What causes smell loss?

Smell loss or anosmia can be due to many varied causes, such as acute head trauma, a severe cold, chronic sinusitis, nasal polyps, neurological conditions, and rarely tumors.   An important distinguishing factor is the acuity of onset. Acute smell loss can be due to a severe upper respiratory infection or head trauma. Viruses can cause cell death of the olfactory neurons, and head trauma can shear off the olfactory nerves. Both have the potential for recovery, as olfactory nerves can regenerate, though it can take years.

Brain tumors of the olfactory groove (or anterior base of skull) can cause a gradual smell loss. These can include esthesioneuroblastoma or meningiomas – treatment would be surgical resection.

A common cause of chronic smell loss is chronic sinusitis, which through inflammation can cause swelling of the sinus mucosa, and will block the path of odor molecules to the olfactory groove. Fortunately a combination of nasal topical steroids, prednisone and surgery may be able to improve smell.

Chronic sinusitis with polyps is chronic sinusitis with more inflammation where the normal lining of the sinuses, the mucosa, becomes swollen and edematous forming small grape-like polyps. These physically block the passage of smell molecules. Surgery can help with this.

There is some data out of Stanford showing that olfactory retraining is a beneficial therapeutic option for patients with smell loss. This is a simple, cheap treatment option for patients with smell loss that Dr. Meier offers.

 

Josh Meier, M.D. F.A.R.S.

 

What are the symptoms of chronic sinusitis?

Chronic sinusitis (CRS) is defined as 12 weeks or more of two or more of the following signs and symptoms:

  • Mucopurulent drainage (anterior or posterior)
  • Nasal obstruction
  • Facial pressure or pain or fullness
  • Decreased smell

In addition, inflammation must be documented by one or more of the following findings:

  • Purulent mucus or edema in the middle meatus or anterior ethmoid
  • Polyps in the nasal cavity
  • Radiographic imaging showing inflammation in the sinuses

Traditionally chronic sinusitis is managed first with saline rinses and a topical nasal steroid. For patients that continue to have a decrement in their quality of life despite medical therapy, then endoscopic sinus surgery can be considered as an option.

 

Image Guidance in Endoscopic Sinus Surgery

Endoscopic sinus surgery is surgery that is performed using cameras through the nostrils to open up and drain the sinuses. There are no external incisions. Since its inception in the 1980s, it has advanced in leaps and bounds, allowing more extensive surgery with less complications and easier recovery. One of the keys to this advancement has been the use of “image guidance” or computer assisted surgery.

At the beginning of endoscopic sinus surgery, the surgeon will trace the outline of the patients’ face and the computer will align and fuse it with the patient’s sinus CAT scan.   There are two ways that the computer can track where the instruments are during the operation, using magnets or an infrared system. We use the Medtronic Fusion® system at both St. Mary’s and Renown. Once it has been registered, the computer screen will show the surgeon where the tip of the suction or probe is during the operation on the computer screen. This enables the surgeon to confirm his or her location within the sinuses and allow the surgeon to access more complicated structures such as the frontal sinus, the sphenoid sinus and orbital or skull base lesions.

The American Academy of Otolaryngology – Head and Neck Surgery and the American Rhinologic Society endorses the use of image guidance in endoscopic sinus surgery in following situations:

  • Revision sinus surgery.
  • Distorted sinus anatomy of development, postoperative, or traumatic origin.
  • Extensive sino-nasal polyposis.
  • Pathology involving the frontal, posterior ethmoid and sphenoid sinuses.
  • Disease abutting the skull base, orbit, optic nerve or carotid artery.
  • CSF rhinorrhea or conditions where there is a skull base defect.
  • Benign and malignant sino-nasal neoplasms.

Dr. Meier uses this technology commonly, and it enables him to address more disease safely. In the past extensive frontal sinus disease would require an external approach that has increased morbidity, however now with improved visualization, techniques and instrumentation in conjunction with image guidance, Dr. Meier is able to endoscopically treat the majority of frontal sinus disorders without incisions.

