Objectives: To develop an understanding of olfactory disorders

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.