Olfactory disturbance

The olfactory ability is extremely important for a person: it performs both a protective and a signaling function. Smell 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 (for example, gas) in the air. 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 as a perverted perception of aromas, a complete or partial loss of the olfactory ability. This pathology often becomes one of the symptoms of viral lesions - 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 speak of idiopathic smell disorder.

Epidemiology

Violation of the sense of smell is a fairly common complaint of patients with which they turn to a doctor. In general, the global distribution of the problem is estimated at more than 19%: a decrease in olfactory sensitivity is more common (about 13%), anosmia occurs less frequently (almost 6% of cases).

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

The vast majority of disorders are disorders 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 to detect food, find potentially dangerous objects, perceive pheromones and look for partners. The most important direction of "scent" is the prevention of possible danger (smoke, toxic gases, fumes) and the search for food.

Scientists also identify 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 couple. Scents also play a role in memory and recall processes.

The loss of the olfactory ability deprives people of the opportunity to enjoy food and life in general: according to statistics, patients with prolonged anosmia often suffer from depressive disorders.

Causes of the smell disorders

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

Peripheral pathology is caused by malfunctions of nasal receptors - for example, due to such problems:

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

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

• craniocerebral damage;
• hypovitaminosis A;
• brain tumor processes;
• Alzheimer's disease, Parkinson's;
• schizophrenia, deep depression.

In addition, impaired sense of smell may be due to the use of neurotoxic drugs, complications of meningeal infection, and unsuccessful neurosurgical interventions. The “culprits” are often congenital defects in the olfactory receptors and the nasal cavity, as well as regular inhalation of dusty and polluted air, which may be associated with a person’s professional activities.

Among numerous medicines, amphetamines, thiazides, levodopa can lead to olfactory disorders.

Loss of smell after coronavirus

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

Over time, neuroscientists at Harvard concluded that the problem was caused by damage to the supporting 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 coronavirus infection has an indirect effect on the nervous system, inhibiting the function of auxiliary cell material, which further leads to disruption of the olfactory nerves.

Since no direct damage to the olfactory nerve fibers and bulbs is detected with COVID-19, the function of detecting odors is gradually restored. Complete elimination of olfactory disorders is observed for 14-100 days, sometimes a little more. According to the observations of experts, after 2 weeks after recovery, the ability to catch aromas returns in about one in four patients. In general, this period is different, which depends on the severity of the coronavirus infection, and on the presence of background and chronic otolaryngological diseases. Special drugs that can accelerate the recovery of this function are not yet provided.[2]

Nasal polyposis with impaired sense of smell

A large number of patients experience nasal breathing disorders due to 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 proceeds in certain stages, depending on how much the respiratory channels overlap. The main symptoms are often:

• breathing difficulties;
• nasal discharge (mucopurulent or watery);
• deterioration of olfactory and taste sensations;
• pain in the head;
• lacrimation, sometimes - cough (caused by the flow of secretions along the posterior pharyngeal wall).

Violation of the sense of smell in polyposis is eliminated mainly by the surgical method, which can be represented by different execution techniques. The type of surgical intervention is selected by the surgeon on an individual basis.[4]

Violation of smell in SARS

Acute respiratory viral infection combines several inflammatory processes at once, which are characterized by such signs:

• 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 has swelling of the tissues of the nasal cavity, mucous secretions appear, and the temperature rises. Without timely treatment, the sense of smell worsens, and for some time it may disappear altogether.

A few days later, after the temperature has returned to normal and the catarrhal symptoms have gradually disappeared, the ability to catch aromas resumes.

Since SARS can be caused by different viruses, it is impossible to say exactly how strong the violation of smell will be, and how long it will last. In addition, a significant role is played by the general state of human health, the presence of chronic diseases of the ENT organs and the respiratory system as a whole.[5]

Impaired sense of smell with a cold

The mucous tissue in the nasal cavity is the first protective barrier that protects the human body from infection through the respiratory tract. If the bacteria got on the mucous membrane, then 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.

With a runny nose, blood circulation in the nasal cavity is disturbed, 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, and headaches. It is possible to spread the complication to the organs of vision and hearing.

