The evaluation and management of olfactory disorder following upper respiratory tract infection

Anosmia following URTI is acute and often complete at onset. A thorough history and physical examination is usually all that is necessary to rule out other significant pathologic conditions. If the onset of anosmia is sudden and follows a URTI without a history of trauma, then other significant causes of anosmia are unlikely. The physical examination should focus on the intranasal anatomy with and without vasoconstriction. Nasal endoscopy will rule out any intranasal disease such as polyps or tumors. The Pennsylvania Smell Identification Test will confirm anosmia objectively. Neurological evaluation, including cranial nerve testing, will detect abnormalities suggestive of intracranial disease. If any other neurological abnormalities are discovered on examination, then an MRI is the next logical step in the workup of a central nervous system lesion. Patients should be counseled on their disability and the need for working smoke and gas detectors, as well as other quality of life issues.