From the Guidelines
To improve olfaction, or the sense of smell, it is essential to address the underlying causes of smell impairment, which can include chronic rhinosinusitis (CRS), nasal polyps, and other inflammatory conditions, and treatment may involve a combination of medical and surgical interventions, as well as the use of olfactory tests to monitor progress, as recommended by the European position paper on rhinosinusitis and nasal polyps 2020 1. The most effective approach to improving olfaction will depend on the individual's specific condition and the severity of their smell impairment.
- For patients with CRS, treatment with systemic corticosteroids, such as oral prednisolone, has been shown to improve smell in some studies, including a study by Ecevit 2015 1, which found that prednisolone significantly improved smell in patients with bilateral CRSwNP.
- In addition to medical treatment, surgical interventions, such as endoscopic sinus surgery, may also be necessary to remove nasal polyps or other obstructions that are contributing to smell impairment.
- Olfactory tests, such as the UPSIT or Sniffin'Sticks, can be used to assess the severity of smell impairment and to monitor progress over time, as recommended by the European position paper on rhinosinusitis and nasal polyps 2020 1.
- It is also important to note that smell loss has been reported in 60 to 80% of CRS patients, and that olfactory impairment is significantly worse in patients with CRSwNP, as stated in the European position paper on rhinosinusitis and nasal polyps 2020 1. Some key points to consider when evaluating and treating smell impairment include:
- The use of rigid endoscopy to visualize the nasal cavity and to identify potential causes of smell impairment, such as nasal polyps or tumors.
- The importance of assessing smell subjectively and objectively, using tests such as the UPSIT or Sniffin'Sticks, to determine the severity of smell impairment.
- The potential benefits of treatment with systemic corticosteroids, such as oral prednisolone, in improving smell in patients with CRS.
- The need for surgical intervention, such as endoscopic sinus surgery, to remove nasal polyps or other obstructions that are contributing to smell impairment.
From the Research
Improving Olfaction
To improve olfaction, or the sense of smell, several methods can be employed:
- Nasal douching, also known as nasal washout, irrigation, or lavage, can help clear mucus and allergens from the nose, which may improve the sense of smell 2.
- Saline nasal irrigation has been shown to possibly have benefits for relieving symptoms of acute upper respiratory tract infections, which can affect the sense of smell 3.
- Treating allergic rhinitis with second-generation antihistamines may also help improve olfaction by reducing symptoms such as congestion and runny nose 4.
- Nasal saline irrigation can be used as a prophylaxis for airway-infections and to enhance the health of the nasal mucosa, which may also improve the sense of smell 5.
- Managing antihistamine impairment in patients with allergic rhinitis is crucial, as some antihistamines can produce sedation, impairment, and reduced quality of life, including decreased sense of smell 6.
Methods for Nasal Douching
Nasal douching can be performed using:
- A home-made solution made with common household ingredients, which is considered equally safe and effective as ready-mixed products 2.
- Ready-mixed products, which can be more expensive but may be easier to use 2.
- Nasal douching can be performed 10-20 minutes before using a corticosteroid nasal spray to increase the efficacy of the treatment 2.
Precautions and Considerations
When using nasal saline irrigation, it is essential to: