title: The optimal evaluation and management of patients with a gradual onset of olfactory loss.
abstract: OBJECTIVE
  The aim of this review is to provide an overview of the causes of olfactory dysfunction, their evaluation and management, with a main focus on the gradual/progressive loss of smell.
  
  
  RESULTS
  As the sense of smell gives us essential information about our environment, its loss can cause nutritional and social problems while threatening an individual's safety. Recent surveys have shown quite a substantial prevalence of hyposmia (one out of four people) and anosmia (one out of 200 people) in a variety of populations.
  
  
  CONCLUSIONS
  Nasal inflammatory diseases such as allergic rhinitis and predominantly chronic rhinosinusitis account for the major and common causes of gradual/progressive loss of smell. However, they are also among the most successfully treated forms of olfactory dysfunction. The management of gradual/progressive smell deficit must always address its etiological causes. In most cases, a detailed medical history and nasal examination, smell testing, and imaging will help to establish an appropriate diagnosis. In addition to anti-inflammatory therapy, mainly nasal and systemic corticosteroids, recent investigations on smell training suggest that the controlled exposure to selected odors may increase olfactory performance.
  
  
  BACKGROUND
  See the Video Supplementary Digital Content 1 (http://links.lww.com/COOH/A8).
authors.affiliation: aRhinology Unit and Smell Clinic, Otorhinolaryngology Department, Hospital Clínic, Barcelona, Catalonia, Spain bOtorhinolaryngology Department, Hospital Regional PEMEX Salamanca, Guanajuato, México cClinical & Experimental Respiratory Immunoallergy, Institut d'Investigacions Biomèdiques August Pi I Sunyer (IDIBAPS), Barcelona, Catalonia, Spain.
authors.forename: Karla
authors.initials: K
authors.lastname: Enriquez
authors.forename: Eduardo
authors.initials: E
authors.lastname: Lehrer
authors.forename: Joaquim
authors.initials: J
authors.lastname: Mullol
mesh_terms: D018450:Disease Progression; D006801:Humans; D000857:Olfaction Disorders / Q000175:diagnosis* / Q000628:therapy*