TOC  | ID |  Neurology

March 2004

KP - Head & Neck Surgery Topic of the Month: Anosmia

CC: "I can't smell"

HPI: This 54 year old gentleman presented with a complaints of decreased smell that started a few months after elective knee surgery. The patient denied any recent URI's, chronic sinusitis, head trauma, or allergy symptoms. Examination of the nasal cavity revealed healthy pink mucosa without any obstructing lesions. A CT scan of the sinuses revealed only mild mucosal swelling, and a head CT was normal.

The patient was given a trial of nasal steroids without any benefit. The patient sought evaluation at a nasal dysfunction clinic where they attributed his anosmia to a subclinical viral infection which was essentially nonreversible. He was counseled on the need for smoke and natural gas detectors, and awareness of potential food poisoning.

Diagnosis: Anosmia

CAUSES: Conductive vs. Sensorineural





  1. § History and Physical: most informative in determining site of lesion
  2. § Smell disorders can usually be differentiated from taste disorders; many will note a change in taste sensation with anosmia, even with normal taste testing
  3. § Evaluate for signs of nasal allergy, infection, polyps, masses, structural disorders
  4. § If olfactory cleft appears normal, a sensorineural loss is diagnosed


Standardized (scratch and sniff) or common items (coffee, ammonia, water)

Imaging: used when no obvious cause, or if PE dictates further evaluation


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