Evaluation of olfactory loss

概述 
理论 
急症 
诊断 
资源 

最后审阅： 29 Sep 2026

最后更新： 15 Apr 2026

Olfactory loss has been linked to a variety of causes and can profoundly influence a patient's quality of life.

Epidemiology

It is estimated that olfactory dysfunction affects approximately 22% of the general population; however, estimated prevalence rates vary significantly according to assessment techniques used, definitions of impairment, and the population sampled.[1][2][3]

Prevalence of olfactory impairment increases with age and male sex; some degree of olfactory dysfunction may be present in more than 50% of adults ages over 65 years.[1][4][5][6] In one cross-sectional sample of American adults with mean age 68 years, approximately 22% were unable to identify four or more odors using a validated odor identification task.[7] Older African-Americans and Hispanic Americans were more likely to suffer from age-related olfactory dysfunction than white Americans.[7]

Olfactory dysfunction prevalence estimates are generally higher when psychophysical (objective) tools, rather than subjective assessment techniques, are used to assess olfactory dysfunction.[1][5][6][8]

Severe olfactory dysfunction or complete olfactory loss (anosmia) is relatively uncommon in the general population. Prevalence estimates generally range from approximately 1% to 5% of the general population.[9][10]

COVID-19 pandemic

The global COVID-19 pandemic has significantly impacted prevalence rates of olfactory dysfunction, creating an additional cohort of people affected by both acute and postinfectious impairment or loss of olfactory function.[1]

Systematic reviews and cohort studies have reported olfactory dysfunction prevalence of between 48% and 86% in COVID-19 patients.[11][12][13][14] Prevalence of chemosensory dysfunction in patients with COVID-19 appears to differ between populations and ethnicities.[15][16][17]

Etiology

In patients presenting primarily for loss of smell, the most commonly identified etiologies include a prior viral upper respiratory infection, head trauma, and underlying chronic sinus inflammation.[14][18][19][20] These 3 causes account for over 50% of patients.

Pathophysiology

Olfactory loss may occur as a sensorineural loss, following degenerative changes in the olfactory neuronal receptors or neuroepithelium in the olfactory cleft.[21] It may also occur as a conductive loss following an obstruction or inflammation within the nasal vault that prevents access of odorants to the olfactory receptors.

Types of olfactory loss

The loss may be complete (anosmia) or partial (hyposmia). It may be associated with perceived odor distortions (dysosmia) that are related to actual environmental odorant stimulation (parosmia) or occur spontaneously (phantosmia) in the absence of an odor source.[22]

Presentation

Patients may present complaining of both smell and taste loss, or isolated taste loss, but on investigation their taste function is intact. This relates to the common confusion between taste and flavor. Taste sensation includes salt, sour, sweet, bitter, and umami (savory).[23] Flavor perception is based upon olfactory, tactile, and thermal sensations as well as taste, with olfactory being arguably the most important of these sensations. The loss of olfactory input makes food generally unappealing, something most patients notice very quickly. However, a true measurable taste loss is distinctly uncommon.[18]

Treatment

For patients with olfactory loss due to an inflammatory process, reducing inflammation and obstruction in the nasal vault can effectively restore the ability to smell.[24]

Unfortunately, in most cases of olfactory loss, no specific therapy is available. However, patients will continue to seek medical opinion until they feel a thorough workup has been performed and a thorough explanation has been provided.[25]

There are some data to indicate that olfactory training can increase the potential recovery after a postviral or post-traumatic olfactory loss.[26][27] Olfactory training is a recommended therapy (by expert consensus) in patients with neurosensory olfactory loss.[14][28][29]

Preliminary data suggest that submucosal injection of platelet-rich plasma into the olfactory cleft may benefit patients with olfactory dysfunction.[30][31][32] Randomized controlled clinical trials are required.

Adverse sequelae

Safety issues related to olfactory loss include the inability to detect gas leaks, fire, or spoiled foods. However, the most significant impact for each patient is typically the loss in quality of life related to eating and drinking.[1][29] This can be devastating. In some cases it may result in diminished appetite and inadequate nutritional intake, and in other cases it can cause increased oral intake and weight gain as patients seek chemosensory satisfaction. These consequences can have a negative impact on associated medical conditions such as diabetes and high blood pressure. Invariably, patients receive little sympathy from friends and, on occasion, family and sometimes even from their physician.

