HomeAnswersOtolaryngology (E.N.T)smell and taste disturbancesWhy do I have pain and numbness in the olfactory region with a weak sense of smell and taste?
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Can rhinosinusitis cause permanent damage to the sense of taste and smell?

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The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.

Answered by

Dr. Vinay. S. Bhat

Medically reviewed by

iCliniq medical review team

Published At January 8, 2022
Reviewed AtAugust 29, 2023

Patient's Query

Hello doctor,

I have had numbness and throbbing pain around my olfactory region with a weak sense of smell and taste for the past nine months. I consulted an ENT. He did an endoscopy and said that everything was normal. There is no inflammation or mucosa thickening. He added that it could be because of ethmoids, which he cannot examine with an endoscopy. He prescribed me some medications, and now the pain has subsided, but my sense of smell and taste is still weak. Is it possible that permanent damage has been done to the sense of smell? Thank you.

Answered by Dr. Vinay. S. Bhat

Hello,

Welcome to icliniq.com.

Thanks for describing your medical history in detail. It is clear from your symptoms that you were suffering from chronic rhinosinusitis with eustachian tube dysfunction, and you responded well to nasal steroid rinses. In the case of chronic rhinosinusitis with nasal polyposis, the complete return of the sense of smell is unpredictable, and many patients do not get it back even after complete treatment or surgery. Since you had a diagnosis of chronic rhinosinusitis without nasal polyposis, there is a high chance of returning the sense of smell with continued steroid nasal rinses or changing over to steroid nasal sprays (Fluticasone spray). Chances of recovery of the sense of smell reduce if you stop the medications altogether. As far as the return of symptoms of chronic rhinosinusitis is concerned, you may require long-term steroid nasal rinses or sprays, which may even be needed for a couple of years. Many patients develop long-term remission lasting five to ten years or more after initial treatment with intranasal steroids. My suggestion to you is to discuss with your doctor regarding continuing steroid rinses or changing over to sprays that are more convenient and easy to use I hope I answered your questions. Take care.

Patient's Query

Hello doctor,

Thanks for the reply. Does the sense of smell ever return to normal? Or is it near normal? Thanks.

Answered by Dr. Vinay. S. Bhat

Hello,

Welcome back to icliniq.com.

Near normal is when you feel it is normal, but olfactory tests show a mild reduction in the sense of smell. So, recovery to near-normal is practically fine for our routine. Take care.

Patient's Query

Hi doctor,

Thanks for the reply. I can still smell; however, it is weak. I cannot smell subtle things or things in the air like the scent of a room, women's perfume. I am having difficulty determining if my sense of smell is still impaired or as good as it gets. When you mention your patients who have a mild loss of sense of smell, what sorts of things are they unable to detect? Thanks.

Answered by Dr. Vinay. S. Bhat

Hello,

Welcome back to icliniq.com.

Most of the patients who have partial anosmia complain of inability to sense the smell of of certain types of food, perfumes, the and liquid petroleum gas, gasoline, etc. Though their routine is not impaired significantly, they feel it is not like completely normal. It is almost similar in your case, I guess. Mostly the sense of smell of strong odors are fine, and sensing subtle, and mild odors will be a problem. Regards.

Patient's Query

Hello doctor,

Thanks for the reply The remaining symptoms that I have are mild tinnitus in my left ear. My ENT told me this might now be related to sinusitis. I also hear a clicking sound in my ears when I swallow. I have a sensation that the top of my nose is swollen but no pain regularly. I have a weak sense of smell too, as you know. Sometimes during the day, for a short time, I get very mild pressure in my forehead, which then goes away. I can smell stronger scents like cooking and food; however, I struggle with weaker scents. I still feel my sense of smell is impaired. Kindly help.

Answered by Dr. Vinay. S. Bhat

Hello,

Welcome back to icliniq.com.

Tinnitus and clicking sensation are due to eustachian tube dysfunction which in turn is caused by chronic rhinosinusitis. Since your treatment is not yet complete and longer duration of treatment is necessary for complete resolution of chronic rhinosinusitis, these symptoms should resolve completely as the treatment continues. Pressure over the sinuses, facial heaviness are also part of chronic rhinosinusitis symptoms, even this should resolve completely. As far as sense of smell is concerned, almost all of my patients who regained sense of smell to near normal, never felt it annoying or problematic in their life. Thanks.

Patient's Query

Hello doctor,

Thanks for the reply. I have been continuing my treatment with Budesonide for 10 months now. For those with near normal sense of smell, is there a risk for permanent damage to the sense of smell over time? Thanks.

Answered by Dr. Vinay. S. Bhat

Hello,

Welcome back to icliniq.com.

Yes, most of my patients have regained near normal sense of smell with medical treatment alone. Rest of the symptoms have gone completely after continuing treatment for for atleast ten months. Thanks.

Patient's Query

Hello doctor,

Thanks for the reply. My ear clicking is very weak now. I still have tinnitus but only in the left ear. My smell is still weak. I do not have throbbing pain but the sides of my head feel a little swollen inside. I am assuming this is near the olfactory epithelium and it is still swollen a little bit. Another ENT told me it takes time for the cytokines and inflammatory mediators in the olfactory region to lessen and disappear. She told me it can take weeks. Is that true? Thanks.

