Patient's Query
Hello doctor,
I have chronic sinusitis without polyps. I am taking Budesonide rinses, which I do twice a day. These have greatly helped with my symptoms. However, I still suffer from a weak sense of smell. Since my other symptoms are controlled, should my sense of smell improve over time? Can you please help me with my sense of smell?
Kindly advise.
Hello,
Welcome to icliniq.com.
I read your query and understood your concern.
Anosmia or hyposmia is a frequent occurrence associated with rhinosinusitis, and many factors lead to it. Firstly sinusitis is an inflammatory condition associated with edema and the release of inflammatory mediators that cause olfactory mucosa to respond less to odors.
The second accompanying nasal obstruction also impedes the free flow of odor to the higher olfactory mucosa, which can cause a decreased sense of smell. Third, there is a direct effect on the olfactory nerves, which also affects this sense. So with the successful treatment of allergy and associated rhinosinusitis, the sense of smell should return.
However, since the nerves might take time to recover from the damage, to restore their functioning to normal physiology, the recovery can be prolonged, maybe even months.
I hope this was helpful.
Thank you.
Patient's Query
Hello doctor,
Thank you for your reply. Let me give you some background on my case. I was diagnosed with chronic sinusitis without polyps one and a half years ago. Since then, I have had symptoms ever. It started with a weak sense of smell, throbbing pain, congestion, postnasal drip, cough, tinnitus, and headache.
I had a CT scan, and my ENT said there were no polyps and a mildly deviated septum, but it did not need surgery. He said I have a mild case of sinusitis. I do not have asthma or allergies. Now, I have been using Budesonide rinses for about six months, and all my symptoms are gone except mild clicking in my ears upon swallowing, tinnitus in my left ear, and, of course, a weak sense of smell and taste.
Sometimes my sense of smell intensifies significantly, but only for a few minutes. It did so a few days ago when I woke up. There is a dull pain at the very top of my head which subsides after five or 20 minutes. I am very frustrated because I am concerned that I will not be able to regain my sense of smell. However, I have responded well to treatment. Should I wait patiently?
Kindly advise.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
Loss of taste and smell can be particularly recalcitrant to treatment. Even when other symptoms have improved, taste and particularly smell can take longer to recover. Now that CT (computed tomography) did not reveal anything significant or no abnormality was detected on clinical examination, no other active intervention other than pharmacotherapy is needed.
The sense of smell should improve with time. You also need to supplement your diet with Omega-3 fatty acids and other antioxidants like Vitamin C, Vitamin E, and Zinc.
I hope this was helpful.
Thank you.
Patient's Query
Hello doctor,
Thank you for the reply. I have been doing that every day. Why is the sense of smell so difficult to treat? Do most people recover their sense of smell and taste in your experience? Does it ever usually go back to normal?
Kindly advise.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
Yes, most of the patients do eventually recover. Since smell is a subjective perception, it does vary even normally among individuals. So it will depend upon the individual. Since neurons might take time to return to the original baseline, it is often difficult to predict how early one can regain the sense of smell.
I hope this was helpful.
Thank you.
Patient's Query
Hello doctor,
Thank you. I am a little anxious because I read that long-term chronic sinusitis can cause permanent damage to the sense of smell. I have had symptoms for one and a half years and am now getting them under control. Is there a high risk for me to have a permanent weak smell? Do most patients return to normal?
Kindly advise.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
Yes, even when symptoms are well controlled, it might take some time for the sense of smell to return to normal. This is because the nerves might need to recover from the damage and reset to normal. You do not have to be anxious; most often, the sense of smell returns to normal. And further, even if the nerves do not regain their full physiological functioning, our brain does, to an extent, adapt to this new normal.
I hope this was helpful.
Thank you.
Patient's Query
Hello doctor,
Thank you. My sense of smell improved momentarily a couple of weeks ago. I would say that I could smell 80 to 90 percent normally. This only lasted 30 minutes or so. I am becoming anxious because I would guess 90 percent of my inflammation is controlled. And I have no other symptoms except for smell loss and tinnitus in one ear. So, is some time required for the sense of smell to heal and return to normal once all other symptoms are controlled? Does this take a couple of months? And you say it is quite rare for someone to have permanent damage to their sense of smell?
Kindly advise.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
Yes, total permanent anosmia is rare. It may take months or even a year or more to return to normal.
I hope this was helpful. Kindly follow up if you have more doubts.
Thank you.
Patient's Query
Hello doctor,
Thank you. Can it take that long? Thankfully, I do not have anosmia. I do have hyposmia. However, do most of your patients return to normosmia? Or do many of them remain hyposmic?
Kindly advise.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
Well, most of them often recover. However, some do complain about certain alterations in the sense of smell. But most of them do not consider it too worrisome.
I hope this was helpful.
Thank you.
Patient's Query
Hello doctor,
Thank you.
Yes, I saw an ENT who performed a CT scan at the beginning of last year. He said I had sinusitis in my maxillary and ethmoid sinuses only. He said I had mild inflammation but no polyps. I have a mildly deviated septum, but surgery is not necessary. There are no allergies, no asthma, no infection or purulence. All sinus Ostia are open. When the ENT again examined me six months later, he said he found no inflammation and the mucosa looked healthy. However, I still have the symptoms up higher in the nasal cavity, which he said he could not see without special instruments. My treatment is working. I have attached two files, where I began, and the only place where I feel I have remaining inflammation and some mild pressure.
Kindly advise
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
Well, if this pain or headache is rhinogenic, it should resolve with successful treatment, and your sense of smell should slowly regenerate. Have you had a nasal endoscopy? Was it okay? Did you use an antihistamine nasal spray? Sorry, I did not receive any file. The thing is, most of the time, mild sinus inflammation is asymptomatic. Only when ostia are blocked, and secretions are pent up, do symptoms appear.
Symptoms are more of a drag or a sense of fullness over the cheeks or around the glabella. So if your symptoms are improving, it means sinus drainage is re-establishing, and this drag should go away. As free drainage and air circulation are established, other functions, including smell, would also improve.
I hope this was helpful.
Thank you.
Patient's Query
Hello doctor,
Thank you. There has been a definite improvement. However, I still have mild tinnitus in my left ear that only came with sinusitis. Also, I have eustachian tube dysfunction in both ears. My ears do not feel full, but they sometimes click when I swallow. This has diminished too. I only have a strange pressure up high, which I can feel under the skull base. This, I assume, is still some mild inflammation in the ethmoid sinuses, which is interfering with my sense of smell. Sometimes, I feel a mild pressure in my forehead, although my frontal sinuses are not affected, my ENT tells me. It is not painful, but a vague pressure that is sometimes hard to tell is there. Also, sometimes I feel the same strange pressure on the sides of my head. Yet, I can breathe, have no congestion or pain in my maxillary sinuses at all. When I do my Budesonide rinses at night, I lean over the side of the bed and let the medicine seep into my ethmoid sinuses for five minutes. Then, I turn around and tilt my head down on the floor and soak again. Finally, I rinse out my maxillary area. There has been a marked improvement over the past month. I am, however, an anxious person and take medication for panic disorder. I can handle the other symptoms, but anxiety over my sense of smell returning causes me much anxiety.
Kindly advise
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern. I would say anxiety would definitely make your symptoms worse. Especially the sense of fullness and pressure around the nasal bridge and the tinnitus. How long have you been taking medicines for panic disorder, and what medicines are you taking?
I hope this was helpful.
Thank you.
Patient's Query
Hello doctor,
Thank you.
I have been taking medicine for anxiety for 20 years. I take Escitalopram, called Cipralex, 40 mg a day. I noticed today that, although I cannot sense it, there is still some inflammation on my forehead. I could feel it decline and come back. It did not hurt, and there was no pressure, but I could sense a very mild fullness that kept moving around.
Kindly advise.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
SSRI (Selective serotonin reuptake inhibitors) like Escitalopram can cause alterations in taste and smell by altering serotonin uptake. Since you have been on an SSRI for 20 years, it might be adding to the altered smell.
I hope this was helpful.
Thank you.
Patient's Query
Hello doctor,
Thank you.
But my doctor insists that I take it, and I have never had issues with taste or smell before the sinusitis. What should I do? The treatment has really begun to work. I do not have any pain or pressure. However, last night I felt a strange release of pressure at the top of my head. It was like a heaviness that fluctuated. Maybe the treatment will eventually clear everything up.
Kindly advise.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
You might want to talk to your doctor if he agrees. He might put you on alternative medications. Since your symptoms are improving and the treatment you think is working, it is better to wait. As I told you, as the sinus and nasal allergy issue clears, your sense of smell might also improve, hopefully.
I hope this was helpful.
Thank you.
Patient's Query
Hello doctor,
Please mention whether I have any damage due to permanent loss. I do not have allergies.
Kindly advise
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
The course is often difficult to predict. The loss is temporary in most cases. In some cases, it can be permanent. Having 75 percent of recovery might be good enough to restore a good quality of life. Having a sufficient recovery helps to improve the quality of life.
I hope this has helped you.
Thank you.
Patient's Query
Hello doctor,
I still remain weak, but I can smell. My inflammation in the head has gone, except for a small part right near the olfactory area. I can sense it right there. It does not hurt, but I have a mild pressure there. If I can control this area, will my sense of smell improve?
Kindly advise.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
It would hopefully improve. As I told you earlier, even when your symptoms remain totally controlled, it might take some time for the smell to improve. I suggest you gradually taper down your Budesonide rinses. Decrease the frequency and quantity initially, and then stop it.
I hope this has helped you.
Thank you.
Patient's Query
Hello doctor,
Will many patients have a diminished sense of smell even if all their symptoms are controlled?
Kindly advise
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
Well, I will not say most of them. A few of them have a weak sense of smell even when other symptoms are controlled.
I hope this has helped you.
Thank you.
Patient's Query
Hello doctor,
Is this weak sense of smell permanent? Do these patients find a way to improve it?
Kindly advise.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
Well, very rarely, I have seen patients complaining of permanent loss of sense of smell. Eventually, most patients regain good functionality.
I hope this has helped you.
Thank you.
Patient's Query
Hello doctor,
Ok, could there be permanent hyposmia, or is this rare?
Kindly advise.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
The thing is that there remains some degree of altered smell, definitely. But there is no reason why one should have total and permanent loss even when functioning is restored.
I hope this has helped you.
Thank you.
Patient's Query
Hello doctor,
What types of altered smell do your patients have?
Kindly advise.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
The patients can have a decreased sense of smell or hyposmia, absence of smell (anosmia), or even an altered smell (parosmia), usually a bad smell like that of rotten rags (cacosmia).
I hope this has helped you.
Thank you.
Patient's Query
Hello,
Thank you, doctor, for the reply.
So will I have hyposmia for the rest of my life?
Kindly advise.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
Well, nothing can be said with conviction. But a favorable outcome is more likely. More often than not, normal physiology is restored.
I hope this has helped you.
Thank you.
Patient's Query
Hello doctor,
Could you please repeat your answer?
Thank you.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
The majority of your symptoms are resolving, and your concern now centers around your sense of smell. As previously discussed, these neural functions tend to recover later in the healing process, making it uncertain whether permanent damage has occurred. However, if the ongoing issue has been mitigated to some degree, there is a chance that nerve function will be restored, approaching if not entirely reaching normalcy.
Additionally, another physiological change might contribute to further recovery. Even if nerve cell damage has transpired, there is a potential for the remaining healthy cells to enhance their function, leading to partial restoration. Given the improvement in some of your symptoms, there is room for optimism that alterations in smell will also show signs of improvement.
I hope this has helped you.
Thank you.
Patient's Query
Hello,
Thanks, doctor, for the reply.
My sense of smell has been intermittently improving again, with periods of increased intensity. Last night, smells became more distinct, and my sense of smell briefly returned to normal for a few minutes last week. While I do not experience pain or pressure, there is a faint sensation of pressure solely at the top of my head. Notably, there is no throbbing sensation, and the pressure appears localized to the olfactory region. In your experience, have you come across numerous patients who lack polyps but have still sustained permanent damage to their sense of smell?
Kindly advise.
Hello,
Welcome back to icliniq.com.
I read your query and understood your concern.
I would like to inform you that cases of patients reporting permanent loss of smell after a sinus infection are quite rare. This outcome is more commonly observed in individuals with a history of head trauma or brain lesions.
I hope this has helped you.
Thank you.
Same symptoms don't mean you have the same problem. Consult a doctor now!
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