Olfactory dysfunction is a widespread health problem that seriously damages the quality of life, and its clinical treatment is still facing major challenges. As the core regeneration engine of the olfactory system, olfactory epithelial stem cells, including horizontal basal cells (HBCs) and spherical basal cells (GBCs), maintain the continuous regeneration of olfactory sensory neurons (OSNs) through precise steady-state regulation. This review systematically reviews the molecular regulatory networks of olfactory epithelial stem cells in physiological and pathological microenvironment, analyzes the respective roles and synergistic effects of notch, Wnt, FGF and BMP signaling pathways in olfactory epithelium, and explores how they drive the proliferation, renewal and differentiation of olfactory epithelium, maintain survival and microenvironment support. At the same time, it deeply analyzes the differential pathological mechanisms of olfactory dysfunction related to acute injury, chronic inflammation and aging. On this basis, we further discussed the current difficulties and future development of innovative treatment strategies based on stem cell transplantation, which laid a solid theoretical foundation for promoting the clinical precise intervention of olfactory dysfunction.