If you’ve lost your sense of smell (anosmia), you’re probably curious about treatment options—especially whether steroids could help you. The latest research offers some clear insights. In this article, we will explain what causes anosmia, how it’s treated, and who’s most likely to benefit from steroid therapy. We’ll also cover how your sense of smell works, what can disrupt it, and what to try if steroids aren’t the answer for you.

What is anosmia, and why does it happen?

Anosmia is the medical term for losing your sense of smell. It can be temporary or permanent, and either acquired or congenital (present from birth).¹

How do we normally smell?

The olfactory bulb is a part of the brain that is responsible for detecting odour signals. These signals then pass through key areas like the piriform cortex, amygdala, and hippocampus to be processed. Any disruption, whether mechanical, neurological, or inflammatory, along this pathway can cause anosmia.

Common causes include

• Inflammatory and Obstructive Disorders: Nasal polyps, allergic rhinitis, and chronic sinusitis cause 50–70% of anosmia cases³
• Infections: Viruses, especially COVID-19, can trigger a sudden loss of smell²
• Head Trauma: Injuries to the face or skull may damage olfactory nerves or block airflow
• Neurodegenerative Disorders: Smell loss may precede Alzheimer’s, Parkinson’s, or Lewy Body dementia⁴
• Ageing: It's normal for your sense of smell to get weaker as you get older.
• Congenital Conditions: Like Kallmann or Turner syndrome
• Toxins and Medications: Smoking, exposure to chemicals, or certain drugs (e.g., beta-blockers, ACE inhibitors) may impair smell. Of course, if this applies to you, we don’t recommend that you discontinue your drugs without a medical professional's opinion⁵
• Other Medical Conditions: Diabetes, hypothyroidism, subarachnoid haemorrhage, tumours like olfactory groove meningiomas

How steroids work in treating anosmia

Steroids work by reducing inflammation in the nasal and sinus tissues, particularly useful when anosmia is caused by conditions like allergic rhinitis, sinusitis, or nasal polyps.

Types of steroids used

• Topical (nasal spray): Budesonide, fluticasone
• Systemic (oral): Prednisone, used short-term to test responsiveness

Steroids may also help restore olfactory neuron function, though the exact mechanism isn’t fully understood. When inflammation is the root cause, these medications can offer dramatic improvement.

Who benefits most from steroids?

Steroid responsiveness varies widely depending on the cause of anosmia. Here’s what studies show:

• Best Responders: Studies say patients with chronic rhinosinusitis and nasal polyps usually notice the biggest improvements⁶
• Moderate Responders: Those with allergic rhinitis might benefit to a lesser extent⁷
• Limited Responders: People with post-viral or long-COVID smell loss often show poor or no response, and they might need a longer duration of treatment

Other influencing factors include how soon treatment is started, dosage, and the degree of inflammation in the nasal tissues.

What the research says

A study in The Laryngoscope studied 299 patients with olfactory dysfunction. Here’s what they found:

• Steroid Experiment: All patients first received oral steroids. Their smell function was assessed using a TDI (Threshold, Discrimination, Identification) score⁷
• Two Groups Emerged:
  • Steroid-Responsive Anosmia (SRA): TDI improved by ≥6 points
  • Non-SRA: No significant improvement

Afterwards, all patients received topical budesonide, alone or with neomycin (an antibiotic). Surprisingly:

• Non-SRA patients improved more from topical treatment than SRA patients.
• Adding antibiotics gave even better results in the non-SRA group, suggesting a possible additional mechanism, like inflammation control or bacterial suppression.⁷

This shows that even if you don’t respond to oral steroids, topical therapy (especially combined with antibiotics) may still work for you.

Steroids vs other treatment options

Steroids are one tool—but not the only one. Depending on the cause of anosmia, other options include:

• Saline nasal rinses: Help clear mucus and allergens
• Antihistamines: Useful for allergy-related causes
• Olfactory training: Smell rehabilitation using scent exposure (like essential oils)
• Surgery: Reserved for structural issues (e.g., severe polyps, tumours)

In some cases, combining treatments—like olfactory training with topical steroids—yields better results than one alone.⁷

Risks and considerations

Like all medications, steroids have side effects:

• Topical steroids: Can cause nasal dryness or irritation
• Systemic (oral) steroids: Risk of weight gain, mood changes, and immune suppression if used long-term.

Also consider:

• Steroids aren’t for everyone—especially those with certain infections or underlying medical conditions.
• Monitoring is key, especially if symptoms persist or worsen.

When to talk to a specialist

An ENT specialist can help if:

• You’ve had anosmia for more than a few weeks
• There’s no improvement with initial treatments
• You have red flags like behaviour changes, headaches, or a history of head trauma

They may recommend imaging (like an MRI or CT scan) or a nasal endoscopy to explore further.

FAQs

How long does it take for steroids to work for anosmia?

If steroids are going to help, improvement is usually seen within 1–2 weeks of treatment; however, treatment needs to be continued.

Are nasal sprays better than oral steroids?

Nasal sprays are safer long-term, but oral steroids may be used first to test if you're responsive.

What if I don’t respond to steroids?

Don’t worry, olfactory training, antibiotic combinations, or other treatments may still help; you just need to be patient.

Can steroids make anosmia worse?

Not directly—but overuse of nasal sprays or delayed diagnosis can complicate things.

Does timing matter in treatment?

Yes. The sooner anosmia is treated, especially post-viral or inflammatory, the better the chances of recovery.

Summary

Steroid treatments, especially intranasal corticosteroids, are most effective for anosmia caused by inflammation, like chronic rhinosinusitis or nasal polyps, with these patients seeing the biggest improvements. On the other hand, people with post-viral or long-COVID-related smell loss often experience only limited benefits and may need other therapies.

Pinpointing the root cause of your anosmia and tailoring your treatment is key; if oral steroids don’t help, don’t lose hope—topical steroids or combinations with or without antibiotics might still work for you. Early diagnosis and a personalised approach under medical supervision really boost your chances of getting your sense of smell back.