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PubMed2004

Future directions in chemosensory research.

The past two decades have witnessed phenomenal growth in chemosensory research in the basic sciences and clinical studies. Although chemosensory disorders today are recognized more widely for their marked impacts on QOL and public safety, the increased research focus has yet to translate into significant therapeutic advances for human olfactory or gustatory dysfunction. Nevertheless, it should be expected that active chemosensory research eventually will yield discoveries necessary to generate better treatment options for otolaryngologists and other physicians caring for smell and taste loss patients. As the understanding of chemosensory biology and disease pathophysiology grows, there is great promise that medical science will conquer the frustrating and debilitating health problems posed by olfactory and gustatory dysfunction. Moreover, it is likely that the lessons gained through chemosensory research will apply broadly to a range of human diseases affecting sensory modalities and the central nervous system.

Chemoreceptor Cells↗
PubMed1999

Monorhinal odor identification and depression scores in patients with seasonal affective disorder.

BACKGROUND: Visual and olfactory pathways are interconnected. Olfactory deafferentation unmasks photoperiodic responsiveness in some nonphotoperiodic animals such as laboratory rats. By analogy, we hypothesized that olfactory deficits may unmask seasonal rhythms in certain individuals, namely those with seasonal affective disorder (SAD). Since previous studies suggest lateralized hemispheric dysfunction in SAD, and since olfactory neurons' primary projections are largely ipsilateral, we assessed olfactory identification performance on both the right and left side of the nose. METHODS: Twenty-four patients with SAD and 24 matched controls were studied using a phenyl ethyl alcohol detection threshold test bilaterally and the University of Pennsylvania Smell Identification Test unilaterally. Subjects rated their mood using the Self Assessment Mood Scale for SAD. Patients' testing was done in both 'depressed' and 'improved on light' states. RESULTS: No difference in olfactory performance was found between patients and controls or between patients before and after light treatment. However, right-side identification scores were negatively correlated with 'typical' depression scores (r = -0.56, P = 0.006), while left-side olfactory scores were not. Atypical depression scores were unrelated to olfactory performance. Similar correlations emerged between the olfactory identification laterality quotient (Right - Left)/(Right + Left) and typical depressive scores (r = - 0.64, P < 0.001) and total depression scores (r = - 0.59, P < 0.004). LIMITATIONS: We studied a demographically heterogeneous sample and did not control for menstrual factors. DISCUSSION: Our results add to previous evidence of lateralized hemispheric involvement in SAD and suggest that olfaction may be related to seasonal emotional rhythms in humans.

Adult↗
PubMed1998

[Semiologic study of chronic perennial and permanent paranasal sinus dysfunction. Prevalence of symptoms].

Rhino-sinus dysfunction is associated with several symptoms: nasal obstruction, anterior and posterior rhinorrhea, episodes of sneezing, painful or heavy feeling in the face, taste and smell disorders. Certain manifestations have an impact on the pharynx, the larynx or the tracheobronchial tree. This prospective study was conducted in 449 consecutive patients who consulted over an 18-months period from November 1995 to May 1997. The objective was to determine the symptom pattern, main disease of the nasal cavities and paranasal sinuses which were involved: chronic rhinitis, anterior sinusitis, bilateral and symmetric pansinusitis with or without nasosinus polyps. In the first part of the study, the frequency of different symptoms were determined for the main nasosinus diseases. Statistical analysis of the correlations between symptoms and diseases provided a specific approach to symptoms.

Adolescent↗
PubMed2004

Hazardous events associated with impaired olfactory function.

OBJECTIVE: To evaluate the risk of olfactory-related hazardous events in patients with impaired olfactory function. DESIGN: Retrospective cohort study. SETTING: A university-based clinic for smell and taste disorders. PATIENTS: A total of 445 patients who underwent olfactory testing between 1983 and 2001. INTERVENTIONS: Patient interview, olfactory testing. MAIN OUTCOME MEASURES: (1) Frequency of olfactory-related hazardous events including cooking incidents (ie, burning pots or pans), undetected fires, undetected gas leaks, and ingestion of spoiled foods or toxic substances; (2) level of olfactory function (anosmia; severe, moderate, or mild hyposmia; or normosmia) as determined by olfactory testing. RESULTS: Olfactory testing revealed that 76% of patients had some degree of impairment; 30% had complete anosmia. Thirty-seven percent of patients with olfactory impairment but only 19% of patients without impairment experienced at least 1 olfactory-related hazardous event. Of the hazardous events reported by impaired patients, cooking-related incidents were most common, representing 45%, with ingestion of spoiled food (25%), inability to detect a gas leak (23%), and inability to smell a fire (7%) reported less frequently. There was a significant correlation between frequency of hazardous events and degree of olfactory impairment (Cochran-Armitage trend test, P<.001): at least 1 hazardous event was reported by 45.2% of patients with anosmia, 34.1% with severe hyposmia, 32.8% with moderate hyposmia, 24.2% with mild hyposmia, and 19.0% of patients with with normal olfaction by testing. CONCLUSION: Patients with impaired olfactory function are more likely to experience olfactory-related hazardous events than those with normal olfactory function.

