respiratory pathologies, such as influenza, adenoiditis, acute respiratory viral infections, etc. The mucous tissue swells, the openings become difficult to pass or impassable. A secretion accumulates inside the sinuses, in which microorganisms begin to actively multiply.

A decrease or loss of olfactory function is one of the main signs of the disease. However, in addition to this symptom, others must also be present:

• the appearance of cloudy (purulent) nasal discharge;
• difficulty breathing through the nose;
• increase in temperature;
• headache (may get worse if you tilt your head down);
• sometimes - swelling of the upper part of the face.

Timely treatment with antiseptic, anti-inflammatory, and decongestant agents allows for the symptoms to disappear in a short time: the sense of smell returns within 2-3 weeks. [ 12 ]

Risk factors

The main factors causing olfactory disorders are:

• infections (including viral);
• traumatic brain injury;
• inhalation of aromatic substances that irritate the mucous membranes of the nasal cavity;
• nervous pathologies, including stressful situations.

The pathological basis for the appearance of olfactory disorders is a disorder of cell metabolism and oxygen deficiency, which prevent the perception or conduction of nerve impulses.

Respiratory olfactory disorders are often provoked by the following factors:

• swelling of the nasal mucosa;
• closure of the openings connecting the nasal cavity and nasopharynx;
• birth defects;
• foreign objects in the nasal cavity;
• nasal septum deformities;
• neoplasms in the nose (benign or malignant tumors).

Almost any obstacle that arises on the way of inhaling air can cause olfactory disorders. Atrophic processes in the nasal cavity, flu, childhood infections, intoxications, tuberculosis also negatively affect aromatic sensitivity. Irreversible pathological processes develop with damage to the olfactory zone and damage to the conduction pathways and the olfactory center.

Pathogenesis

Olfactory stimuli are processed by unmyelinated fibers. Olfaction gives people an idea of the surrounding biochemical space and can influence various aspects of life, participate in the formation of positive or negative emotional memories associated with smells. If olfactory impairment develops, both the emotional-personal sphere and the cognitive functions of a person may suffer.

Patients with olfactory deficit often complain of digestive problems, which is due to the close connection between the perception of smells and tastes. In addition, people lose the ability to detect their own unpleasant odors (sweat or uncleaned teeth), which makes them socially vulnerable and increases the risk of social isolation. The olfactory function also supports the detection of fear signals.

The area of the nasal mucosa responsible for the sense of smell is located in the upper concha and contains special sensory receptors. In order for us to be able to smell aromas, the air flow containing particles of odorous substances must reach this respiratory section. If such passage of air is impossible - for example, if there are any anatomical barriers - then the sense of smell is impaired, and aromatic sensitivity is reduced. This phenomenon is not uncommon in patients with deformations of the nasal septum, hypertrophy of the nasal mucosa, sinusitis or adenoid growths.

Olfactory impairment may be caused by problems that arise in different parts of the olfactory sphere. In healthy people, signals from sensitive receptors of the nasal mucosa along a certain path get to the subcortical region and the brain's olfactory center. Pathology often accompanies injuries and damage to the olfactory nerve fiber, which occurs with craniocerebral injuries, neurosurgical interventions. If the neurostructures are affected unilaterally, then olfactory impairment is noted only on the affected side.

Weak aromatic sensitivity often appears in almost any disease affecting the mucous tissues of the nasal cavity - for example, this can be rhinitis, sinusitis, acute respiratory viral infections and other processes that are accompanied by damage to peripheral nerve receptors. The underlying cause can also be degenerative damage to brain structures - in particular, Alzheimer's disease, Parkinson's disease, as well as malignant tumor diseases in the brain. In such situations, olfactory impairment is explained by atrophic processes and necrosis of neurons in the area responsible for olfactory function.

Olfactory disorders develop in a completely different way in epilepsy: patients complain of a false sense of unpleasant odors, but this problem is caused by the formation of excitation areas in brain structures and the spread of impulses to the cortical areas. In addition, the appearance of olfactory disorders is characteristic of depression, schizophrenia, psychosis, hysterical states, which is associated with improper functioning of the nervous system.