In order to fully restore all the functions that were disturbed as a result of rhinitis, doctors prescribe, in addition to drugs, physiotherapy: ultraviolet irradiation, inhalation and heating. As a rule, after a while, the sense of smell returns to its previous volume.[6]

Endocrinological causes

Hypothyroidism is considered to be one of the reasons for poor perception of odors - a reduced function of the thyroid gland. The manifestations of pathology are varied. The primary form of the disease occurs mainly in women: patients complain of constant fatigue, lethargy, chilliness, memory impairment. Possible deterioration of the skin, nails, hair. Hypotension, bradycardia, edema on the face and legs, impaired sense of smell and taste are noted. The temperature is usually low (even during infectious diseases), due to a slow metabolism.[7]

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

Similar symptoms are characteristic of diabetes. In the stage of decompensation of the disease in patients, severe dryness of the skin, wrinkling and peeling, and a decrease in turgor can be noted. Eight out of ten patients have dermatoses caused by metabolic disorders and deterioration of microcirculation. No less often found blurred vision, impaired sense of smell. Joints, the digestive and urinary systems, and the liver are also affected.[9], [10]

Violation of the sense of smell with sinusitis

The diagnosis of sinusitis is established if we are talking about an acute or chronic inflammatory process in the maxillary sinuses, which are responsible for cleansing the inhaled air flow and for olfactory function. These sinuses have a complex shape, narrowly connected to the nasal cavity, and therefore are often affected by bacterial and viral agents.[11]

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

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;
• difficulties with nasal breathing;
• temperature rise;
• pain in the head (may increase if you tilt your head down);
• sometimes - swelling of the upper part of the face.

Timely treatment with the use of antiseptic, anti-inflammatory, decongestants allows you to quickly achieve the disappearance of symptoms: the sense of smell returns within 2-3 weeks.[12]

Risk factors

The main factors of 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 a nerve impulse.

Respiratory disorders of smell are often provoked by the following factors:

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

Almost any obstacle that arises in the way of inhalation of air can cause disturbances in the sense of smell. Atrophic processes in the nasal cavity, influenza, childhood infections, intoxication, tuberculosis also negatively affect aromatic sensitivity. Irreversible pathological processes develop when the olfactory zone is damaged and the pathways and the olfactory center are damaged.

Pathogenesis

Processing of olfactory stimuli occurs through unmyelinated fibers. The sense of smell gives people an idea of the surrounding biochemical space and is able to influence various aspects of life, participate in the formation of positive or negative emotional memories associated with smells. If a violation of smell develops, then both the emotional and personal sphere and the cognitive functions of a person may suffer.

Patients with an olfactory deficiency often complain of digestive problems, which is due to the close relationship between the perception of smells and tastes. In addition, people lose the ability to detect their own unpleasant odors (the smell of sweat or uncleaned teeth), which makes them socially vulnerable and increases the risk of social exclusion. 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 of the nose and contains special sensitive 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 not possible - for example, if there are any anatomical obstructions - then the sense of smell is impaired, aromatic sensitivity is reduced. A similar phenomenon is not uncommon in patients with deformities of the nasal septum, hypertrophy of the nasal mucosa, sinusitis, or adenoid growths.

Smell impairment may be due to problems that have arisen in different parts of the olfactory sphere. In healthy people, signals from sensitive receptors in the nasal mucosa enter the subcortical region and the cerebral olfactory center along a certain path. Pathology often accompanies injuries and damage to the olfactory nerve fiber, which occurs with traumatic brain injuries, neurosurgical interventions. If neurostructures are affected unilaterally, then a violation of smell 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, it can be rhinitis, sinusitis, SARS and other processes that are accompanied by damage to peripheral nerve receptors. The root cause can also be a degenerative lesion of brain structures - in particular, Alzheimer's disease, Parkinson's disease, as well as tumor malignant diseases in the brain. In such situations, the violation of smell is explained by atrophic processes and necrosis of neurons in the area responsible for smell.

An olfactory disorder in epilepsy develops in a completely different way: patients complain of a false sensation of unpleasant odors, but this problem is due to the formation of excitation sites in the brain structures and the spread of impulses to the cortical regions. In addition, the appearance of olfactory disorders is characteristic of depression, schizophrenia, psychosis, hysterical conditions, which is associated with a malfunction of the nervous system.