Answered by Dr. Vinay. S. Bhat
Ear clicking and tinnitus are due to eustachian tube dysfunction which will eventually resolve. Sensation of heaviness and swelling inside the nose is because of partial blockage to frontal and ethmoidal sinuses which are near to olfactory area of nose. Inflammatory mediators are responsible for that swelling and block in the sinuses. Directly they don't produce symptoms but they are responsible for inflammation in chronic rhinosinusitis.. Intranasal steroids will reduce inflammation by weakening the function of cytokines and other inflammatory mediators and inturn reduce inflammation and swelling.. So with continued treatment all those symptoms should resolve but it may not happen in few weeks but may take months

Patient's Query

Do you know why sometimes my sense of ell improves? Why does it fluctuate?
Answered by Dr. Vinay. S. Bhat
Fluctuation of sense of smell is due to variation in inflammatory changes in the olfactory area as you are using steroid nasal sprays.. It also is the sign of impending recovery

Patient's Query

For the past three days I don't have any throbbing at all in my face, not even a small one. My head feels normal except on the sides of the head at the very top. It feels a little swollen inside. Everything else feels ok but my smell is weak. My ear clicking is very weak too.
Answered by Dr. Vinay. S. Bhat
Your recovery seems to be progressing well and if this continues you should be fine within couple of months. Beware that initially there may be fluctuation of symptoms and later it will be long lasting

Patient's Query

Will the sense of smell still fluctuate or should it stabilize too?
Answered by Dr. Vinay. S. Bhat
It will stabilize eventually... Fluctuation is usually a sign of impending recovery

Patient's Query

I've just woken up. I don't have any throbbing at all. It still feels a little diseased at the skull base at the temples. It's hard to explain. I'm concerned because my ENT said that over time, sinusitis can cause damage to the sense of smell Can your patients with near normal sense of smell taste food properly?

Answered by Dr. Vinay. S. Bhat

Smell and taste are closely inter related.. As I said earlier chronic rhinosinusitis without polyposis won't cause permanent damage to olfactory mucosa. Near normal sense of smell doesn't really effect your taste but moderate to severe loss of smell can reduce taste sensation. Coming to pressure sensation over your forehead and temporal area is because of inflammation in the sinuses and as your inflammation reduces, this sensation should reduce

Patient's Query

I can still taste food flavors but more subtle flavors are hard to detect. Are you patients with near normal sense of smell still able to detect all food flavors?
Answered by Dr. Vinay. S. Bhat
Yes.. All patients who have regained sense of smell to near normal Do not complain of any taste deficits

Patient's Query

That's reassuring doctor. As I said earlier, I no longer have major pain or throbbing, however, this morning for example, I have a very mild pressure in the lower forehead. Aside from this, I feel quite good. Patients with near normal sense of smell can taste flavors normally?

Answered by Dr. Vinay. S. Bhat
Chronic rhinosinusitis with or without nasal polyposis does not involve the nerves which carry sensation of taste. Alteration in sense of taste occurs secondary to reduction in sense of smell. So as the sense of smell improves the taste also improves. Its good to know that your symptoms such as pressure and facial pain are improving

Patient's Query

You are very helpful doctor. I hope you don't mind me asking so many questions. I am an anxious patient. Today marks 2 years since symptoms began for me. Sometimes my sense of smell increases momentarily but doesn't revert to normal. For example, today a worker was using a strong glue and people complained of the smell, but I couldn't smell it at all. However, I could taste my supper tonight and was able to smell some items at home I held up to my nose. There is no throbbing left but a mild mild pressure at the temples and behind the forehead.
Answered by Dr. Vinay. S. Bhat
All my patients who have recovered never complained about any deficits in sense of taste.. Infact near normal sense of smell is usually not troublesome

Patient's Query

Do your patients complain of not being able to detect food flavours? For example they cannot taste subtle flavours of foods with slight aromas or tastes?
Answered by Dr. Vinay. S. Bhat

When the symptoms are severe and we make a clinical diagnosis of chronic rhinosinusitis without polyposis, common complaints by most of the patients are intermittent nasal congestion, facial pain, heaviness of Head, decreased sense of smell, post nasal discharge and slight reduction in sense of taste Once we start treatment and symptoms start decreasing most of the patients get relief from most of the symptoms within 6 months of starting treatment. Sense of smell is the last symptom to recover As patients start recovering from sense of smell their taste sensation also recovers. Patients who regain sense of smell to near normal don't complain of difficulty in sensing or tasting most of flavours we use daily..

Patient's Query

As of yesterday, weak sense of smell seems to be my only remaining symptom. That's why islts so concerning. It's a strange feeling. I basically feel normal and am concerned my sense of smell won't improve anymore. My ears still click when I swallow, but I have no throbbing, congestion, post nasal drip or facial pain or pressure. Will smell start to improve now in your experience? How long does it usually take smell to return after the other symptoms are gone in your practice?

