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PubMed1975

[Evaluating function and disorders of smell].

Firstly the review deals with the olfactometry after discussing the olfactory and trigeminal sensitivity of the sense of smell. The term olfactometry will be newly fixed concerning the present problems of odor analysis. Under clinical aspects the methods of subjective olfactometry are discussed and valued. Olfactory tests basing on registering several psychosomatic reflexes (e.g. cardial and/or respiratory frequencies) cannot be described as "objective". Rather methods are objective which record poststimulatory electrophysiological events at different steps of olfactory pathways. The electric response olfactometry representing a cortical evoked so-called twin-potential containing equivalents for trigeminal and olfactory sense activity starts to demonstrate its efficiency. At least a complete test of olfactory function today includes the rhinomanometry for recording ability in nasal odor transport capacity. In the second part are discussed the olfactory disorders with clinical importance. Air borne disorders are confronted with sensorineural, which again are divided in prebulbar, bulbar, and postbulbar ones so far as possible. Respiratory smell disorders depend on nasal ventilation and occur in nasal deformations, in abnormalities of respiratory pathways, in cases of foreign bodies, mucosal inflammations, tumors, intoxications and allergy. Sensorineural olfactory disorders can be attached to age, to malformations or idiopathic defects, inflammations of the olfactory-neural apparatus, head injuries, brain tumors, metabolic or endocrinological diseases. Furthermore often they are accompanied with neurological and psychiatric diseases or professional and chemical intoxications and/or iatrogenic influences. The poor therapeutical possibilities are demonstrated as far as possible. Finally the experting problems in olfactory disorders are delineated, at which the evidence of objective olfactometry can be distincted.

Animals↗
PubMed1971

The Kallmann syndrome.

The endocrinologic status of three patients with the Kallmann syndrome and anosmia were studied. Other than hypogondotropic hypogonadism, no abnormalities were found. Although the testosterone response to human chorionic gonadotropin was normal in all three patients, none of them responded to the antiestrogen, clomiphene. These patients are compared to others from the literature and it is concluded that the Kallmann syndrome is a heterogeneous category, comprising a number of clinically and genetically distinct disorders.

Adolescent↗
PubMed2005

Essential tremor: mild olfactory dysfunction in a cerebellar disorder.

Olfactory dysfunction has been reported to occur in patients with cerebellar disorders, including degenerative ataxias and essential tremor (ET). Previous studies have not considered the effects of mild cognitive deficits, which can occur in ET, and could explain the lower olfaction test scores in ET cases. We more than doubled our initial sample (37 ET cases and 37 controls) [Louis ED, Bromley SM, Jurewicz EC, Watner D. Olfactory dysfunction in essential tremor: a deficit unrelated to disease duration or severity. Neurology 2002;59:1631-3. ] and made adjustments for the mini mental status test score. The University of Pennsylvania Smell Identification Test score remained lower in 87 ET cases compared to 92 controls after adjustment for mini mental status test score and other potential confounders (p = 0.04). These findings: suggest that olfactory dysfunction in ET patients occurs independently of mild cognitive deficits and support recent work that the cerebellum may play a role in central olfactory processing.

Aged↗
PubMed1999

[Special characteristics of expert assessment of olfactory and taste disorders].

BACKGROUND: The number of medical expert opinions dealing with smell and taste disorders has continuously increased in recent years. However, an overview of the specific problems and results of those expert opinions has not been published until now. INDIVIDUALS AND METHODS: Olfaction was assessed by multiple subjective tests in 145 individuals with chemosensory dysfunction caused by trauma or occupational and environmental exposures. Additionally, a gustatory test, nasal endoscopy, anterior rhinomanometry, and radiography of the paranasal sinuses were performed. Malignering was diagnosed on a trial of multiple symptoms. Retronasal olfaction was tested using the Güttich gustatory olfaction test. RESULTS: Most of the medical expert opinions have been ordered by professional associations (42%) and insurance companies (28%). Compensation for olfactory dysfunction was claimed after trauma (64%), occupational exposure (23%) rhinosurgical procedures (8%), and laryngectomy (5%). Anosmia or hyposmia was claimed by 66% and 24% of all individuals, respectively. According to the results of the chemosensory tests, 41% of patients suffered from anosmia and 40% had hyposmia. Malignering was registered in 14%. CONCLUSIONS: The study shows that the "characteristic case" is a male in the late fourties, complaining of anosmia initially noticed after an occipital or frontobasal head trauma. The assessment of olfactory deficits related to toxic or chemical occupational exposure is difficult when a latency between the occupational exposure and the onset of chemosensory dysfunction is present. Moreover, interactions between the occupational exposure and nicotine or alcohol abuse must be taken into consideration. Claims for medical liability arose in 3% of the study group after septoplasty and sinus surgery.

Adolescent↗
PubMed1988

Olfactory dysfunction.

Otolaryngologists, neurologists and other medical practitioners are often not well equipped for assessing olfactory (dys)function. They either use no or inadequate olfactory tests. This problem of inadequate olfactory testing was systematically attacked by American psychologists in the early 80's and led to the construction of odour identification tests which are easy to administer. Combining the advantages of two of these American tests we developed a Dutch odour identification test (GITU), consisting of two subsets of 18 natural odourants and applicable in two ways: one for use in the ENT clinic, the other for industrial purposes. The first results of this test indicate that the incidence of serious olfactory disorder among adults in the Netherlands may be conservatively estimated at about 1%. The GITU readily discriminates between patients and controls and is sensitive to variables known to affect olfaction (gender, age). The recognition of olfactory dysfunction as a major problem has led in the U.S.A. to the establishment of clinical research centers for the study of human chemoreception. Evaluation results of four of those clinics together with data of three more case series--with a total number of patients of 4000--show that two thirds of all patients fall into three etiological categories: 1. Nasal disease and/or paranasal sinus disease. 2. Viral infection of the upper respiratory pathway. 3. Head trauma. For each of the three categories the literature is reviewed in order to arrive at a clearer picture of the olfactory patient with respect to age, gender, degree of olfactory deficit, spontaneous recovery, effectiveness of therapy and localization of the defect along the olfactory pathway. Finally an appeal is made to clinicians with interest in the subject to exchange more information with research scientists in olfaction. Such exchange is considered essential to making progress in this field.

Adolescent↗
PubMed2000

[Olfactory disorders due to medications: analysis and review of the literature].

INTRODUCTION: Olfactory disorders caused by medicinal drug intake are an uncommon occurrence. However, such an etiology should be systematically taken into account and investigated, as olfactory loss may be reversible once the particular treatment has been stopped. CURRENT KNOWLEDGE AND KEY POINTS: An analysis of the literature shows that of the large number of drugs that are apparently responsible for olfactory disorders, this adverse side effect has in fact only been observed in animal study populations, and no clinical case report has been made on the subject. The real toxicity to man is therefore only hypothetical. Of the 150,000 cases recorded in the pharmacovigilance centers in France, only 68 have reported olfactory complications (0.05% of cases), and only 22% of the medical files on this disorder reach a satisfactory level of plausibility. Cardiovascular drugs are mainly implicated in the development of olfactory disorders. Of these, certain drugs in particular should be mentioned: conversion enzyme (ACE) inhibitors which are responsible for taste disorders, some betablockers, and a calcium antagonist (a dihydropyridine derivative). Olfactory disorders have also been reported following administration of drugs used in anesthesia, in cancerology, endocrinology (carbimazole), in immunology (interferon), in the treatment of infectious diseases (ciprofloxacine, dioxycycline, terbinafine), and in rheumatology (D-penicillamine). FUTURE PROSPECTS AND PROJECTS: It is frequently difficult to establish a direct relationship between drug exposure and an olfactory disorder, and it is often not easy to determine with any certainty the causative role of the drug in the development of this disorder.

Animals↗
PubMed1997

[Disorders of smell and taste. Standard and recent methods in diagnosis and therapy].

Compared to disorders of the ears and eyes, diseases of smell and taste seem to be far less outstanding: however, the unimpaired perception of odours and flavours comprises an important part of our well-being, as can be seen in the perfume industry or in drinking and eating habits. The ENT-specialist covers organic causes of these senses, as he has the tools to explore and treat in the depth of the nasal and oral cavities. The "Arbeitsgemeinchaft Olfaktologie/Gustologie der Deutschen Gesellschaft für Hals-Nasen-Ohrenheilkunde, Kopf- und Halschirurgie" therefore is in process of establishing a new set for a standardised smell and taste test, which is based in part on the sniffin'sticks, which were developed by Prof. Kobal, Erlangen. The examination procedure of nasal and oral chemosensory performance requires a high test-retest reliability and an efficiency comparable to internationally established measurements in order to render valid results in diagnostic and therapeutic procedures. The new test kit with the sniffin'sticks is presented in this paper, followed by an overview on some disorders of smell and taste perception and proposals for actual therapeutic procedures.

Ageusia↗
PubMed1995

[Olfactory evoked potentials and contingent negative variation in expert assessment of disordered sense of smell].

Normally, the sense of smell is assessed by means of traditional subjective tests (sniff test, gustatory smell test, and trigeminus test). When results are inconclusive, an objective smell test is indicated. Simultaneously registering olfactory evoked potentials (OEP) and contingent negative variation (CNV) permits evaluation of both odor perception and odor discrimination. We can even objectively assess the false olfactory sensations in parosmia patients who are unable to discriminate between different odors. In this study, the results of 59 patients with olfactory disorders are presented. Head trauma and upper respiratory infections were the most common causes of the patients' complaints. In twelve cases, lack of cooperation and patient unrest prevented us from evaluating the data. In anosmia, the objective results agreed completely with the patient's subjective assessment. In hyposmia and parosmia, the results agreed with the patient's subjective assessment in most cases; here we were able to arrive at a more specific diagnosis in several cases. The objective smell test can be used to supplement subjective methods and thus provide more reliable assessment of olfactory disorders.

Attention↗
PubMed2006

Olfactory functions in asymptomatic carriers of the Huntington disease mutation.

Huntington's disease (HD) is a neurodegenerative disorder initially affecting the basal ganglia and especially the head of the caudate nucleus. Neuropsychological research has indicated that olfactory dysfunction may appear early in HD, prior to the onset of significant motor or cognitive dysfunction. The aim of this study was to examine whether asymptomatic carriers of the Huntington disease mutation also exhibit olfactory dysfunction. To address this issue we presented an extensive olfactory test battery comprising tasks assessing olfactory sensitivity, intensity discrimination, quality discrimination, episodic odor memory, and odor identification, to a group of gene carriers and nonmutation carriers of the disease. The results showed that gene carriers were selectively impaired in discriminating odor quality, although performance did not differ from noncarriers across the other tasks. The role played by striatum and then in particular the caudate nucleus for olfactory processing in general, and for odor quality discrimination in particular, is discussed.

Adult↗
PubMed1985

[Clinical symptoms and findings in the upper airway of soot-exposed workers].

Under conditions of the channel black technique of the carbon black producing factory in Oranienburg, DDR, some inhalative noxious agents are discussed, especially dust of carbon black in concentrations three times higher than permitted and the climate is causing aggravated conditions. 58 still exposed, 35 formerly exposed workers and 60 control persons of the same age and smoking habits were asked using a questionnaire and they were examined clinically to find out disturbances of health in the upper airways. Complaints concerning chronic rhinitis partly complicated by crusts and sanguineous nasal secretion more frequently had been stated by exposed workers compared to the control persons. The rhinoscopical findings of the exposed workers and control persons are emphasizing the case history details. By it, more severe chronical mucosal findings were diagnosed in 29 percent of the exposed, but only in 9 percent of the control persons. Obstructions of the nasal breathing are not to be related to the profession in spite of the significant differences of the anamnestical data and clinical findings. On the contrary the disorders of smell seem to be more important concerning the soot exposed workers. The roentgenological findings of the paranasal sinus and the cytological results of nasal secretion do'nt give further hints. The importance of an exposition of more than 10 years is apparent concerning the described morbid changes. Significant fewer complaints concerning the ENT were stated by the formerly exposed workers than the still exposed. Special examinations by an ENT physician should be performed on workers exposed to carbon black having already longer persistent complaints particularly concerning chronical mucosal findings and disorders of smell.

Adult↗
PubMedDate not supplied

Disturbances of taste and smell induced by drugs.

We reviewed the current literature (1980-1990, 1991-1996) concerning drugs associated with anosmia, hyposmia, dysgeusia, parageusia, and ageusia, and the impact of these adverse effects. Case reports of patients with sudden and delayed onset of one of these disorders with evidence for implication of a drug were included. Disturbances of taste and smell among the elderly and chronically ill, including those with thermal injury, decreases interest in eating and secondarily impairs healing of wounds. Mechanisms involved with these sensory disturbances include deposition of silver sulfate in nerves after use of topical agents containing silver, altered influx of calcium and other ions, chelation or depletion of tissue-bound zinc, disturbed bradykinin catabolism and second messenger synthesis, catabolism, and altered prostaglandin systems. Other mechanisms, particularly prolonged chemosensory disorders after early drug discontinuation, remain unknown.

Drug-Related Side Effects and Adverse Reactions↗
PubMedDate not supplied

Hypogonadotropic hypogonadism and anosmia (Kallmann's syndrome) associated with a marker chromosome.

A patient with hypogonadotropic hypogonadism and anosmia (Kallmann's syndrome) had an associated chromosomal abnormality. Evaluation of the hypothalamic pituitary axis showed undetectable basal LH and FSH and slight increases in both gonadotropins in response to GnRH. Augmented gonadotropin response to GnRH after serial subcutaneous injections of GnRH confirmed a hypothalamic defect. Additional endocrine tests failed to reveal other hormone dysfunctions. A supernumerary chromosome was detected by routine chromosome analysis. The extra genetic material was identified by differential cytogenetic banding procedures as an accessory bisatellited marker chromosome originating from either chromosome group D or G. Chromosome analyses of both parents were normal. Our results suggest that, in at least some cases, the Kallmann's phenotype may be associated with a chromosome abnormality.

Adult↗
PubMedDate not supplied

Inherited Alzheimer's disease PS-1 olfactory function: a 10-year follow-up study.

This study was undertaken to evaluate smell tests as a clinical marker for identifying mutation carrier status and determining the clinical diagnosis of presenilin-1 Alzheimer's disease (AD) in family members of those afflicted with the disease. Ten years ago, we gave the self-administered, 40-question scratch and sniff University of Pennsylvania Smell Identification Test to 18 at-risk family members, individuals with dominantly-inherited Alzheimer's disease. Testing results were normal 10 years ago except in the case of one individual who had smoked three packs of cigarettes a day for more than 23 years. Four subjects tested in 1990 are now afflicted with Alzheimer's disease, including the smoker. The smell test in 1990 did not demonstrate predictive capabilities before clinical conversion to dementia. At follow-up, two subjects were too impaired to take the test. Two "converted" from normal smell function to abnormal function with a wide range in score. Study findings indicate that the smell test is too variable a measure to be used as a reliable test for predicting or verifying a diagnosis of presenilin-1 Alzheimer's disease.

Aged↗