Symptoms olfactory disorders

The clinical picture of olfactory impairment depends on many factors. Many patients report decreased sensitivity to familiar aromas, or a complete loss of odor sensitivity. Complete loss most often develops gradually: at the first stage, a person stops feeling subtle, barely perceptible aromas, then loses the reaction even to a pronounced smell (in particular, ammonia). Some people experience simultaneous disruption of taste buds.

The nature of other symptoms depends on the underlying cause of the olfactory disorder. For example, with rhinitis and sinusitis, mucous or purulent nasal discharge, a feeling of nasal congestion, difficulty breathing, a sensation of a foreign body in the nasal cavity, headache, sneezing, etc. may appear.

With other olfactory disorders, sensitivity to odors, on the contrary, increases. This condition is extremely uncomfortable for the patient: irritability, headache, increased excitability, etc. are observed. Perversion of olfactory sensitivity is also likely: a person senses foreign odors that are not actually there, and normal, familiar odors acquire a foul tint. For example, washing powder begins to smell like gasoline, and clean washed linen – like feces. Such disorders in themselves do not pose a health hazard, but they may indicate the development of neurological and other pathologies, so they require the attention of a medical specialist.

Persistent olfactory impairment

The olfactory function does not always recover in a short time after pathologies. In some cases, recovery takes more than a month, or does not occur at all.

Olfactory impairment can occur in two ways:

• according to the conductive type, in which there is a problem at the level of the mucous tissue of the nasal cavity;
• sensorineural type, when the problem is present in the olfactory area of the brain.

As a rule, the second type of pathology is more prone to a long-term and persistent course.

It is worth remembering that anosmia can be caused by such serious diseases as multiple sclerosis, Alzheimer's disease, malignant tumors, and traumatic brain injuries. In such situations, the disorder is truly persistent, which can negatively affect the patient's physical and psychological state.

With COVID-19 coronavirus infection, the lost olfactory ability most often returns within a month. Sometimes this happens later, which depends on the severity of the infection and some other individual characteristics: for example, in patients with chronic ENT diseases, olfactory impairment may be more persistent.

Olfactory impairment during pregnancy

Pregnancy is a period of powerful hormonal changes in the female body. And such transformations cannot pass without leaving a trace: the level of hormones increases significantly, the mucous membranes swell, nasal breathing becomes difficult. Regular rhinitis can greatly bother women, because often the quality of life suffers and sleep is disturbed. [ 13 ]

Olfactory impairment most often occurs in the first trimester of pregnancy. It can be caused by allergic, hormonal, infectious reasons. Symptoms can include the following manifestations:

• difficulty breathing through the nose;
• pathological nasal discharge;
• olfactory and gustatory changes;
• exacerbation of sinusitis;
• sleep and concentration disorders;
• constant fatigue, headache.

It is important to note that pregnant women are especially advised not to self-medicate: if necessary, you should consult a doctor.

Forms

Olfactory impairment may manifest itself as a distorted sense of smell, as a complete or partial loss of smell, as a sensation of false smells (which do not actually exist). The following types of olfactory impairment are usually distinguished:

• perceptual impairment;
• conductive;
• mixed.

In addition, the pathology may have an acute, subacute or chronic course, and be acquired or congenital (for example, in Kallmann syndrome).

All olfactory disorders are divided into the following categories:

• increased olfactory sensitivity;
• decreased or loss of olfactory sensitivity;
• perversion of olfactory sensitivity.

Determining the type of disorder is no less important than determining its cause. This is necessary in order to prescribe the correct and competent treatment in the future.

In addition, doctors distinguish the following types of pathology:

• hyperosmia is a pathological enhancement of olfactory sensations, which often occurs in neurogenic and autoimmune diseases, tick-borne borreliosis, and hormonal changes;
• hyposmia – a weakening of the olfactory sensation that occurs in diseases of the cerebral cortex, dysfunction of the receptor mechanism in the nasal cavity;
• anosmia – loss of the ability to sense smells, which is typical for traumatic brain injuries, nasal polyposis, destruction of mucous tissues in the nasal cavity, chemical intoxication;
• parosmia – an incorrect, distorted olfactory sensation, characteristic of mental disorders, hormonal disorders, ENT pathologies;
• phantosmia – aromatic hallucinations, the sensation of false aromas that do not actually exist, can occur in mental pathologies, brain damage, tumor processes, epilepsy;
• agnosia – loss of the ability to recognize and identify even familiar aromas, which is caused by damage to the olfactory region of the cerebral cortex (for example, in patients with stroke, brain abscess, tumor processes).

Depending on the localization of the cause of the pathology, there are:

• rhinogenic olfactory disorder (caused by problems in the nasal cavity: rhinitis, deformed septum, polyposis);
• neurosensory disorder (caused by damage to the olfactory receptors or corresponding brain centers).

Loss of smell and speech impairment

Sometimes olfactory impairment is accompanied by certain neurological symptoms, such as problems with short-term memory or cranial nerves (double vision, difficulty speaking or swallowing). Here it is important to promptly suspect and identify a stroke, which is the second most common cause of human death from pathologies (after ischemic heart disease).

Acute cerebrovascular accident causes the death of many neurons. The sooner medical care is provided for a stroke, the more complications can be avoided. Therefore, a patient with suspected major stroke should be taken to a medical facility as soon as possible. [ 14 ]

Symptoms of a stroke may include:

• a sharp deterioration in vision, hearing, olfactory impairment, disturbance of spatial orientation, balance, motor skills;
• sudden headache, dizziness;
• cool sweating, facial flushing, dry mucous membranes, nausea (often leading to vomiting), increased heart rate or convulsions;

Numbness of half of the body (or the entire body), facial muscles;

• speech impediment;
• memory problems;
• disturbance of consciousness.

If a person has similar symptoms, but he himself is not aware of what is happening, then it is necessary to pay attention to the following signs:

• one of the pupils does not react to light;
• the smile is not wide, as if crooked;
• the person cannot raise one hand, does not remember what day it is or even his own name.

If these symptoms occur, you should immediately call an emergency medical team. [ 15 ]

Complications and consequences

Olfactory disorders are an indication from the body that there are some more serious health problems. Often, even a temporary loss of olfactory ability causes more than just discomfort: a person develops neuroses and depressive states.

In the vast majority of cases, aroma insensitivity is accompanied by taste disorders: the patient stops distinguishing taste shades, all food becomes bland. Doctors note that in acute respiratory diseases and viral infections, loss of taste is almost always due to the loss of olfactory function. But in the case of coronavirus infection COVID-19, the problem is explained by direct damage to the nerve endings (facial and glossopharyngeal nerve) responsible for taste lingual sensitivity.

In some people, such pathological changes are persistent, taste and smell disorders are detected simultaneously, sensitivity is distorted. The consequences of such developments are nervous disorders, gastrointestinal tract pathologies.

Due to the inability to detect the presence of dangerous toxic substances or smoke in the air, a person with olfactory impairment becomes especially vulnerable: as a result, injuries, intoxications, etc. become more frequent. [ 16 ]

Diagnostics olfactory disorders

It is usually not difficult to determine the olfactory disorder. But in most cases it is possible to diagnose the cause of the disorder only after a thorough examination. Doctors say that in childhood and adolescence, the causes are often closed or open injuries. In people aged 20-50, viruses are often the "culprits". For older people, psychoneurological pathologies and neoplasms are more typical.

Basic instrumental diagnostics can be represented by the following methods:

• Rhinoscopy – allows you to visualize the condition of the nasal canals.
• Aroma tests – help assess the degree of loss of smell.
• Magnetic resonance imaging allows us to exclude or confirm the presence of a tumor process in the brain or nasal sinuses, and to detect atrophy of the olfactory bulbs.
• Electroencephalography – helps to identify areas of increased seizure readiness in the cerebral cortex, assess the likelihood of structural and metabolic encephalopathies, tumor processes, etc.

When collecting anamnesis, the doctor specifies the time of appearance of the first signs, establishes their relationship with trauma or infectious and inflammatory processes. If there is additional nasal hypersecretion, the doctor pays attention to the nature of the secretion (watery, mucopurulent, bloody, etc.).

Further examination is carried out taking into account the neurological picture. The quality of memory, the function of the cranial nerves (for example, diplopia, speech difficulties, tinnitus, dizziness, etc.) are assessed.

The anamnesis should also include clarification of previous diseases. Particular attention is paid to pathologies of the paranasal sinuses, head injuries, surgical operations, allergic processes.

