ear, nose, and throat disorders
Loss of Smell
Evaluation of Anosmia
The following information can help people decide whether a doctor's evaluation is needed and help them know what to expect during the evaluation. The following findings are of particular concern: Recent head injury Symptoms of nervous system dysfunction, such as weakness, trouble with balance, or difficulty seeing, speaking, or swallowing Sudden start of symptoms Local or global outbreak of COVID-19 People who have warning signs should see a doctor right away. Other people should see a doctor when possible. Doctors first ask questions about the person's symptoms and medical history and then do a physical examination. What doctors find during the history and physical examination often suggests a cause and the tests that may need to be done (see table). Doctors ask when and how anosmia started and how long it has lasted. They also ask whether it started before or shortly after a cold, bout of flu, or head injury. They note other symptoms such as a runny or stuffy nose and whether any nasal discharge is watery, bloody, thick, or foul-smelling. Doctors check for neurologic symptoms, especially those that involve a change in mental status (for example, difficulty with short-term memory) or the cranial nerves (for example, double vision or difficulty speaking or swallowing). Questions about the person's medical history involve sinus disorders, head injury or surgery, allergies, medications and illicit drugs used, and exposure to chemicals or fumes. During the physical examination, doctors inspect the nasal passages for swelling, inflammation, discharge, and polyps. Doctors also do a complete Neurologic Examination that is particularly focused on mental status and the cranial nerves. To test smell, doctors hold common fragrant substances (such as soap, a vanilla bean, coffee, and cloves) under the person's nose, one nostril at a time. The person is then asked to identify the smell. Smell can be tested more formally with standardized commercial smell test kits. One kit requires the person to scratch and sniff many different smell samples and try to identify them. Another kit contains diluted samples of a smelly chemical. Doctors see how dilute the sample can be before the person can no longer smell the chemical. If COVID-19 is suspected, viral testing is done, and the person is managed according to local protocols, including isolation guidelines. If there is no clear cause of anosmia, Computed Tomography (CT) (CT) or 