Q. I have chronic sinusitis with smell and taste disturbance. Can it be reversed?

Answered by
Dr. Vinay S Bhat
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 19, 2019

Hello doctor,

I was diagnosed with chronic sinusitis last week. I have a very weak sense of smell and taste, tinnitus, post-nasal drip, and congestion. My sense of smell is also getting weaker for the last five days. Can chronic sinusitis permanently damage my sense of smell at this time? Or can it be reversed? I have used nasal sprays, antibiotics, and Prednisone to no avail. This has lasted nine weeks.



Welcome to icliniq.com.

Chronic rhinosinusitis is a chronic inflammation of the nose and sinuses where there will be significant dysfunction in sinus physiology. This causes swelling of the nose tissues leading to symptoms such as nasal congestion, nasal discharge, post nasal drip and heaviness of head. Decreased sense of smell or loss of sense of smell is also one of the symptoms of chronic rhinosinusitis. Disturbance in sense of smell in chronic rhinosinusitis is usually due to mechanical obstruction to the passage of air to the nerves which carry the sense of smell rather than actual injury to the nerves.

Usually, there will be recovery of sense of smell and may take a few months with treatment for rhinosinusitis. You may need to take better antibiotics such as Clarithromycin for a week, along with a repeat course of steroids. Nasal washes with saline mixed with steroid respules are also useful in reducing the swelling and improving the sense of smell.

I can say that permanent loss of sense of smell is very unlikely in chronic rhinosinusitis. Treatment of rhinosinusitis either by medicines or surgery usually brings back the sense of smell.

Investigations to be done:

CT (computed tomography) scan of paranasal sinuses, diagnostic nasal endoscopy.

Treatment plan:

Clarithromycin 500 mg once daily after food for seven days. Montair LC (Montelukast and Cetirizine) once daily in the night for a week. Wysolone (Prednisolone) 10 mg two times daily for five days. Nasowash saline washes two times daily (mix two respules of Budecort to 500 ml of solution for washing). Pan 40 (Pantoprazole) once daily before food for seven days.

Thank you doctor,

So far, I have taken 300 mg Clindamycin for two weeks and Prednisolone taper 25 mg for 14 days. I use nasal sprays two times a day and do saline rinses. None of these have worked. I have an ENT consultation in two weeks time and I am trying to get a CT scan done. I have spoken to numerous doctors about this, and they concur with what you are saying. However, I did speak with an ENT specialist who has told me that loss of smell is caused by obstruction but also inflammation which affects the olfactory mucosa. This could do permanent damage over time. This is why I am so worried about this. What is your opinion regarding that?

My sense of smell has been weakened for almost three months and I am afraid it will not recover. Another doctor told mentha olfactory receptors are dormant right now but the sense of smell will likely return at a later time. Is there any truth to what the ENT has told me?



Welcome back to icliniq.com.

Chances of permanent loss of sense of smell can occur in nasal polyposis but not in chronic rhinosinusitis. Chances of recovery are high. Till now I have not seen anyone with chronic rhinosinusitis having permanent loss of sense of smell. Probably you will recover with the present treatment itself. You need to get a CT scan to confirm chronic rhinosinusitis and MRI (magnetic resonance imaging) for the evaluation of olfactory nerve fibers and related structures.

Thank you doctor,

Can nasal polyps develop in the sinuses in nine weeks? I have yet to be diagnosed and there is a possibility that I do have polyps. Since I have a loss of smell and taste, is not this highly indicative of nasal polyps? A few doctors I have spoken too said they do not believe I do have polyps. However, one doctor said she may have seen a polyp up high in the left nostril but later said she cannot be too sure because of all the swelling. She used an otoscope.



Welcome back to icliniq.com.

Nasal polyps cannot be diagnosed by direct nose examination. You need to get a test known as diagnostic nasal endoscopy. It will show the polyps if at all there are any. CT scan alone may not diagnose polyps but when combined with diagnostic nasal endoscopy we can confirm it and also can comment about the extent of polyps and possibility of it blocking the olfactory nerves.

Thank you doctor,

Sometimes my sense of smell improves a bit. It seems to get stronger, then weaker. Is this possible with nasal polyps? Additionally, in every other acute infection I have had, my sense of smell has disappeared but still returned. I have also experienced a few hours where it does go back to normal. Also, if indeed it is polyps, should the Prednisone have had an effect on them? I took 25 mg for 14 days. There was no effect at all. I am just throwing questions out there. What do you think? In course I will have the CT scan completed soon I hope.



Welcome back to icliniq.com.

In acute infections, loss of sense of smell is purely because of mechanical obstruction and once you take medicines such as decongestants you sense of smell comes back. It is a good sign of your sense of smell is coming back once in a while. It means that nerve endings are still functional and with appropriate diagnosis and treatment they should improve.

Not all polyps respond to steroids. Some polyps are steroid resistant especially once in the olfactory area. CT scan probably would give a lot of information.

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