Loss of smell

The ability to smell is often taken for granted. Not only are there many life enhancing odors such as the smell of fresh baked goods from a bakery or a rose garden in the spring, but the ability to smell can warn of life threatening dangers such as a nearby fire or spoiled food. Most of the “taste” of food is in fact attributed to the neurons responsible for smell rather taste buds on the tongue. Over two million Americans are believed to be effected by taste and smell disorders. The inability to detect odors is clinically termed anosmia, while the decreased ability to detect odors is hyposmia. The olfactory neurons which are responsible for smell are located at the upper area of the nasal chamber.

Since there are many causes of anosmia, a thorough history and physical is required. A formalized “scratch and sniff” test called the University of Pennsylvania Smell Identification Test is often used as an objective adjuvant to exam. A physician may also elect to use a nasal endoscope to inspect the condition of the inside of the nose. A CT scan and possible MRI may also be necessary for further evaluation.

Anosmia may be caused by a variety of disorders. Most commonly, inflammation of the nasal mucosa is responsible for blocking odors from reaching the roof of the nose. This inflammation can be caused by allergy, sinusitis, or even chronic cocaine use. Any nasal mass such as a nasal polyp or even a nasal cancer can also be causes of anosmia.

Sometimes, the cause of anosmia is due to direct damage to the olfactory neurons. Head trauma is a common cause. A common upper respiratory infection can also directly damage olfactory neuroepithelium. One of the first signs of Alzheimer’s disease can be a loss of smell. There are many other rare causes of loss of olfaction. These disorders which directly damage the olfactory neuron are difficult to treat and the anosmia is often permanent. Sinus and allergy disorders can often be treated with medical therapy. Occasionally sinus disease will require endoscopic sinus surgery to restore nasal drainage and airflow.

Due to the variety of disorders which can cause anosmia, these disorders necessitate evaluation by a physician to identify the cause of anosmia.

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