Symptoms of the smell disorders

The clinical picture in violation of the sense of smell depends on many factors. Many patients report a decrease in sensitivity to familiar odors, or a complete loss of odor sensitivity. Complete loss most often develops gradually: at the first stage, a person ceases to feel subtle, barely perceptible aromas, then he loses his reaction even to a pronounced smell (in particular, ammonia). Some people have a simultaneous violation of the taste buds.

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

With other violations of smell, sensitivity to smells, on the contrary, increases. Such a state is extremely uncomfortable for the patient: irritability, headache, irritability, etc. Appear. Perversion of olfactory sensitivity is also likely: a person feels extraneous odors that are not really there, and ordinary habitual odors become fetid. For example, washing powder starts to smell like gasoline, and clean washed clothes smell like feces. Such disorders in themselves do not pose a health hazard, but may indicate the development of neurological and other pathologies, and therefore require the attention of a medical specialist.

Persistent loss of smell

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

Violation of the sense of smell can proceed 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;
• according to the sensorineural type, when the problem is present in the olfactory brain area.

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

Do not forget that anosmia can be caused by such serious diseases as multiple sclerosis, Alzheimer's disease, malignant tumors, as well as traumatic brain injuries. In such situations, the disorder is indeed stable, which can adversely affect the patient's physical and psychological state.

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

Loss of smell during pregnancy

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

Sense of smell most often occurs in the first trimester of pregnancy. It can be caused by allergic, hormonal, infectious causes. Symptoms can be represented by such manifestations:

• difficulty in nasal breathing;
• pathological secretion from the nose;
• olfactory and taste changes;
• exacerbation of sinusitis;
• sleep disturbances and concentration;
• constant fatigue, headache.

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

Forms

Smell impairment can manifest itself as a perverted sense of aromas, as a complete or partial loss of smell, as a sensation of false odors (which do not actually exist). Typically, these types of olfactory disorders are distinguished:

• perceptual disturbance;
• conductive;
• mixed.

In addition, the pathology can have an acute, subacute or chronic course, be acquired or congenital (for example, with Kalman syndrome).

All olfactory disorders are divided into the following categories:

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

Determining the type of disorder is just as important as determining its cause. This is necessary in order to prescribe the correct and competent treatment in the future.

In addition, doctors distinguish such types of pathology:

• hyperosmia - a pathological increase in olfactory sensations, which is often found in neurogenic and autoimmune diseases, tick-borne borreliosis, hormonal changes;
• hyposmia - a weakening of the olfactory sensations, which occurs with diseases of the cerebral cortex, dysfunction of the receptor mechanism in the nasal cavity;
• anosmia - loss of the ability to smell, which is typical for traumatic brain injury, 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, a sensation of false aromas that are not actually there, can occur with mental pathologies, brain damage, tumor processes, epilepsy;
• agnosia - the loss of the ability to recognize and identify even familiar aromas, which is due to 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, they distinguish:

• rhinogenic disturbance of smell (due to problems in the nasal cavity: rhinitis, septal deformity, polyposis);
• neurosensory disorder (due to damage to the olfactory receptors or the corresponding brain centers).

Loss of smell and speech impairment

Sometimes a smell disorder is accompanied by certain neurological symptoms, such as problems with short-term memory or with cranial nerves (double vision, difficulty speaking or swallowing). Here it is important to suspect and detect stroke in a timely manner, which is the second most common cause of human death from pathologies (after coronary 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 a suspected major stroke should be taken to a hospital as soon as possible.[14]

Symptoms of a stroke may include:

• a sharp deterioration in vision, hearing, impaired sense of smell, disorder of spatial orientation, balance, motor skills;
• sudden headache, dizziness;
• cool sweating, flushing of the face, dry mucous membranes, nausea (often to the point of vomiting), increased heart rate or convulsions;

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

• speech difficulty;
• 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 such signs:

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

With these signs, you should immediately call the emergency medical team.[15]

Complications and consequences

Olfactory disturbances are an indication from the body that there are some more serious health problems. Often, even a temporary loss of the olfactory ability causes not just discomfort: a person develops neuroses and depressive states.

