Association of Nasal Anatomy, Airflow, and Surgery With Olfactory Outcomes: A State-of-the-Art Review.

OBJECTIVE: Olfactory function is influenced by nasal airflow dynamics and anatomical variations within the nasal cavity. This narrative review evaluates how nasal anatomy and airflow relate to olfactory outcomes, with a particular focus on olfactory changes following functional nasal surgery. DATA SOURCES: PubMed. REVIEW METHODS: A comprehensive review was performed by searching the PubMed database for English-language publications from 2000 to 2025. Search terms included: "olfaction," "sense of smell," "nasal airflow," "nasal anatomy," "nasal obstruction," "septoplasty," and "functional septorhinoplasty." CONCLUSIONS: Structural abnormalities such as a deviated nasal septum or a narrow internal nasal valve can impair olfactory function by altering nasal airflow patterns and limiting odorant access to the olfactory cleft. Functional nasal surgery, including septoplasty and functional septorhinoplasty, can modify these anatomical constraints and is frequently associated with improvements in psychophysical olfactory scores and patient-reported smell. While most patients report an improved olfactory function following nasal surgery, outcomes are still variable. Patient‑specific factors, surgical techniques, and differences in subjective and psychophysical outcome measures likely contribute to variability in olfactory performance after surgery and are not yet fully understood. IMPLICATIONS FOR PRACTICE: Improving nasal airflow through functional nasal surgery can be associated with enhanced olfaction in patients with anatomical obstruction. Understanding airflow-olfaction relationships can aid surgical planning and patient counseling.