Chester, A C · Integrative physiological and behavioral science : the official journal of the Pavlovian Society · 1993 · DOI
This paper proposes a new theory: that extreme fatigue in ME/CFS and related conditions might be the body's protective reflex triggered by nasal or sinus problems. The idea is that in our evolutionary past, when a good sense of smell was crucial for survival, fatigue would have kept sick animals resting safely at home while their nose healed. The author suggests this ancient reflex may still be active in humans today.
This hypothesis could redirect research attention toward previously underexplored nasal and olfactory mechanisms in ME/CFS, potentially opening new diagnostic and therapeutic avenues. If nasal dysfunction is mechanistically linked to fatigue in some patients, targeted nasal treatments might improve outcomes, and understanding the underlying reflex could illuminate why standard treatments often fail.
This paper presents a hypothesis only—it does not provide experimental evidence that a nasal fatigue reflex actually exists or causes ME/CFS. The work does not demonstrate that nasal problems are a primary cause of ME/CFS fatigue in any patient population, nor does it prove that nasal treatment resolves fatigue in the present day. Historical anecdotes about neurasthenia treatment do not establish mechanism or efficacy in modern ME/CFS.
About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →
The first block is for the primary paper and is the citation you should use in research work. The atlas-snapshot line only applies if you are specifically referring to this atlas’s reading of the paper on the date shown.
Primary citation
Chester, A C (1993). Hypothesis: the nasal fatigue reflex.. Integrative physiological and behavioral science : the official journal of the Pavlovian Society. https://doi.org/10.1007/BF02691201
BibTeX
@article{mecfsatlas-chester-1993-hypothesis-nasal,
author = {Chester, A C},
title = {Hypothesis: the nasal fatigue reflex.},
journal = {Integrative physiological and behavioral science : the official journal of the Pavlovian Society},
year = {1993},
doi = {10.1007/BF02691201},
note = {PubMed: 8476744},
url = {https://www.mecfsatlas.com/evidence/chester-1993-hypothesis-nasal},
}Atlas snapshot reference
ME/CFS Atlas. Generator v1 / Scanner v1.4 / policy v0.1. Accessed 2026-05-28. https://www.mecfsatlas.com/evidence/chester-1993-hypothesis-nasal
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