This site is intended for healthcare professionals

Go to /sign-in page

You can view 5 more pages before signing in

Assessment of anosmia in primary care

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

History (1,2)

  • history of olfactory should include:
    • duration of symptoms
      • should evaluate how the disorder started, for example, suddenly, after a trauma or a (severe) cold, which then makes a post-traumatic disorder or a disorder after an upper respiratory tract infection (post-URTI), very likely
      • gradual onset and difficulties in recalling a triggering event also might suggest age-related, idiopathic disorder, or disorder due to a neurodegenerative disease
      • if the patient has difficulties recalling the exact moment the disorder began and describes olfactory fluctuations, sinonasal disorders are more likely (2)
      • patients suffering from neurodegenerative diseases also describe the smell loss as either 'gradually diminishing' or as 'gone' but rarely as fluctuating
    • taste disturbance
      • because individuals may respond differently to the olfactory impairment, it is importan to assess the impact of perceived and/or measured impairment on the patient's eating behaviors and nutritional status (2)
    • nasal discharge (mucous, purulent, cerebrospinal fluid)
    • preceding events (head trauma, recent upper respiratory tract infection/viral symptoms)
    • previous sinonasal surgery
    • use of recreational drugs (including alcohol and tobacco)
    • medication review - current and recent medication
    • chronic medical conditions (especially diabetes, renal or hepatic dysfunction, Alzheimer’s disease, and Parkinson's)
    • rhinological symptoms (facial pain/ pressure, epistaxis, nasal obstruction)
    • neurological symptoms (headaches, seizures)
    • social factors
      • loss of the ability to smell (unpleasant) odors can greatly impact personal hygiene
      • patients can exaggerate their personal hygiene, for example, by showering several times a day or excessive use of perfume or aftershave - a patient may consider that an olfactory impairment affects their relationship with their partner, friends, and family

Always consider red flag features

red-flag symptoms for olfactory dysfunction include (1):

  • unilateral nasal symptoms
  • bleeding
  • crusting/scabbing within the nasal cavity
  • cacosmia (perceived malodorous smell)
  • orbital symptoms (swelling, visual symptoms, or ophthalmoplegia)
  • severe frontal headaches
  • frontal swelling
  • the onset of new neurological/meningitic symptom

Examination in primary care

  • general examination of undertaken of the external nose for signs of trauma and gross nasal deformity;
  • examination of the entry to the nasal cavity may reveal nasal discharge, deviated nasal septum, nasal polyps or masses, foreign bodies, or signs rhinitis
  • neurological examination is guided by the history
    • cranial nerve examination focusing on the optic nerve, trigeminal nerve, and facial nerve may be indicated; fundoscopy for signs of raised intracranial pressure
    • memory assessment and examination for signs of Parkinson's disease may be indicated

Reference:

  • Deutsch PG et al. Anosmia: an evidence-based approach to diagnosis and management in primary care British Journal of General Practice 2021; 71: 135-138. DOI: https://doi.org/10.3399/bjgp21X715181
  • Boesveldt S et al. Anosmia- A Clinical Review Chem Senses. 2017 Sep; 42(7): 513–523.

Related pages

Create an account to add page annotations

Annotations allow you to add information to this page that would be handy to have on hand during a consultation. E.g. a website or number. This information will always show when you visit this page.

The content herein is provided for informational purposes and does not replace the need to apply professional clinical judgement when diagnosing or treating any medical condition. A licensed medical practitioner should be consulted for diagnosis and treatment of any and all medical conditions.

Connect

Copyright 2024 Oxbridge Solutions Limited, a subsidiary of OmniaMed Communications Limited. All rights reserved. Any distribution or duplication of the information contained herein is strictly prohibited. Oxbridge Solutions receives funding from advertising but maintains editorial independence.