TableĀ 8

Investigation and management of change in smell

InvestigationsPotential resultsClinical management plan
Actions from history, medication and dietary assessment
Medication findingsChemotherapy related
Opioid related
  1. Reassure.

  2. Consider alternative medications.

  3. Consider referral to psychological medicine.

  4. Inform patient about the charity Fifth Sense.2

First line
Testing of the olfactory nerveNeurological defectRefer to neurology team.
Olfactory hallucinations
  1. Consider neurological referral.

  2. Consider referral to psychological medicine.

Blood test for zinc and vitamin B12DeficientArrange replacement.
Second line
Refer to ENT teamEg, nasal polyps, sinus infection
CT/MRI head/PETBase of skull diseaseRefer to the appropriate MDT requesting an appointment within 2 weeks.
Third line
If normal investigations/no response to interventionReassure.
  • CT, computerised tomography; ENT, ear, nose and throat; MDT, multidisciplinary team; MRI, magnetic resonance imaging; PET, positron emission tomography.