In the overwhelming majority of cases, aromatic insensitivity is accompanied by taste disorders: the patient ceases to distinguish taste nuances, all food becomes insipid. Doctors note that in acute respiratory diseases and viral infections, the loss of taste is almost always due to the loss of olfactory function. But with coronavirus infection COVID-19, the problem is explained by direct damage to the nerve endings (facial and glossopharyngeal nerve) responsible for taste and language sensitivity.

In some people, such pathological changes are stable, at the same time a violation of taste and smell is detected, sensitivity is distorted. The consequences of this development of events are nervous disorders, pathologists of the gastrointestinal tract.

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

Diagnostics of the smell disorders

Determining a violation of the sense of smell is usually not difficult. 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 injuries of a closed or open nature. In people 20-50 years old, viruses often become the “culprits”. For the elderly, psychoneurological pathologies and neoplasms are more characteristic.

The main instrumental diagnostics can be represented by the following methods:

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

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

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

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

Next, the doctor performs a rhinoscopy, assesses the condition of the mucosa and the capacity of the nasal passages. Both nasal passages should be examined to detect obstruction.

Analyzes are prescribed as part of general clinical studies:

• general blood analysis;
• general urine analysis.

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

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

If the reason for the appearance of a violation of smell 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, then the examination and management of the patient is carried out within the framework of 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 score from 3 to 7	Olfactory disorder moderate
Anosmia	Scale score from 7 to 10	Severe olfactory disorder

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

Differences between impaired sense of smell in COVID-19 coronavirus infection and in ARVI:

	Coronavirus infection	SARS
The first signs of a violation of smell	Discomfort in the nasal cavity, dryness	Feeling of stuffiness in the nose
Cause of the disorder	Inflammatory reaction affecting the nerve endings responsible for smell	Swelling of mucous membranes, pathological nasal discharge
The rate of onset of the disorder	Instant	Gradually increasing
Degree of olfactory deterioration	Often a complete loss of smell	Usually partial loss, the person continues to pick up bright scents

Treatment of the smell disorders

For the correct restoration of the sense of smell, the doctor must first determine the cause of its violation. Depending on the detected pathology, 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 return a lost function. In some cases, antibiotics help, in others it is enough to use local agents (drops, aerosols) for irrigation and washing of the nasal canals.

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 involved, 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:

• with intranasal polyps;
• with tissue hypertrophy;
• with adenoid vegetations;
• with deformities, congenital anomalies, etc.

Medications

The main direction of treatment is to reduce the severity of the disorder, eradicate the inflammatory process, and eliminate mucosal edema in the nasal cavity. As symptomatic agents, local hormonal, anti-inflammatory, antiseptic drugs are most often used, which the doctor should prescribe. Inside, according to indications, antihistamines, antibiotics are taken. It is important to understand that the 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, decongestant, anti-inflammatory, immunostimulating and antiviral activity. Under the influence of the drug, drainage and ventilation of the nasal sinuses are restored, congestion disappears, tissue edema decreases. Tablets are taken in 2 pcs. Three times a day, and oral drops - 50 cap. Three times a day. Side effects in the form of allergic reactions are rare.
Acetylcysteine	It is used for respiratory pathologies, which are accompanied by the formation of a viscous secret, as well as for bronchotracheitis, cystic fibrosis, sinusitis, coronavirus infection, accompanied by anosmia. Adults and children from 14 years of age are prescribed the drug in the amount of 400-600 mg / day, after meals. Treatment can last from one to several weeks. Rarely there are side effects in the form of heartburn, headache, allergic reactions.
Nasonex	Nasal spray containing mometasone furoate, a synthetic topical corticosteroid with strong anti-inflammatory effects. Nasonex is injected into each nasal passage 1-2 injections 1-2 times a day. Among the possible side effects: 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 in case of 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 (feeling of severe congestion after discontinuation of medication).
Pinosol	The preparation of local action, has antiseptic and antibacterial action, activates granulation and epithelization processes. Adults are administered 2-3 drops of the drug several times a day. The most likely side effects: hypersensitivity reactions, burning in the nose, irritation of the skin and mucous membranes.
Sinudafen	Plant-based capsules with secretolytic activity, contributing to 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. The duration of treatment is 1-2 weeks. In the presence of hypersensitivity to the components of the drug, it is contraindicated to use it.

