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Anosmia (Loss of Smell): ENT or Neurologist?

For most adults with persistent smell loss after a viral illness — including COVID-19 — an ENT (otolaryngologist) is the best first specialist. ENTs evaluate nasal passages and can guide olfactory training. A neurologist becomes appropriate when smell loss accompanies other neurological symptoms or when ENT evaluation finds no structural cause.

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What is anosmia and what causes it?

Anosmia is the complete loss of the sense of smell. Hyposmia refers to a reduced ability to smell. Parosmia is a distorted perception of smells — familiar odors become strange, often unpleasant.

The most common causes of smell loss in adults include:

  • Post-viral anosmia — the most frequent cause worldwide, significantly amplified by COVID-19. Viruses can damage the olfactory nerve endings (olfactory receptor neurons) in the nasal epithelium or cause inflammation that blocks the flow of smell molecules to the nerve.
  • Sinonasal disease — chronic sinusitis, nasal polyps, or allergic rhinitis can physically obstruct the passage of scent molecules to the olfactory epithelium, causing conductive anosmia that often improves when the underlying condition is treated.
  • Head trauma — injury can shear the delicate olfactory nerve fibers as they pass through the skull.
  • Neurodegenerative disease — Parkinson's disease and Alzheimer's disease are associated with olfactory loss, sometimes years before other symptoms appear. This is a minor but relevant consideration in older adults with unexplained smell loss.
  • Medications — some drugs, including certain antibiotics, nasal sprays (particularly intranasal zinc products), and chemotherapy agents, can affect smell.
  • Aging — the sense of smell naturally diminishes with age.

Should I see an ENT or a neurologist for smell loss?

Start with an ENT for most cases. An otolaryngologist can: - Perform nasal endoscopy to examine the nasal passages for polyps, structural obstruction, or infection - Assess for sinonasal disease (sinusitis, allergic rhinitis) that may be blocking smell molecules from reaching the olfactory epithelium - Diagnose post-viral olfactory dysfunction and initiate or guide olfactory training - Order smell testing (such as the University of Pennsylvania Smell Identification Test or the Sniffin' Sticks battery) to document the type and degree of impairment - Refer to neurology when the evaluation suggests a neurological cause

See a neurologist if: - Smell loss is accompanied by other neurological symptoms — weakness, memory problems, tremor, coordination difficulties, personality changes - Smell loss appears to be related to a head or brain injury - ENT evaluation finds no sinonasal cause and the loss does not improve - There is suspicion of a neurodegenerative condition based on age and other symptoms

For post-viral smell loss specifically — the situation most people are asking about — an ENT is the right starting point.

What is olfactory training (smell training)?

Olfactory training, also called smell training, is a structured practice that has the strongest evidence for improving smell function after post-viral anosmia 2. The approach involves repeatedly and deliberately sniffing four specific scents — commonly rose, lemon, eucalyptus, and cloves — twice daily for at least 12 weeks, and ideally longer.

The rationale is neuroplasticity: repeated stimulation of the olfactory system encourages regeneration of olfactory receptor neurons and reorganization of smell pathways. Unlike many treatments, smell training has virtually no side effects and can be done at home with inexpensive essential oils or commercially prepared kits.

Structured olfactory training is associated with measurable improvement in smell function in a meaningful proportion of people with post-viral anosmia 2. Results vary by individual and are not guaranteed — some people recover fully, some partially, and recovery can continue for 12–18 months or longer after the initial illness.

Are there medications that help with anosmia?

Current evidence does not support any medication as a reliable standalone treatment for post-viral anosmia. What may be helpful:

  • Intranasal corticosteroids — steroid nasal sprays reduce inflammation and are appropriate when sinonasal disease (polyps, sinusitis) is contributing to the olfactory blockage 1. They do not appear to directly restore nerve function.
  • Oral corticosteroids — a short course may be considered in some cases (particularly early post-COVID anosmia) to reduce inflammation, though evidence for long-term benefit is limited.
  • Vitamin A nasal drops — used in some European protocols as a potential stimulant to olfactory receptor regeneration; evidence is emerging but not yet conclusive.
  • Omega-3 fatty acids and sodium citrate nasal spray have been studied with mixed results.