Next, the doctor performs a rhinoscopy, evaluates the condition of the mucous membrane and the throughput of the nasal passages. To detect obstruction, both nasal passages should be checked.

Tests are prescribed as part of general clinical studies:

• general blood test;
• general urine analysis.

In some cases, the doctor prescribes a blood test for hormones, sugar, and a sputum test.

In order to determine the damage of the olfactory analyzer, olfactometry is performed. The essence of the procedure is as follows. The patient is closed one nasal canal, and through the other one is asked to determine the smell of some known substance - for example, coffee, vanilla or bay leaf. Then the procedure is repeated with the other nasal canal.

If the cause of the olfactory disorder remains unclear, then a CT scan of the head with contrast is prescribed to exclude a tumor process or injury to the bottom of the anterior cranial fossa. Magnetic resonance imaging is used to assess the state of intracranial structures.

If a patient is suspected of having a coronavirus infection, the patient is examined and managed according to locally accepted protocols.

Differential diagnosis

Differences between complete and partial loss of smell (using the generally accepted diagnostic scale):

Hyposmia	Scale indicator from 0 to 3	Mild olfactory disorder
	Scale indicator from 3 to 7	Moderate olfactory disorder
Anosmia	The scale indicator is from 7 to 10	Severe olfactory disorder

Hyposmia (partial deterioration of sensitivity to odors) is said to occur if a mild or moderate degree of disorder is determined. The diagnosis of anosmia (complete loss of sensitivity to odors) is established when a severe disorder is detected (7-10 points).

Differences between olfactory impairment in COVID-19 coronavirus infection and in acute respiratory viral infections:

	Coronavirus infection	ARVI
The first signs of olfactory impairment	Discomfort in the nasal cavity, dryness	Feeling of stuffiness in the nose
The cause of the disorder	An inflammatory reaction affecting the nerve endings responsible for the sense of smell	Swelling of the mucous membranes, abnormal nasal discharge
Speed of onset of disorder	Instant	Gradually increasing
Degree of olfactory impairment	Often there is a complete loss of smell.	Usually partial loss, the person continues to detect strong odors

Treatment olfactory disorders

To correctly restore the sense of smell, the doctor must first determine the cause of its impairment. Depending on the pathology detected, treatment is prescribed - conservative or surgical. The first method is more common, especially if the problem is caused by infectious and inflammatory processes in the body.

There are many ways to restore the lost function. In some cases, antibiotics help, in others, it is enough to use local means (drops, aerosols) for irrigation and washing of the nasal passages.

In case of toxic damage to the receptor mechanism, detoxifying agents are prescribed, as well as drugs that optimize the transmission of nerve impulses. If necessary, physiotherapy is used, aimed at restoring olfactory innervation and improving microcirculation processes in the nasal cavity. It is important to prevent the transformation of an acute disease into a chronic one, since when the process becomes chronic, it becomes more difficult to restore the sense of smell.

Surgery may be indicated:

• for intranasal polyps;
• in tissue hypertrophy;
• with adenoid vegetations;
• in case of deformations, congenital anomalies, etc.

Medicines

The main direction of treatment is to reduce the severity of the disorder, eradicate the inflammatory process, and eliminate swelling of the mucous membrane in the nasal cavity. As symptomatic means, local hormonal, anti-inflammatory, and antiseptic drugs are most often used, which must be prescribed by a doctor. Antihistamines and antibiotics are taken orally according to indications. It is important to understand that independent uncontrolled use of drugs often leads to adverse health consequences.

What medications can a doctor prescribe?

