Table 2

Nasal symptoms that may accompany loss of smell

SymptomsClassificationOther associated signs and symptomsRelevance to patient
Does your nose feel blocked on both sides, and can the most affected side alternate?AllergicSneezing, itching, watery rhinorrhoea, temporal association with allergenAllergen avoidance and medical therapy with antihistamines and nasal steroids may offer relief
Does your nose feel consistently blocked on one side?StructuralExternal deformityA history of an adult with new unilateral blockage without preceding trauma should prompt face-to-face examination
Does your nose feel consistently blocked on both sides?RhinosinusitisRhinorrhoea, facial pain, asthmaIntranasal steroids and saline douche are an appropriate first line treatment
Can you detect a foul smell within your nose?CacosmiaPurulent discharge, foul smell apparent to others, dental diseaseMay represent underlying dental disease and should be directed concurrently for dental and ear, nose, and throat review
If you blow your nose, do you get streaks of blood mixed in with the mucus from both sides of the nose?EpistaxisEvidence of digital trauma or substance abuse, bruising to minor traumaAvoid local trauma (eg, nose picking), common anticoagulant and antiplatelet agents are associated with epistaxis
If you blow your nose, do you get streaks of blood from the nostril that feels persistently blocked?Urgent suspected cancerNumbness of the face, loose dentition, visible massPatient should be informed that sinonasal malignancy is an uncommon but important differential
Do you have a new neck lump?Urgent suspected cancerNumbness of the face, visible mass, nasopharyngeal cancer most common in people of southern Chinese descentPatient should be informed that nasopharyngeal malignancy is an uncommon but important differential