Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology · 2026
Smell and the sinuses: Mechanisms, evaluation, and management of olfactory dysfunction in sinonasal disease.
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Pierre Zachary, Mattos Jose L
Аннотация
BACKGROUND: Olfactory dysfunction is a common and clinically significant manifestation of inflammatory sinonasal disease.
OBJECTIVE: To summarize the mechanisms, evaluation, and management of smell loss in sinonasal disease, with an emphasis on practical clinical approaches.
DATA SOURCES: Peer-reviewed literature, consensus guidelines, and major position statements related to olfactory dysfunction, chronic rhinosinusitis, nasal polyposis, allergic rhinitis, and type 2 inflammatory diseases.
STUDY SELECTION: Relevant clinical trials, systematic reviews, meta-analyses, and guideline-based recommendations were selected based on their clinical relevance.
RESULTS: Olfactory dysfunction in sinonasal disease arises through conductive mechanisms that impair odorant delivery to the olfactory cleft and inflammatory mechanisms involving cytokine-driven neuroepithelial injury; these pathways frequently coexist. Type 2 inflammation-mediated by eosinophils, interleukin (IL)-4, IL-5, and IL-13-plays a central role in chronic rhinosinusitis with nasal polyposis and aspirin-exacerbated respiratory disease, disrupting epithelial integrity and impairing neuronal regeneration. Clinical evaluation integrates targeted history, nasal endoscopy with olfactory cleft assessment, validated psychophysical smell testing, and selective imaging. Evidence-based management includes intranasal corticosteroids, saline irrigation, endoscopic sinus surgery for medically refractory disease, and biologic therapies, which demonstrate rapid and sustained olfactory improvement with steroid-sparing effects. Septoplasty and turbinate reduction address structural contributors. Olfactory training provides additional benefit as a low-risk adjunct across etiologies.
CONCLUSION: Olfactory dysfunction is a key manifestation of inflammatory sinonasal disease that reflects the interplay between mechanical obstruction and immunologic injury. A structured diagnostic and therapeutic approach enables the identification of reversible causes, the selection of targeted therapies, and the optimization of olfactory outcomes.
OBJECTIVE: To summarize the mechanisms, evaluation, and management of smell loss in sinonasal disease, with an emphasis on practical clinical approaches.
DATA SOURCES: Peer-reviewed literature, consensus guidelines, and major position statements related to olfactory dysfunction, chronic rhinosinusitis, nasal polyposis, allergic rhinitis, and type 2 inflammatory diseases.
STUDY SELECTION: Relevant clinical trials, systematic reviews, meta-analyses, and guideline-based recommendations were selected based on their clinical relevance.
RESULTS: Olfactory dysfunction in sinonasal disease arises through conductive mechanisms that impair odorant delivery to the olfactory cleft and inflammatory mechanisms involving cytokine-driven neuroepithelial injury; these pathways frequently coexist. Type 2 inflammation-mediated by eosinophils, interleukin (IL)-4, IL-5, and IL-13-plays a central role in chronic rhinosinusitis with nasal polyposis and aspirin-exacerbated respiratory disease, disrupting epithelial integrity and impairing neuronal regeneration. Clinical evaluation integrates targeted history, nasal endoscopy with olfactory cleft assessment, validated psychophysical smell testing, and selective imaging. Evidence-based management includes intranasal corticosteroids, saline irrigation, endoscopic sinus surgery for medically refractory disease, and biologic therapies, which demonstrate rapid and sustained olfactory improvement with steroid-sparing effects. Septoplasty and turbinate reduction address structural contributors. Olfactory training provides additional benefit as a low-risk adjunct across etiologies.
CONCLUSION: Olfactory dysfunction is a key manifestation of inflammatory sinonasal disease that reflects the interplay between mechanical obstruction and immunologic injury. A structured diagnostic and therapeutic approach enables the identification of reversible causes, the selection of targeted therapies, and the optimization of olfactory outcomes.