Sinupret	A herbal preparation with a complex effect: secretolytic, anti-edematous, anti-inflammatory, immunostimulating and antiviral activity. Under the influence of the preparation, drainage and ventilation of the nasal sinuses are restored, congestion disappears, tissue edema is reduced. Tablets are taken 2 pcs. three times a day, and oral drops - 50 drops. three times a day. Side effects in the form of allergic reactions are rare.
Acetylcysteine	It is used for respiratory pathologies that are accompanied by the formation of viscous secretions, as well as bronchotracheitis, cystic fibrosis, sinusitis, coronavirus infection accompanied by anosmia. Adults and children over 14 years of age are prescribed the drug in an amount of 400-600 mg / day, after meals. Treatment can last from one to several weeks. Side effects such as heartburn, headache, allergic reactions rarely occur.
Nasonex	Nasal spray containing mometasone furoate, a synthetic corticosteroid for topical use with strong anti-inflammatory action. Nasonex is administered into each nasal passage 1-2 sprays 1-2 times a day. Possible side effects include nosebleeds, pharyngitis, burning in the nose, hypersensitivity reactions.
Nazol	A vasoconstrictor for external use that reduces blood flow and eliminates swelling of the tissues of the nasal cavity, paranasal sinuses and Eustachian tube, restores nasal breathing during flu, colds or allergic rhinitis. Treatment with the drug should not be continued for more than 3 days in a row. Side effects: burning sensation in the nose, sneezing, dryness, reactive hyperemia (a feeling of severe congestion after stopping treatment with the drug).
Pinosol	A local drug, has an antiseptic and antibacterial effect, activates granulation and epithelialization processes. Adults are administered 2-3 drops of the drug several times a day. The most likely side effects are: hypersensitivity reactions, burning in the nose, irritation of the skin and mucous membranes.
Sinudafen	Herbal capsules with secretolytic activity, promoting the restoration of drainage and ventilation of the paranasal sinuses, optimizing the antioxidant protection of the body. Adult patients and children over 12 years of age are prescribed 1-2 capsules per day after meals. Duration of treatment is 1-2 weeks. In the presence of hypersensitivity to the components of the drug, its use is contraindicated.

Physiotherapy treatment

After identifying the cause of olfactory disorders, the doctor prescribes medication. If necessary, physiotherapy is used.

Many otolaryngology clinics use the following methods to restore lost or impaired function:

• UZOL-therapy is a hardware method using ultrasonic jet-cavitation irrigation of the mucous tissue of ENT organs. The procedure is used to eliminate swelling of the upper respiratory tract, to improve the aerodynamics of the air flow and optimize access to the olfactory region. After the edema disappears, the compression of the corresponding nerve cells is eliminated.
• Laser therapy is used to restore epithelial tissue in the nasal cavity and, in particular, in the olfactory region, which is appropriate in the development of degenerative-inflammatory and atrophic processes caused by viral infection.
• Transcranial magnetic therapy – is prescribed to optimize blood circulation in the area of inflammation, accelerate healing processes, and eliminate the inflammatory reaction. Thanks to the treatment, the functioning of the central nervous system improves, and signal transmission along the nerve pathways is normalized.

As a rule, physiotherapy for olfactory disorders should be prescribed in a comprehensive manner, with the most complete impact on the cause of the disorder.

Herbal treatment

To eliminate olfactory disorders, it is necessary to deal with infectious agents (if any), stop the development of the inflammatory process, facilitate the removal of mucus, etc. In combination with drug therapy, folk herbal remedies have also proven themselves well.

Phytotherapy has a positive effect:

• to eliminate the main signs of acute inflammation;
• to alleviate the course of a chronic process, such as sinusitis;
• to speed up recovery after an infection;
• to prevent the development of complications.

Decoctions and infusions based on medicinal plants are used both internally and for rinsing or instillation into the nasal cavity. In some cases, it is appropriate to practice inhalations - provided that they are used correctly. It is important that the steam is not hot, breathing is shallow and infrequent, and before inhalation, the nose should be washed with a physiological solution of sodium chloride.

The main medicinal plants that help restore the sense of smell are effective if used for a long time. Such products should have an antiseptic, anti-inflammatory, and regenerating effect.

• Chamomile infusion is successfully used to rinse the nasal passages: for this you will need a small teapot, a syringe or a syringe without a needle. Chamomile flowers cleanse, relieve inflammation and improve the functioning of sensitive receptors. For rinsing, prepare an infusion at the rate of 1 teaspoon of medicinal raw material per 200 ml of boiling water.
• Calendula effectively restores the mucous tissue of the nasal cavity, softens it and eliminates the inflammatory reaction. To prepare the decoction, take 1 liter of boiling water and 4 tablespoons of dry plant material. Boil the decoction for several minutes over low heat, cover with a lid and leave until cool. Use the decoction for rinsing the nose and for internal use (instead of tea during the day). If the product is used for inhalation, then add a few more drops of eucalyptus or mint oil to it.
• Plantain infusion improves mucus evacuation, cleanses the nasal cavity and facilitates the work of receptors. To prepare the infusion, take 1 teaspoon of dry leaves, pour 200 ml of boiling water, leave for half an hour. Drink 2-3 times a day.

