Nasal Polyposis As a Cause/Correlate of Anosmia
I asked Dr. Camnitz if polyps can form high in the nasal cavity, and if he goes up that high in the nasal cavity when he does sinus surgery. He told me yes, they can, and yes, he goes all the way up next to the cribriform plate when doing sinus surgery. In other words, he not only investigates and removes polyps from the sinuses, but also from the nasal cavity, and it is the polyps in the nasal cavity (and/or other obstructions there) that can prevent scented air from reaching the olfactory mucosa.
I also asked Dr. Camnitz if inflammation in tissues near the cribriform plate could produce anosmia by compressing the olfactory neural fibers there. He said yes, it could. He added that polyposis and inflammation of other tissues up there tend to go together -- if you have the one problem, you are likely to have the other problem too. If the inflammation is very bad and prolonged, it can cause permanent damage to the olfactory system, such that later remission of the inflammation will not be accompanied by restoration of the sense of smell. Dr. Camnitz noted that steroids both shrink nasal polyps and reduce inflammation of other tissue up there, and thus can help restore the sense of smell for those whose anosmia is caused by either of these conditions (nasal polyps and inflammation).
This discussion with Dr. Camnitz has helped me understand how sinus surgery can fail to restore one's sense of smell. Even after the polyps are removed, if inflammation is compressing the olfactory fibers and/or preventing the flow of scented air to the olfactory mucosa, the person may remain anosmic, at least after the steroids (often given before, during, and/or after sinus surgery) wear off. Of course, a person could have polyps, inflammation, and yet another problem (such as damaged receptors in the olfactory mucosa) causing anosmia, in which case removal of the polyps and reduction of the inflammation would not be sufficient to restore the sense of smell.
Links
Allergic Rhinitis -- eMedicine article
Allergies, Nasal Polyps, Air Filters, and Anosmia -- What I do to try to avoid the allergens that might aggravate my nasal disease
Dupixent -- New Treatment for nasal polyps, FDA approved in June of 2019
Endoscopic sinus surgery, Functional -- eMedicine article. Highly technical, but a a good read.
Furosemide -- This diuretic, applied intranasally, can retard the development of nasal polyps.
Genetics of Nasal Polyposis -- Could lead to more effective treatments.
Intranasal Steroids -- Putting these up your nose might help.
Leukotrienes -- Leukotrienes may be involved in upper respiratory allergies and polyposis. Salicylates increase their production in the body.
Medical vs Surgical Treatment of Polyposis -- a thesis from Karolinska Institutet, Sweden
Nasal Irrigation -- discussion of how to do it and what solution to use.
Nasal Polyposis Treatment -- Current Concepts in Therapy of Chronic Rhinosinusitis and Nasal Polyposis
Nasal Polyps -- excellent article -- pediatric emphasis, but also lots of information for the adult victim of nasal polyposis.
Nasal Polyps, Nonsurgical Treatment -- eMedicine article
Nasal Polyps, Surgical Treatment -- eMedicine article
Samter's Triad - if you have polyps, asthma, and are sensitive to aspirin, go here.
Sinusitis, Chronic, Medical Treatment - eMedicine article, mentions garlic as a decongestant
Sinusitis, Ethmoid, Acute, Surgical Treatment - eMedicine article
Sinusitis, Frontal, Acute, Surgical Treatment - eMedicine article
Sinusitis, Fungal - eMedicine article
Sinusitis, Fungal, Allergic -- eMedicine article
Sinusitis, Fungal, Non-Allergic -- note from an ENT in Rhode Island
Sinusitis, Maxillary, Chronic, Surgical Treatment - eMedicine article
Sinusitis, Sphenoid, Acute, Surgical Treatment - eMedicine article
Sinus Surgery -- Cost and experience of sinus surgery
Sinus Surgery, Functional Endoscopic -- eMedicine article
Sinus Surgery, Image-Guided -- article contributed by Michael Russell, co-moderator of the Smell Disorders Group
Steroids For Intranasal Application -- sprays, inhalers, nasules
Systemic Steroids to Reduce Inflammation -- oral and injected
Woodstoves and Nasal Polyposis -- Nasal polyposis 13 times more likely in those who heat with woodstoves (as I did for many years)
Contact Information for the Webmaster,
Dr. Karl L. Wuensch
This page most recently revised on 15-February-2020.