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

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.