EpistemisParosmia
Specialty: Neurology.
Why it occurs
- Post-infectious sequelae of upper respiratory tract infections (persistent damage to olfactory receptor neurons with aberrant wiring during regeneration, very common post-COVID-19)
- Craniocerebral trauma with partial shearing of the fibers of the cribriform plate of the ethmoid
- Chronic exposure to toxins or inhaled industrial chemicals (solvents, acid vapors)
- Early neurodegenerative diseases (Parkinson's disease, Alzheimer's)
- Tumors of the olfactory groove (meningioma of the anterior fossa) in stages of partial compression
Initial workup
Standard odor identification test (e.g., Sniffin' Sticks test or UPSIT) to quantify the severity of the olfactory disturbance; MRI of the brain and paranasal sinuses with contrast to evaluate the olfactory bulb and tract, ruling out space-occupying processes in the anterior base of the skull.
red flags
Parosmia of new onset that progressively evolves into total anosmia associated with progressive holocranial headache predominantly in the morning, personality changes or apathy (Foster-Kennedy syndrome due to meningioma of the olfactory groove).
Standard management
- Guided olfactory training — repetitive and conscious daily exposure to essential oils of rose, eucalyptus, lemon and clove for at least 12-24 weeks, considered the most effective therapy supported by evidence
- Intranasal vitamin A in drops — experimental therapy for neuroepithelial regeneration
- Topical nasal corticosteroids (Fluticasone or Budesonide) if a local inflammatory component of the sinus mucosa coexists.
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Neurology
- Listed causes
- 5
- Treatment options
- 3