Permanent anosmia

[DiamondEagle]

All my life (or as far back as I remember) I've been anomsmic - I can't smell.

An ENT sent me for a MRI which revealed that I have a deviated septum (although it's not visible when you look at my face). The ENT's response was that "it could" be this deviated septum that is causing the anosmia. "Could..." He wouldn't commit to a definite answer. But he was willing to perform surgery anyway!

Occasionally I feel a sensation in my nose which could be some kind of smell - I don't know. I don't know what a smell smells like! I don't have any breathing problems, although one of my nostrils is usually "blocked", so I can only breathe through one side of my nose- but that's never bothered me.

I'm at the stage where I'd really like to know what the cause of the anosmia is, but where do I start? What are the chances that the procedure to straighten my septum (septoplasty) would restore some kind of ability to smell?

[DiamondEagle]

Thanks... I'd "sort of" already resigned myself to that fact already.

But is there anything in the above MRI report that specifically points to the cause of the anosmia?

And what does this mean:
"There is a focal area of gliosis demonstrated within the para hippocampal gyrus on the right and there is increased signal in the fusiform gyrus. The aetiology may be previous trauma, an area of infarction or possibly infection."

[ENTMD]

Once you've ruled out the scary stuff, and tried some steroids, there often isn't much more that can be done...Beyond treating any present inflammation or obstruction, there are no known therapies to bring this back.  Sorry.

[DiamondEagle]

Thanks. I did go for a MRI a few months back and it did not reveal any tumors. The report said:

"An axial flair and T2 weighted sequence was obtained.
A coronal flair sequence was obtained.
A T1 weighted sagittal sequence was performed.
A post contrast series was obtained.

The FLAIR coronal sequence demonstrates an area of gliosis within the parahippocampal gyrus. There is also an increase in the signal intensity within the fusiform gyrus on the right side. The grey and white matter otherwise have a normal appearance and configuration. No areas of abnormal signal are demonstrated.
No space occupying lesions are demonstrated. There are no areas of abnormal enhancement. No cerebral haemorrhage is present. The mid line is central. The ventricles, surface subarachnoid spaces are normal.
The corpus callosum is normal. The pituitary gland is normal.
The mid brain, pons and medulla are normal.
The cerebellum and cerebellopontine angles are normal.
A mucous retention polyp is present within the left maxillary sinus.
The paranasal sinuses are otherwise normal.
The orbits are normal.
No areas of abnormal enhancement are demonstrated on the post contrast scan.

There is a focal area of gliosis demonstrated within the para hippocampal gyrus on the right and there is increased signal in the fusiform gyrus. The aetiology may be previous trauma, an area of infarction or possibly infection.

No frontal lobe pathology is demonstrated."

The ENT prescribed the following for the mucous retention polyp, but it made no difference to the anosmia:

Xyzal 5 mg - 30 tablets
Medrol 16 mg - 10 tablets
Flixonase Nasules 400µg / 0.4 ml

At this stage I hit a bit of a dead end with that doctor...

What should I do next?

[ENTMD]

That's what I'm saying.

Likely congenital.  Otherwise viruses are a common culprit.  Smart to get the MRI and rule out a tumor, though.

[DiamondEagle]

I did run! Especially when he told me that I have Waardenburg Syndrome, thanks to the patch of grey hair on my forehead. That's the only symptom I have though - no hearing loss or other symptoms.

Are you saying that a deviated septum can't cause anosmia?
What else could be the cause? I've never suffered any trauma to my nose or head.

[ENTMD]

Deviated septum as the cause?  Has never been described.  I would run.