Importance of Smell Loss to Patients With Chronic Rhinosinusitis With Nasal Polyps: Options for Management and Recovery

TL;DR

Chronic rhinosinusitis with nasal polyps causes significant smell loss, impacting patients' lives, and treatment options like surgery and biologics may help restore smell.

Contribution

This review highlights the mechanisms and treatment efficacy for smell loss in CRSwNP, emphasizing shared decision-making in patient care.

Findings

Smell loss in CRSwNP is linked to conductive and inflammatory factors.

Biologics can improve smell after surgery in some patients.

Shared decision-making is crucial for treatment success.

Abstract

Primary diffuse type 2‐dominant chronic rhinosinusitis with nasal polyps (CRSwNP) is an inflammatory disease of the nasal cavity and paranasal sinuses associated with significant morbidity. Impaired sense of smell is a cardinal symptom of CRSwNP and one of the most burdensome for patients, impacting quality of life, mental health, and even safety. Mechanisms of smell loss in CRSwNP may be related to conductive losses due to significant burden of nasal polyps, as well as the impact of type 2 inflammatory mediators on olfactory sensory neurons. Initial medical management frequently involves intranasal or oral corticosteroids. Patients whose symptoms remain uncontrolled by medical treatment may be offered sinonasal surgery; however, patients may experience recurrence of smell loss following surgery. Guidelines recommend biologics for certain patients with CRSwNP after undergoing complete endoscopic sinus surgery, and data from clinical trials and real‐world evidence support their effectiveness in improving sense of smell. Given the impact of smell loss, shared decision‐making is important in identifying treatment options best suited to achieving patient goals. This review provides an overview of the importance of smell loss in CRSwNP and its known mechanisms, and reviews the evidence for the efficacy of current treatment options in restoring sense of smell.

Chronic rhinosinusitis with nasal polyps (CRSwNP) is a long‐term inflammatory disease of the nose and sinuses. In CRSwNP, small growths called polyps form inside the nasal passages. Symptoms include blocked and runny nose, loss of sense of smell, and facial pain or pressure. Loss of sense of smell is one of the worst symptoms for patients, and it affects their safety, mental health, and quality of life. The way that sense of smell is affected by CRSwNP is not fully understood, but there appears to be both a conductive component as well as a “type 2” immune component. Patients with loss of smell and CRSwNP are usually treated with steroids that can be applied locally in the nose or taken as a tablet. If steroids can’t control the symptoms, patients can have surgery to remove the polyps. Surgery can help, but many patients lose their sense of smell again. For some patients with CRSwNP, medical guidelines recommend biologic drugs (“biologics”) after complete sinus surgery, which can improve sense of smell. It’s important that healthcare providers work together with patients to understand what they want to achieve with their treatment, and to help find the right treatment for them.

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