Physiotherapy treatment

After discovering the cause of the appearance of olfactory disorders, the doctor prescribes medication. If necessary, physiotherapy is involved.

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

• USOL-therapy is a hardware method using ultrasonic jet-cavitational irrigation of the mucous tissue of the 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 area. After the disappearance of the edema, 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 for the development of degenerative-inflammatory and atrophic processes caused by viral damage.
• Transcranial magnetotherapy is prescribed to optimize blood circulation in the area of inflammation, accelerate healing processes, and eliminate the inflammatory response. Thanks to the treatment, the work of the central nervous system improves, signal transmission along the nerve pathways normalizes.

As a rule, physiotherapy for olfactory disorders should be prescribed in a complex manner, with the fullest possible impact on the cause of the disorder.

Herbal treatment

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

Phytotherapy has a positive effect:

• to eliminate the main signs of acute inflammation;
• to facilitate the course of a chronic process - for example, sinusitis;
• to speed up recovery after an infection;
• to prevent the development of complications.

Decoctions and infusions based on medicinal plants are used both inside and for washing or instillation of the nasal cavity. In some cases, it is appropriate to practice inhalations - provided 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 rinsed with saline sodium chloride solution.

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

• Chamomile infusion is successfully used for washing the nasal passages: for this you need a small kettle, a syringe or a syringe without a needle. Chamomile flowers cleanse, relieve inflammation and improve the functioning of sensitive receptors. For washing, an infusion is prepared at the rate of 1 tsp. Medicinal raw materials 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 a decoction, take 1 liter of boiling water and 4 tablespoons of dry raw materials of the plant. The broth is boiled for several minutes over low heat, covered with a lid and insisted until cool. Use a decoction for washing the nose and for oral administration (instead of tea during the day). If the product is used for inhalation, then a few more drops of eucalyptus or mint oil are added to it.
• Plantain infusion improves mucus evacuation, cleanses the nasal cavity and facilitates the work of receptors. To prepare the infusion, take 1 tsp. Dry leaves, pour 200 ml of boiling water, insist for half an hour. Drink per day in 2-3 doses.

In addition to mono-remedies, mixtures of medicinal herbs can also be used. In such mixtures, several plants with different mechanisms of action are combined. Combined teas are also used for internal use and for instillation into the nose. Mixtures may contain plants such as St. John's wort, primrose, initial letter, eucalyptus, sage, linden blossom.

Surgery

Surgery 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 this pathology is allergic reactions, chronic inflammatory processes in the upper respiratory tract, anatomical defects, etc.

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

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

Sinus puncture is a puncture with a special sterile needle, with further suction of the purulent mass and washing with an antiseptic solution. The doctor can insert a catheter into the puncture area, through which the sinus is washed daily without re-puncture.

Endoscopic intervention is indicated for chronic sinusitis, to restore the natural axillary anastomosis. After correcting the outflow of fluid, free breathing and 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, and malignant tumors of the maxillary sinus. For an open operation, the patient is placed in a hospital. Rehabilitation is long.

Prevention

In order not to get problems with the sense of smell, experts advise in advance to prevent the appearance of causes that can cause such violations:

• Dress appropriately for the weather. Most often, respiratory diseases develop in the autumn-winter period, when a person does not yet have time to change his wardrobe, the weather changes dramatically, and humidity rises. It is important to orient yourself in time and dress according to the weather, avoiding hypothermia.
• Seek medical attention promptly. At the first signs of illness, 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. Perform 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 washing. After the procedure, you need to blow your nose. Experts recommend such washings at the first sign of a cold, as well as after visiting crowded places (especially during periods of seasonal SARS).
• Observe the rules of body and oral hygiene, visit the dentist regularly.
• Avoid injury, lead a healthy lifestyle, stop smoking and drinking alcohol.

Forecast

The prognosis for a person with impaired sense of smell depends on what caused the pathological disorder. If there is no irreversible damage to the upper respiratory tract and brain centers, then the prognosis can be considered predominantly 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 they speak of an unfavorable outcome of the pathology.

In case of impaired sense of smell, doctors always select an individual treatment regimen that 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 timely contact qualified specialists who will prescribe modern and effective treatment.