In addition to single-agent preparations, herbal mixtures can also be used. Such mixtures combine several plants with different mechanisms of action. Combined teas are also used for internal use and for nasal instillation. The mixtures may contain such plants as St. John's wort, primrose, betony, eucalyptus, sage, and linden blossom.

Surgical treatment

Surgical intervention is indicated for nasal polyps - benign neoplasms that form on the mucous tissues of the nasal cavity and sinuses. As they develop, polyps increase in size and can not only negatively affect the sense of smell, but also block the nasal passages, preventing normal breathing. The most common cause of such pathology are allergic reactions, chronic inflammatory processes in the upper respiratory tract, anatomical defects, etc.

Often, neoplasms are removed using a laser: this is a minimally invasive endoscopic procedure that helps destroy polyps with a targeted laser beam. Endoscopic equipment is used for the intervention: the growth is removed at its base, the tissues are coagulated, which eliminates the possibility of bleeding. The procedure is performed in a hospital setting if the patient has no contraindications, such as acute bronchitis or exacerbation of bronchial asthma, and in women, pregnancy.

In addition to polyps, sinusitis may also require surgical treatment - in particular, the purulent form of the disease, which requires puncture, endoscopic surgery, or even open surgery.

Sinus puncture is a puncture of the sinus using a special sterile needle, followed by suction of the purulent mass and rinsing with an antiseptic solution. The doctor can insert a catheter into the puncture area, through which the sinus is washed daily without repeated puncture.

Endoscopic intervention is indicated for chronic sinusitis, to restore the natural sinus ostium. After correction of the fluid outflow, free breathing and sense of smell return.

Open intervention is indicated for such serious pathologies as bone infection, damage to the maxillary-oral septum with the development of odontogenic sinusitis, malignant tumors of the maxillary sinus. For open surgery, the patient is hospitalized. Rehabilitation is long.

Prevention

In order to avoid problems with the sense of smell, experts advise preventing the occurrence of causes that can cause such disorders in advance:

• Dress according to weather conditions. Most often, respiratory diseases develop in the autumn-winter period, when a person does not have time to change his wardrobe, the weather changes dramatically, and humidity increases. It is important to orient yourself in time and dress according to the weather, avoiding hypothermia.
• Seek medical attention promptly. When the first signs of illness appear, take measures to prevent deterioration of breathing and the development of pathogenic microorganisms.
• Practice proper breathing. The quality of breathing directly affects our health. Interestingly, most of us breathe incorrectly, which prevents normal aeration. A simple exercise to correct breathing: cover one nostril with your finger and take a deep breath, exhaling through your mouth. Then cover the other nostril, repeat the exercise. Do 8-10 repetitions. If you do this 5-6 times a day (at room temperature), you can significantly improve the functioning of the respiratory system.
• Rinse your nose, clear it of mucus. A weak solution of sea salt (1/2 teaspoon per 250 ml of warm water) is excellent for rinsing. After the procedure, you need to blow your nose. Experts recommend doing such rinsing at the first signs of a cold, as well as after visiting crowded places (especially during periods of seasonal ARVI).
• Observe the rules of body and oral hygiene, visit the dentist regularly.
• Avoid injuries, lead a healthy lifestyle, quit smoking and drinking alcohol.

Forecast

The prognosis for a person with olfactory impairment depends on what caused the pathological disorder. If there is no irreversible damage to the upper respiratory tract and brain centers, the prognosis can be considered mostly favorable, since the olfactory function is restored in more than 90% of cases after the therapy prescribed by the doctor.

If we are talking about damage to the olfactory innervation, the central nervous system, or age-related changes that could prevent the restoration of normal function, then in this case we are talking about an unfavorable outcome of the pathology.

In case of olfactory disorder, doctors always select an individual treatment plan, which takes into account all the features of the disease and the body of a particular patient. Often, even in difficult cases, it is possible to improve the patient's condition and restore the lost function. The main condition is to promptly contact qualified specialists who will prescribe modern and effective treatment.