Clinical evaluation of pediatric olfactory disorders: a review from etiology to management

Olfactory perception plays a fundamental role in nutrition, emotional development, and social behavior, yet olfactory disorders (OD) in children remain largely underrecognized and understudied. This mini review summarizes current evidence and proposes a structured clinical approach for the evaluation and management of pediatric OD. Etiologies are diverse, encompassing congenital syndromes such as Kallmann and CHARGE, post-infectious and post-traumatic forms, inflammatory airway diseases, and structural or iatrogenic causes. Accurate diagnosis begins with a detailed medical history and comprehensive ENT examination, complemented by psychophysical olfactory testing adapted for pediatric populations. Although several validated tools exist-such as the Sniffin' Sticks, U-Sniff, Pediatric Smell Wheel, and pBOT-6-standardized age-specific protocols and normative data remain limited. Imaging techniques, particularly MRI, provide valuable insights into congenital and acquired abnormalities of the olfactory bulbs and tracts, while CT is reserved for sinonasal or bony pathology. Multidisciplinary collaboration among pediatricians, neurologists, endocrinologists, geneticists, and otolaryngologists is essential to achieve etiological precision. Management strategies depend on the underlying cause and include medical or surgical treatment for reversible conditions, intranasal corticosteroids for inflammatory diseases, and olfactory training for post-infectious or congenital forms. Regular follow-up with objective testing and family education supports recovery and long-term adaptation. Despite the scarcity of pediatric-specific evidence, this review highlights the need for awareness, early diagnosis, and individualized management of OD in children, proposing a practical diagnostic and therapeutic framework to guide clinical decision-making in everyday ENT practice. A structured search strategy was applied to summarize the currently available evidence and highlight practical implications for clinical care.