Evaluation and treatment of taste and smell disorders
- Norman M Mann, MD
Norman M Mann, MD
- Assistant Clinical Professor, Department of Medicine
- University of Connecticut School of Medicine
- Denis Lafreniere, MD
Denis Lafreniere, MD
- Professor and Chief of the Division of Otolaryngology
- University of Connecticut Health Center
Many individuals with olfactory disorders report a decreased quality of life, particularly those with severe olfactory dysfunction . Olfaction plays a significant role in our detection of the aroma and flavor of foods. It is also responsible for our awareness of fragrances in the environment. Disruption of the experience of a pleasant sensory exposure can sometimes cause depression. Patients may no longer look forward to eating and drinking, and they often refuse to go out to dinner and associate with friends. Important nutritional deficiencies can lead to marked weight loss . Additional dangers associated with olfactory impairment include the inability to detect the odors of spoiled food, smoke, and leaking gas. Furthermore, the importance of olfaction cannot be overemphasized to certain professions such as chefs, perfumers, and fire fighters . Some individuals with olfactory disorders find it difficult to function in everyday life .
The evaluation of patients with abnormalities of taste or smell requires a multidisciplinary approach which may include the primary care clinician, otolaryngologist, neurologist, allergist, and oral consultant. The approach to these patients is reviewed here. The anatomy of taste and olfaction and the causes of abnormalities in these areas are discussed separately. (See "Anatomy and etiology of taste and smell disorders".)
HISTORY AND PHYSICAL EXAMINATION
●Impairment that is intermittent is often seen in allergic rhinitis and the use of topical drugs.
- Neuland C, Bitter T, Marschner H, et al. Health-related and specific olfaction-related quality of life in patients with chronic functional anosmia or severe hyposmia. Laryngoscope 2011; 121:867.
- Mattes RD, Cowart BJ. Dietary assessment of patients with chemosensory disorders. J Am Diet Assoc 1994; 94:50.
- Smith DV, Duncan HJ. Primary Olfactory Disorders: Anosmia, Hyposmia and Dysosmia. In: Science of Olfaction, Serby MJ, Chobor KL (Eds), Springer-Verlag, New York 1992. p.439.
- Kimmelman CP. Clinical review of olfaction. Am J Otolaryngol 1993; 14:227.
- SUMNER D. POST-TRAUMATIC ANOSMIA. Brain 1964; 87:107.
- Jafek BW, Hartman D, Ellen PM. Post viral olfactory dysfunction. Am J Rhinol 1990; 4:91.
- Apter AJ, Mott AE, Frank ME, Clive JM. Allergic rhinitis and olfactory loss. Ann Allergy Asthma Immunol 1995; 75:311.
- Bakay L. Olfactory meningiomas. The missed diagnosis. JAMA 1984; 251:53.
- Emmett EA. Parosmia and hyposmia induced by solvent exposure. Br J Ind Med 1976; 33:196.
- Frye RE, Schwartz BS, Doty RL. Dose-related effects of cigarette smoking on olfactory function. JAMA 1990; 263:1233.
- Guerrier Y, Uziel A. Clinical aspects of taste disorders. Acta Otolaryngol 1979; 87:232.
- Brenner BE, Simon RR. Glossitis and dysgeusia. Am J Emerg Med 1984; 2:147.
- Konnerth CG, Hummel T, Rosenheim K, Kobal G. Screening of olfactory function using a 4 minute odor identification test. Chem Senses 2001; 26:1088.
- Kobal, G, Lang, CJ. Olfactory testing with "Sniffin sticks" in idiopathic Parkinsonism. Chem Senses 2001; 26:1088. Abstract.
- Cain WS, Gent J, Catalanotto FA, Goodspeed RB. Clinical evaluation of olfaction. Am J Otolaryngol 1983; 4:252.
- Bartoshuk L. Clinical evaluation of the sense of taste. Ear Nose Throat J 1989; 68:331.
- Rusiniak KW, Hankins WG, Garcia J, Brett LP. Flavor-illness aversions: potentiation of odor by taste in rats. Behav Neural Biol 1979; 25:1.
- Semmes J, Weinstein S, Ghent L, Tanber HL. Normative study. In: Somatosensory Changes After Penetrating Brain Injuries in Man, Semmes J (Ed), Harvard University Press, Cambridge 1960. p.4.
- Hoekman PK, Houlton JJ, Seiden AM. The utility of magnetic resonance imaging in the diagnostic evaluation of idiopathic olfactory loss. Laryngoscope 2014; 124:365.
- Mott AK. Topical corticosteroid therapy for nasal polyposis. In: Smell and Taste in Health and Disease, Getchell TV, Doty RL, Bartoshuk LM, Snow JB Jr (Eds), Raven, New York 1991. p.554.
- Myers D, Myers EN. The medical and surgical treatment of nasal polyps. Laryngoscope 1974; 84:833.
- PENNYPACKER CS. Hydrocortisone alcohol in the local treatment of hay fever: a preliminary study. J Allergy 1954; 25:513.
- Mygind N. Topical steroid treatment for allergic rhinitis and allied conditions. Clin Otolaryngol Allied Sci 1982; 7:343.
- Stuck BA, Blum A, Hagner AE, et al. Mometasone furoate nasal spray improves olfactory performance in seasonal allergic rhinitis. Allergy 2003; 58:1195.
- Siegel SC. Topical intranasal corticosteroid therapy in rhinitis. J Allergy Clin Immunol 1988; 81:984.
- Graft D, Aaronson D, Chervinsky P, et al. A placebo- and active-controlled randomized trial of prophylactic treatment of seasonal allergic rhinitis with mometasone furoate aqueous nasal spray. J Allergy Clin Immunol 1996; 98:724.
- Minshall E, Ghaffar O, Cameron L, et al. Assessment by nasal biopsy of long-term use of mometasone furoate aqueous nasal spray (Nasonex) in the treatment of perennial rhinitis. Otolaryngol Head Neck Surg 1998; 118:648.
- Canciani M, Mastella G. Efficacy of beclomethasone nasal drops, administered in the Moffat's position for nasal polyposis. Acta Paediatr Scand 1988; 77:612.
- Wilson R, Sykes DA, Chan KL, et al. Effect of head position on the efficacy of topical treatment of chronic mucopurulent rhinosinusitis. Thorax 1987; 42:631.
- Scheibe M, Bethge C, Witt M, Hummel T. Intranasal administration of drugs. Arch Otolaryngol Head Neck Surg 2008; 134:643.
- Parnes SM. The role of leukotriene inhibitors in patients with paranasal sinus disease. Curr Opin Otolaryngol Head Neck Surg 2003; 11:184.
- Henkin RI, Velicu I, Schmidt L. An open-label controlled trial of theophylline for treatment of patients with hyposmia. Am J Med Sci 2009; 337:396.
- Lanza DC, Kennedy DW. Current concepts in the surgical management of nasal polyposis. J Allergy Clin Immunol 1992; 90:543.
- Lawson W. The intranasal ethmoidectomy: an experience with 1,077 procedures. Laryngoscope 1991; 101:367.
- Downey LL, Jacobs JB, Lebowitz RA. Anosmia and chronic sinus disease. Otolaryngol Head Neck Surg 1996; 115:24.
- Litvack JR, Mace J, Smith TL. Does olfactory function improve after endoscopic sinus surgery? Otolaryngol Head Neck Surg 2009; 140:312.
- Mott AE, Cain WS, Lafreniere D, et al. Topical corticosteroid treatment of anosmia associated with nasal and sinus disease. Arch Otolaryngol Head Neck Surg 1997; 123:367.
- Costanzo RM, Graziadei PP. Development and plasticity of the olfactory system. In: Neurobiology of Taste and Smell, Finger TE, Silver WL (Eds), John Wiley & Sons, New York 1987. p.233.
- Zusho H. Posttraumatic anosmia. Arch Otolaryngol 1982; 108:90.
- London B, Nabet B, Fisher AR, et al. Predictors of prognosis in patients with olfactory disturbance. Ann Neurol 2008; 63:159.
- DeVane CL, Ware MR, Lydiard RB. Pharmacokinetics, pharmacodynamics, and treatment issues of benzodiazepines: alprazolam, adinazolam, and clonazepam. Psychopharmacol Bull 1991; 27:463.
- Grushka M, Epstein JB, Gorsky M. Burning mouth syndrome. Am Fam Physician 2002; 65:615.
- HISTORY AND PHYSICAL EXAMINATION
- DIAGNOSTIC TESTING
- Chemosensory testing
- - Butanol threshold test
- - Whole mouth taste test
- - Spatial test
- Flavor discrimination test
- Somatosensory testing
- Laboratory studies
- Nasal and paranasal sinus disease
- - Glucocorticoids
- - Other
- Other disorders
- - Parosmia
- SUMMARY AND RECOMMENDATIONS