Answered by Dr. Vinay. S. Bhat
As I said earlier sense of smell is last to recover and it may take even upto two years of continuous treatment for complete or near normal recovery.. As expected rest of your symptoms have recovered

Patient's Query

Does it take 2 years to recover because of damage to the olfactory nerves?
Answered by Dr. Vinay. S. Bhat

No... Chronic rhinosinusitis is a systemic inflammatory disorder and not a disorder of the nose alone. So intense inflammation and oedema around the olfactory area of nose doesn't subside easily with the treatment. That's the reason long term treatment with steroid rinses are necessary.. Two years is a maximum period I have seen for recovery... It may resolve earlier also

Patient's Query

Oh that's reassuring sorry doctor, I misunderstood you. Did you mean that it took one of your patients two years to regain their sense of smell after all the other symptoms had vanished? That's a long time. On average sir how long does it take most of your patients to improve or recover their sense of smell after other symptoms are gone? It has taken me 2 years to get to this point.

Answered by Dr. Vinay. S. Bhat
That depends on severity of disease, response to steroids, innate immunity etc. But on an average it takes around 1 year of continuous treatment. Some patients recover within 3 months of treatment also.. Some take 2 years... I have not seen anyone having significant disability because of decreased sense of smell as they can smell almost everything in daily life normally

Patient's Query

My sense of smell reverted right back to normal a couple of hours ago! Now it has gotten weaker again. Is this normal?
Answered by Dr. Vinay. S. Bhat
Yes... Such fluctuations are normal and also the proof that olfactory neuro epithelium is normal and can function normally once inflammation subsides

Patient's Query

Ok, thank you. For example, yesterday I told you my sense of smell returned to near normal for a few minutes. Once the inflammation is gone, should it stay stable at that level? That is an agreeable level of smell for me. I'd be quite content with that.
Answered by Dr. Vinay. S. Bhat

It will be stable once the recovery occurs.. There will be swelling in the sinus openings and also the area of olfactory epithelium which mechanically blocks the entry of smell to that area to some extent.. Once inflammation and swelling subsides, smell return will remain stable That's what is near normal return of sense of smell where you will be okay with the sensation of smell but when we do detailed examination of sense of smell by various tests, there will be certain subtle deficits

Patient's Query

So, I'm theory, I should be able to maintain the same strength of smell that I experienced yesterday for a few minutes consistently?
Answered by Dr. Vinay. S. Bhat
Yes... As your treatment continues, your senses of smell will remain near normal longer and longer duration and eventually will become almost normal like before

Patient's Query

Out of curiosity, what sorts of subtle deficits do you notice in your smell tests with your patients?
Answered by Dr. Vinay. S. Bhat
Smell tests are done using standardized kits with various types of smells which patients need to identify with closed eyes... Since number of smells in the test are many, some patients fail to identify rarer smells such as musk, and certain flowers... Most of them identify smells we encounter in day to day life

Patient's Query

My snese of smell improved again slightly today but only for a few minutes. It is weaker again. I couldn't taste supper yet 8 could smell certain items better. It keeps changing all the time hour to hour
Answered by Dr. Vinay. S. Bhat
That's usually a good sign... Hopefully you should regain your sense of smell to near normal or normal soon

Patient's Query

Have you encountered a lot of patients who've been able to get rid of all their symptoms but still have a weak sense of smell or do most improve and keep it?
Answered by Dr. Vinay. S. Bhat

Outcome of chronic rhinosinusitis without polyposis depends on severity of disease and response to treatment . Since yours is a milder form of disease and your response to treatment is good I expect a good outcome as far as sense of smell is concerned. Most of my patients who have similar severity of disease like yours and respond to treatment like you do, regain their sense of smell to normal or near normal

Patient's Query

It's an odd feeling only sensing a very, very mild inflammation at the top of my head but having very little sense of smell
Answered by Dr. Vinay. S. Bhat
Feeling of pressure on top of the head is due to sinus inflammation and not due to inflammation in the olfactory area. Since frontal sinus opening is near olfactory area it effects sense of smell also

Patient's Query

I don't have frontal inflammation according to my ENT. When I woke up, ear clicking is far less and extremely, extremely mild sensation of inflammation under the top of my head only. Sense of smell only remaining major symptom. Can there be a long delay between other major symptoms going away and sense of smell coming back? Thank you for 6oyr kindness and patience with me
Answered by Dr. Vinay. S. Bhat

Frontal recess inflammation is different from frontal sinus inflammation. Inflammation in the area of frontal recess is expected in most of the chronic rhinosinusitis without nasal polyposis where in report shows normal frontal sinus. There can be significant delay in regaining smell function when compared to other symptoms.. Which may even last for more than a year

Patient's Query

Do you mean it can last more than a year after all other symptoms go away? Or since time of initial diagnosis of chronic sinusitis?