 

Josh Meier, M.D. F.A.R.S.

 

Advances in Endoscopic Sinus Surgery

Rhinology is one of the newest medical specialties with many exciting technological advances occurring in recent years. Endoscopic sinus surgery began in the 1980s, and has progressed in leaps and bounds over the ensuing decades. Dr. Meier attends multiple courses annually to stay up to date on the newest technologies employed in the medical and surgical management of chronic sinusitis and diseases of the anterior skull base.

Dr. Meier uses a combination of old and new products to ensure proper healing after endoscopic sinus surgery. He uses a new product, Posisep X, which is a dissolvable dressing made from Chitosan, a naturally occurring molecule that has hemostatic and anti-inflammatory properties. Most of the Posisep will rinse out in the week after sinus surgery.

Another product Dr. Meier uses is the Propel stent in specific cases. This is a degradable steroid-eluting stent that stays in the ethmoid cavity for one month after surgery. By delivering mometasone, it can decrease inflammation after endoscopic sinus surgery.

Dr. Meier does not use splints or non-absorbable packing after endoscopic sinus surgery and septoplasty. This is because of the mucosal-preserving techniques he uses, which reduce bleeding, and speeds up healing and recovery. When packing is not used, there is minimal pain after nasal surgery.

Under Dr. Meier’s guidance, both Renown and St. Mary’s have upgraded their endoscopy camera and tower to the Karl Storz Image One system. Video examples of this technology can be seen at the Karl Storz website. This advanced, high-definition technology has enabled Dr. Meier to perform more complicated endoscopic sinus surgery involving the skull base, the frontal and sphenoid sinuses.

Josh Meier, M.D. F.A.R.S.

New Cone Beam CT Scanner at Nevada ENT

Nevada ENT and Reno Tahoe Sinus Center are excited to announce that we have just completed installation of a brand new Carestream CS 9300 cone beam CT scanner. Our office has offered in-office CT imaging for the last 7 years, and we recently decided to upgrade to the latest technology. We can image both the paranasal sinuses and temporal bone (ear).

Your doctor will review your images with you immediately after the scan. In addition, the board-certified radiologists at Reno Diagnostic Center will review your scan and send a report to our office.

Advantages of in-office cone beam CT imaging:

  • High resolution, down to 0.09mm, for excellent imaging detail
  • CBCT radiation dose is much lower than low-dose and standard conventional CT exams (approximately 1/10 of the dose)
  • Convenience – imaging can be done in our office without a second trip to an imaging center
  • Images can be used for image-guided sinus surgery

We are pleased to offer this new technology to our patients, please do not hesitate to ask your provider for more information.

 

Josh Meier, M.D. F.A.R.S.

Update on Chronic Sinusitis

Chronic rhinosinusitis (CRS) is a condition that a large segment of the population suffers from, with a significant decrement in quality of life. Symptoms of CRS include nasal drainage, congestion, facial pain or pressure, and smell loss. Frequently nasal allergies can contribute to symptoms. In Reno, the bulk of allergy symptoms occur in the fall, when the sagebrush and rabbit brush bloom.

The first line of treatment for CRS is a saline rinse (Neilmed sinus rinse) and an over the counter topical steroid spray (Flonase, Nasocort). For most CRS patients, this will lead to a significant increase in quality of life.   For patients that do not improve, then a consultation with an otolaryngologist can be helpful, and other treatment options can be discussed.

An option for patients that continue to have symptoms, despite appropriate medical therapy, is endoscopic sinus surgery (ESS). New technology and techniques have resulted in much less discomfort and recovery after ESS. Because of my focus on mucosal preservation, there is less bleeding; as a result I do not use nasal packing or splints for patients that undergo nasal surgery.

If you have any questions about your nose or sinus health, please do not hesitate to call and schedule an appointment.

Josh Meier, M.D. F.A.R.S.

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