Your ENT will review which interventions are appropriate based on your specific situation and how long the smell loss has persisted.

When does smell come back after a virus?

Recovery timelines vary significantly. Many people who lose smell after a viral illness — including COVID-19 — recover fully within a few weeks to months. A substantial minority experience prolonged loss (beyond 6 months), and some have persistent impairment.

Several factors appear associated with better recovery prospects: shorter initial duration of loss, younger age, and prompt initiation of olfactory training. Parosmia (distorted smell) can occur during recovery and is actually considered a sign of neural regeneration — the brain is relearning to interpret signals from regenerating olfactory neurons.

Even when recovery is incomplete, smell function can continue improving slowly for 1–2 years. There is no confirmed point at which recovery is no longer possible, which is why ongoing olfactory training is encouraged.

Common questions

Can I do smell training on my own at home without seeing a doctor?

Yes — the basic practice of structured smell training with four essential oils (rose, lemon, eucalyptus, cloves) is safe and can be started at home. However, a clinical evaluation is still worthwhile to rule out treatable sinonasal causes of smell loss, confirm the diagnosis, and provide guidance on additional interventions.

Is parosmia (distorted smell) a sign that my smell is coming back?

Parosmia often indicates that olfactory nerve fibers are regenerating but the brain's smell processing is still recalibrating. For many people, parosmia is a transition phase on the way to improved smell. It can be distressing — everyday foods may smell unpleasant or even foul — but it is generally considered a positive indicator of recovery.

Should I be worried that smell loss means something serious, like a brain tumor?

In the setting of a recent viral illness, smell loss is almost always due to post-viral olfactory dysfunction. A brain tumor or other serious cause is very unlikely without accompanying symptoms such as headache, vision changes, facial pain, or cognitive changes. If any of those are present alongside smell loss, evaluation is more urgent.

Can COVID-19 permanently destroy the sense of smell?

Permanent complete anosmia after COVID-19 does occur but appears to be uncommon. Most people with prolonged post-COVID smell loss recover at least partially over months to years. Olfactory training appears to support recovery. Ongoing research is active in this area.

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When to seek prompt evaluation for smell loss

  • —Smell loss accompanied by severe headache, vision changes, facial numbness, or confusion — these require urgent evaluation
  • —Smell loss following a head injury — should be evaluated by a clinician
  • —Smell loss in an older adult alongside memory problems, tremor, or coordination difficulty — warrants neurological assessment for Parkinson's or other neurodegenerative conditions
  • —Sudden smell loss with ear pain, drainage, or hearing changes — needs ENT evaluation

Loss of smell has many causes, most of which are benign and post-viral. This article is for educational purposes only. Gale does not directly provide ENT or neurology services, but can help you evaluate your symptoms, determine the right specialist referral, and prepare questions for your appointment.

References

  1. 1.Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, Brook I, Kumar KA, Kramper M, et al. (2015). Clinical Practice Guideline (Update): Adult Sinusitis. Otolaryngology–Head and Neck Surgery. doi:10.1177/0194599815572097 ✓Sinonasal disease (sinusitis, polyps) as a cause of conductive olfactory impairment; role of ENT in evaluation of nasal obstruction contributing to smell loss
  2. 2.Alarfaj AA, Aldrweesh AK, Aldoughan AF, Alarfaj SM, Alabdulqader FK, Alyahya KA (2023). Olfactory Dysfunction following COVID-19 and the Potential Benefits of Olfactory Training. Journal of Clinical Medicine. doi:10.3390/jcm12144761 ✓Olfactory training as the primary evidence-based intervention for post-COVID-19 smell loss; adherence to structured training is associated with improvement in olfactory function

2 sources, numbered by first appearance. General health information, not medical advice — synthetic demonstration content.