Answered by Dr. Vinay. S. Bhat

As I said earlier I am talking about maximum period... It can take even a year for smell to recover completely once all other symptoms subside It may recover earlier too

Patient's Query

I see. Is this because of damage and need for receptors to regenerate or because there still could be some very fine inflammation that is undetectable and unable to cause symptoms?
Answered by Dr. Vinay. S. Bhat

On an average of 6 months from the day other symptoms resolve... It may range from 1 month to 1 year There won't be any damage to olfactory receptors and anosmia is mainly due to mechanical obstruction in the olfactory area secondary to inflammation in the nose and sinus openings. It's more like thin layer of inflammed mucosa blocking smell to reach the olfactory receptors

Patient's Query

Yes. And this is the sensation I gave now. I don't have any pain or throbbing but there is swollen tissue in the area that you mentioned. I looked us the front sinus recess. This is the only place I sense swollen tissue and some obstruction.
Answered by Dr. Vinay. S. Bhat

Since these areas are at the top of the nasal cavity (roof) and even nasal rinses don't reach that area efficiently, they don't heal easily and takes bit longer to respond with treatment So continuation of steroid nasal rinses is the only effective way to get rid of all the symptoms

Patient's Query

But it nasal rinses don't effectively reach the olfactory area, then how does it improve?
Answered by Dr. Vinay. S. Bhat
It reaches but not efficient like it reaches other areas.. And there is no simple way to make it reach there.. So when used for long term even small amount which reaches there will have effect and symptoms resolve

Patient's Query

I seem to have a lot of discomfort behind the top of my nose today. Is that normal? I kotoce sometimes before swelling gets less I experience a lot of discomfort first.
Answered by Dr. Vinay. S. Bhat
Our nose epithelium is dynamic in nature and there will be periods of swelling and reduction of swelling throughout the day which is known as nasal cycle. You feel better during the period of no swelling in the nasal mucosa. In normal individual it won't cause much of difference, but in people with chronic rhinosinusitis where there is already existing swelling, slight increase in swelling can cause significant change in symptoms

Patient's Query

Yes. Today was terrible. It felt like there was so much swelling behind the top of my nose all day. No pain or throbbing however. If I could just get rid of this final amount of swelling, I believe this will be the end of it My ENT told me I have a slighty deviated septum. He said it doesn't need surgery and he also told me all my sinus ostia are open and not obstructed. Is it fair to assume that the medication is reaching all the sinuses? I know this is hard to answer without seeing my CT, but if my ENT said sinuses are not obstructed then the budesonide should be reaching all sinuses right?

Answered by Dr. Vinay. S. Bhat
You should be better as you continue treatment. Steroid nasal rinses reach most of sinuses easily except for frontal recess and olfactory area as they are situated high up.. Also because of gravity medications do not stay there for long.. That's the reason any issues with these areas require prolonged medications

Patient's Query

Doctor I just spoke with an ENT online from Australia. He sent me a message to check in on me. I gave spoken to him in 6 months. I explained my current state to him as I gave told you. He said that he thinks it sounds like I have some degree of permanent damage to my olfactory epithelium and recovery of smell is very slim. In so wooriws now. I explained to him how my sense of smell improved last week monetarily but he still said that could happen if there's permanent damage
Answered by Dr. Vinay. S. Bhat

There can be two opinions and they can be different.. In my experience I don't see any chances of damage to olfactory epithelium in your case. I expect complete recovery if treatment is continued... Once olfactory epithelium is damaged there is no chance of temporary improvement in sense of smell... So in my opinion you should recover to normal or near normal sense of smell

Patient's Query

That's what I thought too! I told that ENT this. How could my sense of smell go back to near normal last week for a couple of minutes. Im my estimation, if it's permanently damaged, it won't be able to do this at all, correct?
Answered by Dr. Vinay. S. Bhat
Right... Once the olfactory receptors or nerves are injured you will never get back normal sense of smell or even near normal sense of smell... If you are getting back for some time is a good sign

Patient's Query

Even if it's for a minute or so? I'm sorry I'm so anxious. I don't understand why my smell is so weak and other symptoms and pain are gone
Answered by Dr. Vinay. S. Bhat
Yes... Even if it recovers for a minute also there is good chance of recovery... You need to be patient and continue nasal rinses

Patient's Query

I am definitely doing this. I was understandably upset whe. That ENT told me that there could be permanent damage. Especially when they has been intermittent improvement. Does chronic sinusitis without polyps often change to chronic sinusitis with nasal polyps? Does that occur a lot?
Answered by Dr. Vinay. S. Bhat
Chronic rhinosinusitis without polyposis and with polyposis are of different origin and don't change over as their pathology is different. I can understand your anxiety as sense of smell is a important aspect of our life. I think its matter of time it will improve to satisfactory levels

Patient's Query

I'd even been happy right now with near normal. Yes, it is extremely worrying, especially after what that doctor said to me. He said it's not common for patients with chronic sinusitis without polyps to have major damage done to their sense of smell but he has encountered it before in his practice.
Answered by Dr. Vinay. S. Bhat
There will be exceptions for all the diseases when it comes to recovery. But such cases are rare.. So in large majority of patients with chronic rhinosinusitis without polyposis complete recovery or near normal recovery is expected

Patient's Query

I guess I can't totally worry until my ethmoid sinuses feel exactly 100 percent clear like my maxiallary sinuses. I would say ethmoids for about 80 percent normal. Still an odd tingling or inflammatory feeling in the ethmoids although there's no pain there
Answered by Dr. Vinay. S. Bhat
Yes... Ethmoid and frontal recess are near the olfactory epithelium... Once there is reduction in inflammation in these areas, sense of smell should improve significantly

