olfactory disorder
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Etiology
- conditions that interfere with access of the odorant to the olfactory neuroepithelium
- swollen nasal mucosa due to allergic, viral or bacterial rhinitis & sinusitis
- deviation of nasal septum
- polyps & neoplasms
- abnormalities in nasal mucus secretion
- injury to neuroepithelial receptors
- destruction of neuroepithelium
- viral infection
- neoplasms (meningioma is the most common)
- inhalation of toxic chemicals
- radiation to the head
- vitamin A deficiency (rare in USA)
- destruction of neuroepithelium
- injury to central olfactory pathways
- head trauma
- Parkinson's disease
- Alzheimer's disease[2], see UPSIT
- Korsakoff's psychosis
- nutritional deficiencies
- brain neoplasms of the anterior cranial fossa
- neurosurgical procedures
- neurotoxic agents
- ethanol, amphetamines, topical cocaine, aminoglycosides, tetracycline, tobacco smoke
- Kallmann's disease
- Cushing's syndrome
- hypothyroidism
- diabetes mellitus
- stroke
- psychiatric disorder
- pharmaceuticals associated with olfactory impairment
Pathology
- olfactory dysfunction may primarily originate from the pathology of the olfactory bulb or more distal structures[6]
Clinical manifestations
- patients generally complain of lack of taste, although taste thresholds may be normal
- dysosmia may occur with partial impairment of smell or during recovery phase from neurogenic anosmia
Laboratory
- smell identification test (40 item microencapsulated scratch & sniff test), see UPSIT
- detection threshold for odorant phenylethyl alcohol
- nasal resistance measurement by anterior rhinomanometry for each nostril
- biopsy of olfactory epithelium
Radiology
- computed tomography (CT) of brain with enhancement
Complications
- olfactory impairment is an independent risk factor for cognitive impairment[4] & mortality[5][7][8] in the elderly
- olfactory impairment is associated with increased risk of congestive heart failure in the elderly (RR=1.3)[9]
- olfactory disorders may be associated with depression, social isolation or other mental & physical health problems[10]
Differential diagnosis
Management
- directed towards the underlying etiology
- no effective therapy for sensorineural olfactory loss
More general terms
More specific terms
Additional terms
- age-associated changes in smell
- dysgeusia (taste disorder)
- olfaction & Alzheimer's disease
- olfaction (smell)
References
- ↑ Harrison's Principles of Internal Medicine, 14th ed. Fauci et al (eds), McGraw-Hill Inc. NY, 1998, pg 173-74
- ↑ 2.0 2.1 Wilson RS, Arnold SE, Schneider JA, Tang Y, Bennett DA. The relationship between cerebral Alzheimer's disease pathology and odour identification in old age. J Neurol Neurosurg Psychiatry. 2007 Jan;78(1):30-5. Epub 2006 Sep 29. PMID: https://www.ncbi.nlm.nih.gov/pubmed/17012338
- ↑ Geriatric Review Syllabus, 7th edition Parada JT et al (eds) American Geriatrics Society, 2010
Geriatric Review Syllabus, 8th edition (GRS8) Durso SC and Sullivan GN (eds) American Geriatrics Society, 2013 - ↑ 4.0 4.1 Growdon ME et al. Odor identification and Alzheimer disease biomarkers in clinically normal elderly. Neurology 2015 May 26; 84:2153. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25934852
Devanand DP et al. Olfactory identification deficits and increased mortality in the community. Ann Neurol 2015 Jun 1; PMID: https://www.ncbi.nlm.nih.gov/pubmed/26031760 - ↑ 5.0 5.1 Liu B, Luo S, Pinto JM et al Relationship Between Poor Olfaction and Mortality Among Community-Dwelling Older Adults: A Cohort Study/ Ann Intern Med. 2019. April 30. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31035288 https://annals.org/aim/article-abstract/2732078/relationship-between-poor-olfaction-mortality-among-community-dwelling-older-adults
Kamath V, Leff B Mortality Risk in Older Adults: What the Nose Knows. Ann Intern Med. 2019. April 30. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31035295 https://annals.org/aim/article-abstract/2732079/mortality-risk-older-adults-what-nose-knows - ↑ 6.0 6.1 Lu R, Aziz NA, Reuter M et al Evaluation of the Neuroanatomical Basis of Olfactory Dysfunction in the General Population. JAMA Otolaryngol Head Neck Surg. Published online August 26, 2021 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34436517 https://jamanetwork.com/journals/jamaotolaryngology/article-abstract/2783603
- ↑ 7.0 7.1 Choi JS, Jang SS, Kim J, Hur K, Ference E, Wrobel B Association Between Olfactory Dysfunction and Mortality in US Adults. JAMA Otolaryngol Head Neck Surg. 2021 Jan 1;147(1):49-55. PMID: https://www.ncbi.nlm.nih.gov/pubmed/33090196 Free PMC article
- ↑ 8.0 8.1 Pang NYL, Muhammad Danial Son HJJ, Tan BKJ et al Association of Olfactory Impairment With All-Cause Mortality. A Systematic Review and Meta-analysis. JAMA Otolaryngol Head Neck Surg. Published online April 7, 2022. https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/2790855
- ↑ 9.0 9.1 Chamberlin KW, Yuan Y, Li C et al Olfactory Impairment and the Risk of Major Adverse Cardiovascular Outcomes in Older Adults. J Am Heart Assoc. 2024 Jun 7:e033320. PMID: https://www.ncbi.nlm.nih.gov/pubmed/38847146 Free article. https://www.ahajournals.org/doi/full/10.1161/JAHA.123.033320
- ↑ 10.0 10.1 Gorodisky L, Honigstein D, Weissbrod A et al Humans without a sense of smell breathe differently. Nat Commun. 2024 Oct 22;15(1):8809. PMID: https://www.ncbi.nlm.nih.gov/pubmed/39438441 https://www.nature.com/articles/s41467-024-52650-6