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Anosmia

Checked: 23-08-2020 by Rob Adams Next Review: 23-08-2020

Overview

ENT Clinics are currently under extreme pressure as a result of COVID recovery and increased demand for appointments.

Please consider using primary care management pathways where possible and only refer patients if these options have been exhausted. When referring, please also warn patients of long waits for outpatient appointments. The ENT service kindly requests that if patients approach referrers requesting an appointment to be expedited not to ask them to ring the hospital as they will not be able to help. Only submit written requests to expedite if there is clinical deterioration or concern. Do not submit another eRS referral in this situation as these requests will be returned.

Current waits for outpatient clinics in ENT are as follows (January 2024):

Otology- 8 months
Rhinology- 6 months
Head and Neck- 5 months

Anosmia is often a self limiting symptom caused by a viral URTI.

In most cases the condition is self-limiting and will improve without treatment.

If there is an associated cause such as Rhinosinusitis then please treat with appropriate medical management.

Changes in sense of smell or taste in COVID-19

Changes in sense of smell or taste is a well recognised feature of COVID-19 infection. A study from Korea suggests that most patients will recover their sense of smell within 3 weeks (median 7 days). (1).

Some patients may experience more prolonged effects on their smell and taste. Further advice on management in primary care and when to refer can be found in the resources section at the bottom of this page.

1)Prevalence and duration of acute loss of smell or taste in COVID-19 patients J Korean Med Sci. 2020 May 11;35(18):e174

Who to Refer

Local ENT specialists advise that patients should be referred if symptoms persist for 6 weeks despite treatment (including patients with persistent anosmia following COVID-19)

Referral should be via eRS to ENT nose/sinus (outside of 2WW unless there are other red flags - see below).

Funding is not required if a referral is being made for a diagnosis. If however a benign cause for anosmia has previously been established then referral for treatment is not routinely funded and would require prior approval (see the Non Cosmetic Nasal Treatment and Sinusitis Policy).

Red Flags

Please see Head and Neck 2WW guidelines.

Refer all patients with unilateral nasal obstruction with bloody discharge via 2WW pathway.

Also consider more urgent action (admission/2WW referral/discussion with ENT registrar on call) in patients with nasal symptoms and any of the following:

unilateral symptoms
bleeding
crusting
cacosmia (perceived malodorous smell within the nose)
orbital symptoms
periorbital oedema/erythema
displaced globe
double vision
reduced visual acuity
ophthalmoplegia
severe unilateral or bilateral frontal headache
frontal swelling
sign of meningitis
neurological signs

What to do before referral

Recommended treatment would be nasal steroids for 6 weeks before referral.

The patient is likely to receive fibre optic nasoendoscopy, blood testing and probably a MRI Brain to exclude a rare brain tumour.

Please note that if no concerning pathology is identified then surgical management to treat anosmia is not routinely funded (see the Non Cosmetic Nasal Treatment and Sinusitis Policy).

Services

Referral should be via eRS to ENT nose/sinus (outside of 2WW unless there are other red flags - see below).

If you need advice please also consider the ENT Advice and Guidance service

Resources

Patient resources

NHS UK has information for patients on anosmia including links to smell testing and training resources from AbScent and Fifth Sense. It also highlights safety advice from Fifth Sense as people with anosmia may not be able to smell things like gas leaks, fires and food that’s gone off.

ENT UK has some guidelines for patients who have smell disorders following COVID-19.

Efforts are made to ensure the accuracy and agreement of these guidelines, including any content uploaded, referred to or linked to from the system. However, BNSSG ICB cannot guarantee this. This guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer, in accordance with the mental capacity act, and informed by the summary of product characteristics of any drugs they are considering. Practitioners are required to perform their duties in accordance with the law and their regulators and nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.

Information provided through Remedy is continually updated so please be aware any printed copies may quickly become out of date.