Patient's Query

Is it possible to have inammation there without any major pain? It's hard to explain. It feels normal but tingling or a very mild discomfort.
Answered by Dr. Vinay. S. Bhat
Chronic inflammations are rarely painful... Chronic rhinosinusitis causes long standing low grade inflammation of sinus and nasal mucosa... So symptoms will not be severe but mild to moderate but long standing

Patient's Query

Does the inflammation eventually go away?
Answered by Dr. Vinay. S. Bhat

Chronic rhinosinusitis itself means chronic inflammation of nose and sinus mucosa. So there will be inflammation in both types of chronic rhinosinusitis. Polyps can mechanically press upon olfactory area and can cause permanent damage which does not happen when there are no polyps Chronic rhinosinusitis is thought to be a systemic inflammatory disorder with no involvement of any bacteria. So steroid nasal rinses which otherwise is not used for bacterial or viral infection is the treatment of choice in chronic rhinosinusitis.. So steroid nasal rinses are the only effective way of treatment of this condition which is safe when used for long term With steroid nasal rinses inflammation will eventually subside. Sometimes in cases where there is no improvement with rinses and CT scan shows moderate to severe disease functional endoscopic sinus surgery is performed and after surgery steroid nasal rinses are continued.. Since you have responded well to initial treatment with steroid rinses, surgery is not required

Patient's Query

My sense of smell increased again last night for 10 minutes. I was smelling some items and they increased in intensity and detail. Now it has gotten weak again
Answered by Dr. Vinay. S. Bhat
If such events occur very frequently, then it's good sign and Probably recovery will occur soon...just continue the treatment

Patient's Query

Yes doctor. I notice that there is a very mild pressure on the top of my head just above where the olfactory epithelium area is. This occurred last night and again this morning when I applied the budesonide rinse. Is it fair to say that this area is still slightly diseased? With time I hope this final area of the disease feeling goes away. It doesn't hurt, it just feels like a mild, mild pressure

Answered by Dr. Vinay. S. Bhat
That area around olfactory epithelium is a most difficult area for steroid rinses to act.. As you continue using rinses eventually inflammation and your symptoms should improve with whatever minimal amount of budesonide which reaches that area

Patient's Query

For example, if I hold something under my nose, I can smell it and it smells as it should. Some things smell a little weaker than I remember, however, sometimes their intensity increases momentarily. I can also smell food cooking in the air. I work at a school and other scents further away from me are very difficult to detect. I cannot smell perfumes of students in the balls, body odor, scents of classrooms, etc. *halls not balls

Answered by Dr. Vinay. S. Bhat
Any odour which is strong and when kept near the nose, some receptors can capture the smell and send signal to brain. Because of inflammation only few receptors will be functioning and rest of them will be covered by inflammed mucosa or mucous cover. When odour is weak then functioning receptors can't perceive that... Once oedema and Inflammation subsides remaining receptors will also get exposed to odour and smell can be perceived from distance

Patient's Query

Smells have been improving under my nose. Their intensity gets stronger. Have you had many patients who can smell under their nose but can't get smells further away back?
Answered by Dr. Vinay. S. Bhat
It's a common phenomenon when there is physical obstruction to olfactory neuro epithelium, which is a reason for decreased sense of smell in chronic rhinosinusitis without polyposis

Patient's Query

Oh, I see. So it isn't usually due to physical damage? I have a very sought congestion at the top of my nose. When I try to blow there feels like some mucus trapped but there is no pain or throbbing. It's similar to a cold although I can breathe through my nose fine.
Answered by Dr. Vinay. S. Bhat

Chronic rhinosinusitis produces excessive mucous which usually reduces once you start treatment with steroid rinses. But inflammation in the area of olfactory mucosa because of its position doesn't reduce so easily, so all you symptoms are related to existing low level of inflammation in and round the area of olfactory epithelium In case of physical damage, your sense of smell atleast for some odours will be lost permanently even if that smell is close to your nose . In your case you can still perceive smell so that means there is no physical damage but physical obstruction for odour to reach olfactory receptors efficiently

Patient's Query

Yesterday, my sense of smell increased very slighty all day long. I noticed some things tastes more like they should. Eventually, should the slight feeling of stinging and odd feelings in my ethmoids eventually go away?
Answered by Dr. Vinay. S. Bhat

Maxillary sinus has only one opening and its a large sinus, so medicines work very well for this sinus.. Ethmoid is a group of multiple sinuses with multiple openings.. So it's difficult for rinses to enter this sinus efficiently... That's the reason it takes longer duration of treatment for ethmoid inflammation Your sense of smell seems to be improving frequently and also seems to be staying for longer duration.. This is a very good sign and Probably sign of impending long term recovery

Patient's Query

Can your patients who have a near normal sense of smell smell things that are in the distance or more that 12 inches from their nose like their own body odor, scent of outside air, scents of rooms, people's perfumes, etc? I still can't do that.
Answered by Dr. Vinay. S. Bhat
Yes... They can smell almost everything normal except for some very mild and uncommon odours which are not really important in our daily life

