Loss of smell can be an indicator of a bigger issue with your sinuses.
One unique side effect of COVID-19 is a condition familiar to Otolaryngologists (head and neck surgeons more commonly known as Ear, Nose & Throat physicians). But it is something the public has only recently become aware of. It’s the loss of smell. And it’s more common than you may think.
Post viral smell loss is also known as olfactory dysfunction. It has been treated for decades. The pandemic shed light on how smell loss can drastically impact a person’s quality of life. However, there are many causes of olfactory dysfunction. These include sinus disease, trauma, toxin exposure, certain medications, radiation therapy, underlying systemic disorders, age, tumors, neurodegenerative disease, and smoking. It is important to know when symptoms such as smell loss, a runny or blocked nose, are due to something other than allergies or a cold.
The paranasal sinuses are air-filled cavities connected to our nose. They humidify and filter the air we breathe, protect the face against trauma, aid in the tone of our voice, and play a role in immunological defense. There are four sinuses on each side of our body: inside the cheek, between the eyes, within the forehead, and in the back of the nasal cavity. These sinus cavities are composed of complex drainage pathways. They are directly adjacent to important nerves, your eyes, and the brain, making it vital to address disease before it spreads to these important structures.
Olfactory dysfunction is a main symptom of chronic rhinosinusitis (CRS), along with nasal congestion, facial pain, and discolored mucus. CRS is one of the most common medical conditions worldwide, affecting 5-10% of the population. CRS is an inflammatory process of the nasal cavity lining that later causes blockage of the sinus cavities. While medical therapy can often be sufficient in treating CRS, some patients require surgery as well. The goal would be opening the sinus cavities so that topical medication can work more effectively.
While rare, tumors originating from the olfactory nerves can also lead to smell loss. Tumors in the nose can mimic some of the same symptoms as allergies or sinusitis, such as nasal obstruction or recurring infections. Warning signs of a sinonasal mass include symptoms that are only on one side of the nose or face (or unilateral), vision or neurologic changes. Clear nasal drainage, or rhinorrhea, that is unilateral and tastes salty or metallic may be a sign of a cerebrospinal fluid leak. Many of these rarer conditions originate from what we call the skull base. That is the bone that separates the nasal cavity from the brain. Technological advancements have allowed some of these disorders along the anterior skull base to be accessible entirely through the nostrils without scars or external incisions.
The diagnosis of sinonasal disease can be hard. This is because the nasal and sinus cavities are not visible from the outside, and many symptoms are vague or overlap with other conditions. If you have had any of the above symptoms for more than 3-6 months or have persistent symptoms despite treatment by your primary care provider, it may be time to see a specialist. The only way to fully examine the inside of the nose is to use a camera. This is called a nasal endoscope, and it can easily be done in an Otolaryngologist’s office. The endoscopic technique plays a major role in the care of skull base disease. However, it requires specialized training and collaboration with a neurosurgeon. Saint Alphonsus Regional Medical Center established the first Endoscopic Skull Base Team in the region, dedicated to treating these conditions.
Dr. Erin Reilly, MD is a board-certified Otolaryngologist - Head & Neck Surgeon - who is fellowship trained in Advanced Sinus and Endoscopic Skull Base Surgery at Saint Alphonsus Regional Medical Center in Boise.