For most patients who experience a loss of smell, restorative therapy is limited (unless the loss is secondary to inflammatory rhinosinusitis). Therefore, while most patients do benefit from counseling regarding safety issues and flavor enhancement methods, any information regarding prognosis becomes very important. Studies suggest prognosis relates more to the severity of the initial loss (as confirmed on objective olfactory testing), the age and sex of the patient, smoking, and the presence of dysosmia, than to the etiology of sensorineural loss.[33][34]

鉴别诊断

常见

Viral upper respiratory infection
Nasal polyps
Chronic inflammatory sinus disease
Frontal or occipital trauma
Concussive injury caused by frontal or occipital blow to head
Aging

完整详情

不常见

Chemical exposure
Drug exposure
Radiation therapy of head and neck
Alzheimer disease
Parkinson disease
Anterior craniotomy
Craniofacial procedures
Endoscopic sinus surgery
Granulomatosis with polyangiitis
Sarcoidosis
Sjogren syndrome
Sinonasal tumors
Esthesioneuroblastoma
Olfactory groove meningioma
Turner syndrome
Kallmann syndrome

完整详情

撰稿人

作者

Allen M. Seiden, MD, FACS

Professor of Otolaryngology - Head and Neck Surgery

University of Cincinnati

Cincinnati

利益声明

AMS declares no competing interests.

同行评议者

Spencer C. Payne, MD

Associate Professor of Otolaryngology - Head & Neck Surgery

University of Virginia

Charlottesville

利益声明

all disclosures

Sangeeta Kapur Maini, MS, DNB, DLO(RCS), FRCS(Ed), FRCS (ORL)

ENT Consultant and Honorary Senior Lecturer

University of Aberdeen

Department of Otolaryngology Head and Neck Surgery

Aberdeen Royal Infirmary

Aberdeen

利益声明

SKM declares that she has no competing interests.

Simon Gane, MB, BS, DLO(RCS), FRCS (Ed)

ENT Consultant

Royal National Throat, Nose, and Ear Hospital

London

利益声明

SG declares that he has no competing interests.

Eric H. Holbrook, MD

Massachusetts Eye and Ear Infirmary

Harvard Medical School

Boston

利益声明

EHH declares that he has no competing interests.

Peer reviewer acknowledgements

BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.

Disclosures

Peer reviewer affiliations and disclosures pertain to the time of the review.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

Whitcroft KL, Altundag A, Balungwe P, et al. Position paper on olfactory dysfunction: 2023. Rhinology. 2023 Oct 1;61(33):1-108.全文摘要

Patel ZM, Holbrook EH, Turner JH, et al. International consensus statement on allergy and rhinology: olfaction. Int Forum Allergy Rhinol. 2022 Apr;12(4):327-680.全文摘要

Miwa T, Ikeda K, Ishibashi T, et al. Clinical practice guidelines for the management of olfactory dysfunction - secondary publication. Auris Nasus Larynx. 2019 Oct;46(5):653-62.全文摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

患者教育信息
Parkinson disease: what is it?
Common cold
更多患者教育信息
登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

内容使用需遵循免责声明

Evaluation of olfactory loss

小结

Epidemiology

Etiology

Pathophysiology

Types of olfactory loss

Presentation

Treatment

Adverse sequelae

鉴别诊断

常见

不常见

撰稿人

作者

Allen M. Seiden, MD, FACS

利益声明

同行评议者

Spencer C. Payne, MD

利益声明

Sangeeta Kapur Maini, MS, DNB, DLO(RCS), FRCS(Ed), FRCS (ORL)

利益声明

Simon Gane, MB, BS, DLO(RCS), FRCS (Ed)

利益声明

Eric H. Holbrook, MD

利益声明

Peer reviewer acknowledgements

Disclosures

参考文献

关键文献

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.

患者教育信息

登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

登录或订阅即可浏览 BMJ Best Practice 临床实践完整内容

登录后可浏览 BMJ Best Practice 临床实践完整内容