Patient's Query

Food seemed to improve again today very slightly. It is very slow going but the past few days there seems to be a very slight slight improvement
Answered by Dr. Vinay. S. Bhat
Such events are always a good sign and will become more and more frequent.. Also they start staying for long... I think significant improvement can be expected in next one month

Patient's Query

I don't have any more pain at all. I have a very mild congestion feeling at the top of my nose. When I blow gently, there is some mild obstruction at the top of the nose although I can breathe through it fine.
Answered by Dr. Vinay. S. Bhat

Since ethmoid are situated near the roof of the nose, inflammation in that area won't cause any nasal obstruction.. Symptoms would be sensation fullness in that area and also smell deficits.. Since it's situated in the roof, medications also won't work so easily.. Since you are using medications for many months now, ethmoid inflammation is slowly reducing and day by day your symptoms are improving and will improve further

Patient's Query

Hi doctor, today wasn't such a good day. Smell was very weak again although I could somewhat taste my dinner. My ear clicking is, for the most part, gone. Only tinnitus and weak smell. I have the weakest amount of pressure behind my nose.
Answered by Dr. Vinay. S. Bhat
I think your sense of smell and taste is getting better and better everyday and hopefully would sustain in coming days

Patient's Query

I hope so. It's very odd when the other symptoms are 95 percent gone and my smell is still weak
Answered by Dr. Vinay. S. Bhat
This is the way symptoms resolve in chronic rhinosinusitis without polyposis.. Reason being the situation of olfactory area and surrounding structures which makes it difficult to access for medications to reach

Patient's Query

Yes. I know. I just hope I'm on the right track for recovery. Most of your patients go through a phase where all symptoms are more or less gone but smell needs time to resolve?
Answered by Dr. Vinay. S. Bhat
Yes... Most of the patients go through similar phase in recovery... Few patients take very long time for recovery of sense of smell

Patient's Query

I've just woken up for my day. There is a very vague pressure behind the top of the nose but no pain or throbbing I will not worry until that final vague pressure is gone. For example, I can smell things under my nose. I can smell spiced, perfumes, food, deodorant, etc. There is nothing I cant smell really. However, except for food cooking, I cannot smell other scents further away in the air such as people wearing perfume, grass, scent of the air, etc.

Answered by Dr. Vinay. S. Bhat
Only area of nose where inflammation and oedema is still left over seems to be ethmoid and olfactory area, as I have explained earlier its going to take sometime to recover due to the situation of these structures in the roof of nasal cavity and medications won't really reach in adequate quantities like all other parts of nose.. And there is no way to make them reach there... So long term rinses are the only way out

Patient's Query

Yes true doctor. I am sorry for being a bit of an impatient patient. I must stay vigilant for now. My smell increased again tonight briefly. It had done so briefly over the past 7 or 8 days. My ear clicking is almost gone except after a rinse I get a squishing of water in the ear that disappears over time. Will there be periods in chronic sinusitis without polyps where there will be no inflammation at all provided I continue medications or is inflammation a perpetual ongoing symotom?
Answered by Dr. Vinay. S. Bhat
Yes. Chronic rhinosinusitis without polyposis is curable with medications or sometimes surgery for people who do t respond to medications. There can be recurrent attacks in future but its not predicable.. Even in case of recurrent attacks, treatment needs to be started early so that the recovery occurs fast

Patient's Query

And your patients with near normal sense of smell are able to smell scents further away from them like ambient scents such as scents of rooms, people's perfumes in the air, body odor, scent of outside air, grass etc?
Answered by Dr. Vinay. S. Bhat
Yes... They can smell them almost normal.. I cant say that they can smell every smell but they don't complain about any significant deficits

Patient's Query

Could the fact that I can smell most things under my nose but still struggle with scents around me such as scents of rooms, body odor, outside air, inside 9f my car, etc be suggestive of permanent damage?
Answered by Dr. Vinay. S. Bhat
Permanent damage would cause loss of sensation to odours from any distance.. Faint smells have less number of odour particles which don't find adequate number of receptors to stimulate and perceive smell by the brain.. Inflammation and oedema are the common conditions which can lead to such problem..

Patient's Query

Yes. When my symotoms were bad and I had severe throbbing and congestion, I could justify this. Now, however, because I don't have pain or throbbing, it becomes worrisome because I start to believe I have damage. It is possible to still have some oedema and inflammation that I can't detect really that could still be affecting my sense of smell? Even a month ago, I woke up with some mild throbbing in my head. I wasn't worried as much because I told myself it was swelling. Now, I wake up without any throbbing or pain and I get worried because I think that I'm better but smell isn't coming back. There are some times during the day for an hour where the roof of my nose feels strange however and not quite right. I guess this still could be some residual inflammation that has to clear and restore smell.
Answered by Dr. Vinay. S. Bhat
Definitely it's because of residual inflammation... Permanent damage to olfactory neuro epithelium won't have any sense of fullness.. You will be completely normal apart from decreased sense of smell.. Logical explanation for your symptoms is inflammation and oedema causing mechanical obstruction for faint smell to reach the area of olfactory epithelium

Patient's Query

But when I wake up, I no longer have any sense of fullness. Sometimes during the day, I get an odd feeling of numbness or inflammation on the front part of my face at the skull base but then it goes away. Here is how my day usually goes. When I wake up, I try smelling some items. I can smell nail polish, coffee, lemon scented wipes, peanut butter, garlic, etc when it is under my nose. Sometimes, I can smell the strange synthetic scent of my facemask. When I go to school, however, (I am a teacher), I cannot smell anything. I can't smell scents in the hallways of girls perfumes, body odor etc or the typical scents one encounters during the day. Most of the day is blank. I can smell things under my nose but sometimes they do not smell as strong as I remember them. When I come home, and enter the door, sometimes I smell food cooking. This is the first scent after a long day of nothing. When I eat, I can taste the food for the most part but struggle with fainter tastes of flavour.

Answered by Dr. Vinay. S. Bhat
Inflammation in the sinus changes as per the nasal cycle..there will time where in oedema increases and there will be some time in a day where oedema decreases so will be your symptoms. Very obviously you have a smell deficit which is troubling you, fluctuates throughout the day which is expected in this disease.. There is no easy way out of this condition.. Steroid nasal rinses are the only working therapeutic option..my suggestion would be to continue treatment and not to worry much about permanent damage to olfactory mucosa as its chances are very minimal

Patient's Query

Do you think I have a good chance to recover near normal smell?
Answered by Dr. Vinay. S. Bhat
Analysis of your symptoms suggests very good chance of complete or near normal recovery of sense of smell in the future as the treatment continues

Patient's Query

Yesterday, I had no symptoms alexcept weak smell and weak clicking in the ears. There was no pain, throbbing or anything else. I felt completely normal until the end of the day. There is still some inflammation at the roof of the nose, but it is so faint and weak I had to be completely still and concentrate to sense it. It even isn't a throbbing but hard to explain. For a moment, my sense of smell increased slightly. But it only lasted a minute. I still cannot smell things far away from me. Should this resolve in time? I read in a medical report that only 40 percent of chronic sinusitis patients regain normal sense of smell but that with full control the sense of smell should only be slightly impaired if full normal sense of smell cannot be achieved and that sense of smell usually shows a good chance of improvement. Do you have patients with a long delay in between resolution of other symptoms but regaining smell in chronic sinusitis without polyps?
Answered by Dr. Vinay. S. Bhat

I have not seen anyone with worsening in sense of smell... There were few patients who complained of persistent nasal congestion and decreased sense of smell inspite of long term treatment who eventually underwent surgery and recovered. In them CT was showing significant disease and surgery was given as an option before medications were started. All of our patients with severity of disease similar to yours have recovered completely or atleast to near normal sense of smell with medications alone Sensation of fullness is due to ethmoid inflammation and that will resolve completely. Clinical studies are done with standard smell identification tests and results are published. Near normal improvement of smell though may appear normal to you but those tests will show some degree of smell loss.. So results of such studies are published as complete recovery in only less number of patients in study population. Our intention of treatment is atleast near normal recovery of sense of smell if not complete recovery which is expected in most of the patients we treat. Time taken sometimes may go upto year or more

Patient's Query

Something interested happened. About two hours after my rinse, I felt a strange pressure along the ridge of my skull near both temples. I swallowed a large amount of mucus. Is this the sinuses draining? There is no pain or throbbing though.
Answered by Dr. Vinay. S. Bhat
Usually it takes about 3 months for most of the patients... Some patients have recovered earlier too... Few have taken 1 year plus few months

Patient's Query

Ok that's good then. I was worried for a bit. I'm just worried since except for ears, smell is the only remaining symptom. When I do a rinse, there is a very, very, very faint throbbing. So faint it's hard to tell it there. It lasts 10 minutes and gone
Answered by Dr. Vinay. S. Bhat
Throbbing sensation while you rinse is a normal phenomenon because of irritation of sensory receptors in the nose ans happens to everyone.. It's not a sign of inflammation

Patient's Query

I seem to have made more progress yesterday. There was a swollen tissue sensation behind the top of my nose when I blew my nose. That seems to be gone too now. My right nostril has a little bit of it still but my left nostril is entirely clear now
Answered by Dr. Vinay. S. Bhat
That's how recovery is observed after starting treatment.. Many times it will be temporary but eventually it will recover completely

Patient's Query

So, there should be absolutely no symptoms if chronic sinusitis without polyps is fully controlled?
Answered by Dr. Vinay. S. Bhat
Yes.... Except for minimal reduction in sense of smell in some patients which practically won't be worrying for your day to day life

Patient's Query

Do some of your patients with chronic sinusitis without polyps recover their full sense of smell?
Answered by Dr. Vinay. S. Bhat
Most of them do receiver except few who will have very minimal loss of sense of smell which won't be noticeable in day to day life

Patient's Query

You mean patients with kiminal reduction of smell don't notice unless specific testing is done?
Answered by Dr. Vinay. S. Bhat
Yes.... That's right

Patient's Query

Oh that's very reassuring then. As of the past day I've had no symptoms but weak smell and mild ear clicking. It's concerning if it will ever come back
Answered by Dr. Vinay. S. Bhat
No... Such small fluctuation in symptoms is not really a problem.. It's going occur during treatment period.. Major symptoms such as significant heaviness of Head or post nasal discharge if they reccur then it's matter of concern

Patient's Query

Should I be concerned my major symptoms are gone yet my sense of smell hasn't improved yet?
Answered by Dr. Vinay. S. Bhat
It's not a matter of concern.. If major symptoms return then the treatment is going to continue for much longer

Patient's Query

What I mean is, because the other major symptoms are gone, could this be a sign my sense of smell is permanently damaged?
Answered by Dr. Vinay. S. Bhat

Major symptoms always go first and their disappearance gives significant relief which is necessary when we start treatment for chronic rhinosinusitis without polyposis, and this always proves that medications are working as expected. Minor symptoms like smell loss, mild heaviness and stuffiness always take longer duration of treatment and do not suggest permanent damage to any structure Major symptoms always go first and their disappearance gives significant relief which is necessary when we start treatment for chronic rhinosinusitis without polyposis and this always proves that medications are working as expected. Minor symptoms like smell loss, mild heaviness and stuffiness always take longer duration of treatment and do not suggest permanent damage to any structure

Patient's Query

Today, about an hour after my rinse, I felt some mild pressure in my temples. Then I swallowed some mucus. There was no pain or throbbing. I still have some disease that I couldn't sense. Should I be concerned about this?
Answered by Dr. Vinay. S. Bhat
Not at all.. Nasal rinsing is not an easy process for our sinuses.. It causes temporary blockage of sinuses and thus the pressure sensation in the sinus areas, once water gets cleared its for steroid to act on nasal/sinus mucosa to reduce inflammation. Such sensation after rinsing can be considered normal

Patient's Query

I see. My sinuses feel normal except for an odd feeling near the temples. I'm not congested but it still feels a little odd behind the top of the nose.
Answered by Dr. Vinay. S. Bhat
Ethmoids and frontal sinus opening (frontal recess) are in close relation.. Any inflammation in that area causes blockage of ventilation to frontal sinus causing mild pressure sensation, though frontal sinus CT will be normal..

Patient's Query

Have you had a lot of patients who have been able to control inflammation in their maxiallary sinuses and some in their ethmoid sinuses but are unable to control a little bit of inflammation in the ethmoid sinuses? I'm becoming concerned that I won't be able to get rid of this remaining amount. There is not pain, but a very faint strange feeling in the ethmoids. Like it isn't 100 percent normal. Maybe 90 percent normal. If I stay really, really still, there is a faint throbbing in the ethmoid sinuses in the frontal recess. It doesn't hurt. It's hard to explain. Should I be able to eridicate this remaining amount?
Answered by Dr. Vinay. S. Bhat

Chronic rhinosinusitis is fairly a common condition and patients come with variety of symptoms and severity. Some will require surgery and most of the patients with milder disease do well with medical line of management. Most of the patients with milder disease do very well with treatment and do not complain of any significant symptoms. Many may not feel those subtle symptoms as significant or they are not really bothered about such symptoms but when asked they say they are normal. As far as sense of smell is concerned most of them do very well and as per patients history they do not seem to have any smell deficits after complete treatment. Inspite of asking leading questions my patients say they are normal smell sensation

Patient's Query

I'm worried that I won't be able to clear this remaining bit of inflammation which is affecting my sense of smell although I have responded to treatment very well.
Answered by Dr. Vinay. S. Bhat
It's always frustrating when some symptoms do not subside completely. Many of the patients also express the same But patience is the key here. You have to continue treatment and never loose hope as chances of complete recovery is very high

Patient's Query

So it is therefore rare to not be able to clear all symptoms? I woke up with no pain of throbbing. I just did a nasal rinse. There is no pain or pressure but there is a very, very faint throbbing near olfactory mucosa.

Answered by Dr. Vinay. S. Bhat
Yes, it's rare to see someone with milder disease not to recover completely.. Your remaining symptoms are suggestive of persistent mild /subtle inflammation remaining near olfactory area which should improve in future

Patient's Query

It's such a tiny bit left. Could it be possible that I'm able to get rid of this tiny bit of inflammation but my sense of smell still remains weak? Have you seen many patients like that?
Answered by Dr. Vinay. S. Bhat
That's very unlikely.. I have not seen any patient with chronic rhinosinusitis without polyposis and ith milder disease like yours having permanent smell loss.. I have seen patients who take long duration to recover but never permanent smell loss

Patient's Query

My biggest concern is that I won't be able to control this remaining bit of inflammation. Have you encountered many patients who were able to control most inflammation with medication but needed to have surgery for the remaining amount?
Answered by Dr. Vinay. S. Bhat
We never do surgery for mild symptoms and mild inflammation. Surgery doesn't guarantee complete cure and may be counter productive. Such mild inflammation usually resolves with continuation of treatment but may take some time.

Same symptoms don't mean you have the same problem. Consult a doctor now!

Dr. Vinay. S. Bhat
Dr. Vinay. S. Bhat

Otolaryngology (E.N.T)

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