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The optimal evaluation and management of patients with a gradual onset of olfactory loss

Enriquez, Karlaa,b; Lehrer, Eduardoa,c; Mullol, Joaquima,c

Current Opinion in Otolaryngology & Head and Neck Surgery: February 2014 - Volume 22 - Issue 1 - p 34–41
doi: 10.1097/MOO.0000000000000013
NOSE AND PARANASAL SINUSES: Edited by Samuel S. Becker and Nithin D. Adappa
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Purpose of review The aim of this review is to provide an overview of the causes of olfactory dysfunction, their evaluation and management, with a main focus on the gradual/progressive loss of smell.

Recent findings As the sense of smell gives us essential information about our environment, its loss can cause nutritional and social problems while threatening an individual's safety. Recent surveys have shown quite a substantial prevalence of hyposmia (one out of four people) and anosmia (one out of 200 people) in a variety of populations.

Summary Nasal inflammatory diseases such as allergic rhinitis and predominantly chronic rhinosinusitis account for the major and common causes of gradual/progressive loss of smell. However, they are also among the most successfully treated forms of olfactory dysfunction. The management of gradual/progressive smell deficit must always address its etiological causes. In most cases, a detailed medical history and nasal examination, smell testing, and imaging will help to establish an appropriate diagnosis. In addition to anti-inflammatory therapy, mainly nasal and systemic corticosteroids, recent investigations on smell training suggest that the controlled exposure to selected odors may increase olfactory performance.

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aRhinology Unit and Smell Clinic, Otorhinolaryngology Department, Hospital Clínic, Barcelona, Catalonia, Spain

bOtorhinolaryngology Department, Hospital Regional PEMEX Salamanca, Guanajuato, México

cClinical & Experimental Respiratory Immunoallergy, Institut d’Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain

Correspondence to Joaquim Mullol, MD, PhD, Rhinology Unit and Smell Clinic, Otorhinolaryngology Department, Hospital Clínic i Universitari, Villarroel 170, 08036 Barcelona, Catalonia, Spain. Tel: +34 932279872; e-mail:

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© 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins