Objectives: To develop an understanding of olfactory disorders



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Objectives: To develop an understanding of olfactory disorders

  • Objectives: To develop an understanding of olfactory disorders

  • To develop an understanding of synesthesia

  • Question: What can happen if you lose your sense of smell? Danger wise….also think about memory.




Know the overall epidemiology of olfactory dysfunction (OD)

  • Know the overall epidemiology of olfactory dysfunction (OD)

  • Understand the olfactory circuitry

  • List the main presentations & types of smell dysfxcn

  • Name the main tests of olfactory function

  • Review several of the major causes of OD, their w/u & possible treatments



6 million receptor cells in roof of nasal chamber

  • 6 million receptor cells in roof of nasal chamber

  • Axons project thru the cribiform plate of the ethmoids

  • Join to form the olfactory bulbs at base of frontal lobe

  • These project to the olfactory cortex in the subventricular zone

  • CN I









A redneck died and left his entire estate to his beloved widow…

  • A redneck died and left his entire estate to his beloved widow…

  • But she can’t touch it until she’s 14.

  • Did you hear they’ve raised the minimum age for alcohol for rednecks to 32 years….

  • They want to keep alcohol out of high school.



Anosmia : NO smell

  • Anosmia : NO smell

  • Hyposmia : decreased smell

    • Also called microsmia & partial anosmia
  • Dysosmia : distortion

  • Phantosmia : smell w/o stimulus

  • Hyperosmia : Abnormally acute

  • Olfactory agnosia :

  • Bilateral or unilateral





As per type of smell disorder : No smell, less smell, “weird” smells

  • As per type of smell disorder : No smell, less smell, “weird” smells

  • Taste problems

  • One of earliest sx/sign of

    • Alzheimers
    • Parkinson’s
  • Can it be lethal ?

  • Yes ! When ?

    • Can’t smell : Spoiled food, Fire, gas leak (45% of pt.s)


The “ideal” test: Needs to assess for:

  • The “ideal” test: Needs to assess for:

    • Any sense
    • What level of sense
    • Different smells
    • Malingering
    • Laterality (bi- or uni-)
  • U Penn Smell ID Test (UPSIT)

  • Threshold Olfactory Tests





Commercial

  • Commercial

  • Most used

  • Self-administered in 10-15 minutes

  • Scored in < 1 minute by non-med person

  • Available in various languages

  • 40 “scratch & sniff “ patches

  • Pt. chooses from 4 answers & must choose 1

  • Can detect malingering



Dysfunction classified as Mormosmia, anosmia, mild, moderate or severe microsmia, or probable malingering

  • Dysfunction classified as Mormosmia, anosmia, mild, moderate or severe microsmia, or probable malingering



A dilutional series of a stimulus odor

  • A dilutional series of a stimulus odor

  • Uses an ascending concentration trial

  • Must answer ‘yes’ or ‘no’



Pocket Smell test

  • Pocket Smell test

  • Brief Smell ID Test

  • Squeeze bottle odor threshold test

  • All commercial



How do you know when your’re staying in a redneck hotel?

  • How do you know when your’re staying in a redneck hotel?

  • When you call the front desk and tell the mgr, “I gotta leak in my sink.” and he says,

  • “Go ahead.”





Decreased smell occurs in the normal elderly

  • Decreased smell occurs in the normal elderly

  • The greatest correlation with olfactory decline

  • More severe in men than women (Any conjecture on why?)

  • Multifactorial causes



Most Common cause of permanent smell problems

  • Most Common cause of permanent smell problems

  • Damage olfactory epithelium & possibly central structures

  • Common cold, hepatitis, influenza, HSV, rabies and a bunch I’ve never heard of &

  • thus don’t care about



Herbicides

  • Herbicides

  • Pesticides

  • Solvents

  • Heavy Metals, esp cadmium, nickel, chromium & manganese

  • Damage olfactory epithelium

  • Enter brain, esp. cadmium, gold & manganese



Right-sided foci > left-sided

  • Right-sided foci > left-sided

  • Anti-seizure meds can correct problems



Alzheimers & Parkinson’s :

  • Alzheimers & Parkinson’s :

    • Usually ASX, but present (Kevin, er… Homer)
    • in 85-90% of pts
    • Doesn’t respond to
    • meds
    • Magnitude not assoc
    • with disease stage


Down’s Syndrome

  • Down’s Syndrome

  • Huntington’s Disease

  • Multiple Sclerosis

  • Jacob-Creutzfeld



About 20% of all chemosensory

  • About 20% of all chemosensory

  • disorders

  • Directly related to degree of trauma

  • Also related to strong deceleration injury

  • Occipital and side injury more than frontal

  • If recovery, occurs within 1st year of injury



Cerebellar Degeneration

  • Cerebellar Degeneration

  • Schizophrenia

  • Migraine

  • Hyperemesis gravidarum & hyperosmia

  • A number of systemic diseases

  • Some Medicines

  • Congenital anosmia





Doty R. The Olfactory System and Its Disorders. www.medscape.com/viewarticle/588523

  • Doty R. The Olfactory System and Its Disorders. www.medscape.com/viewarticle/588523

  • Bromley S. Smell & Taste Disorders: A Primary Care Approach. AFP 2000;61:427-36.

  • Diagnosis of Anosmia. Online Medical Books. www.wrongdiagnosis.com/a/anosmia/diagnosis.htm

  • Wilson RS, et al. Olfactory identification & incidence of mild cognitive impairment in older age. Arch Gen Psychiatry 2007;64:802-8.





Briefly describe one of the possible causes of the lack of smell.

  • Briefly describe one of the possible causes of the lack of smell.




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