Accidents, Home↗
PubMed1995

[Sense of smell].

About two million Americans suffer from anosmia. Most result from nasal obstruction, head injuries, and viral infections. Brain disorders like epileptic seizures, tumours, and dementia can distort can distort the sense of smell. Anosmia adversely affects patient well-being. Patients cannot detect spoiled food, gas leakage, or dangerous smoke. They are unable to distinguish flavour and smell the springtime or the ocean. Many products as soaps, cat litter, toilet paper, etc. are perfumed because consumers will more readily buy a product that smells nice than one that has no smell at all. Historically, the importance of odors was very different. The ancient Romans loved exotic aromas during their banquets and orgies. In the Middle Ages the church did not like fragrances. The French revolution of 1789 brought a revolution of deodorization to Europe. Today, fragrance companies' increasing sales are an indication of the power of odor.

Humans↗
PubMed2004

Olfactory dysfunction and daily life.

The objective of the present study was to investigate the hypothesis that subjects with parosmia suffer more in their daily life than patients who experience only quantitative olfactory loss. Two hundred five outpatients of the Smell and Taste Clinic and 25 healthy controls were included. The newly developed Questionnaire of Olfactory Disorders (QOD) was administered in combination with other psychometric tests (Beck Depression Inventory, "Befindlichkeitsskala" and the Short Form-36 Health Survey) along with an olfactory test ("Sniffin' Sticks"). Results of the QOD were found to be an appropriate and valid measure of the impact of olfactory dysfunction on daily life. Patients with parosmia and quantitative olfactory dysfunction show higher rates of daily life complaints when compared to patients suffering from quantitative olfactory impairment only (QOD-PS: P=0.005). In addition, hyposmic and anosmic patients indicated significantly more complaints compared to patients with normosmia. Further, female patients seemed to suffer more from olfactory dysfunction than male patients. In conclusion, the assessment of the degree of qualitative olfactory dysfunction may be possible by the use of instruments based on questionnaires regarding daily life problems.

Adult↗
PubMed2000

[Signs and symptoms, etiologies and clinical course of parosmia + in a series of 84 patients].

Eighty-four patients (72% females and 28% males) consulted between January 1995 and January 1998 for olfactory disorders with parosmia (erroneous olfactory response to stimuli). Parosmia occurred immediately after or during the course of acute rhinitis (n=70, 83%), head trauma (n=7, 9%), naso-sinus polyposis (n=5, 6%), chronic rhinitis (n=1) or frontal tumor (n=1). Quantitative and qualitative olfactory disorders were analyzed and products producing the parosmia were identified. The only cases where parosmia regressed concerned patients who developed parosmia after acute rhinitis (n=28 cases, 33%). The prognosis of parosmia appeared to be better when it was a secondary phenomenon: i) the percentage of improvements was higher though not significant (41% versus 26.7% compared with primary parosmia), ii) delay to improvement was shorter (8.4 +/- 2.1 months versus 14.5 +/- 4.4 months for primary parosmia, p<10(-4) ), iii) there were no cases of persistent parosmia where quantitative disorders improved (compared with 7 cases of persistent primary parosmia, p<0.05). In addition, the prognosis of associated quantitative disorders was the same for both primary and secondary parosmia. Only the delay to improvement appeared to be shorter in case of secondary parosomia (though the difference was not significant). Products which produced the parosmic perception were identified by nearly all the patients (85%). The most frequently cited products were coffee, perfume, certain fruits (melon, banana, citric fruits), tobacco or chocolate. All these products contain tannic acid, a water-soluble polyphenol with many biological properties (influence feeding habits and metabolism in the rate, antioxidant and antimutagenic properties). Thus acid tannic could induce parosmic perception due to its antioxidant properties susceptible of integrating the P-450 cytochromes of the mucosal cells or olfactory neuroepithelium supporting cells.

Adult↗
PubMed2002

[Post-traumatic anosmia: description of a clinical case, proposal of a standardized protocol and medico-legal comments].

Man's olfactory perception is considerably limited compared to that of other animals; this sense is, however, extremely important in our social lives: it helps us to "savour" our food, it enables us to appreciate perfumes and, even more important, to pick up smells that signal a danger, such as a gas leak or a fire. We describe the clinical case of a patient with anosmia and hypogeusia that appeared immediately after suffering a concussive head injury. We go through the diagnostic protocol for medico-legal assessment of hypoanosmias previously described in the literature, which includes a clinical and an imaging section. In 9% of all anosmic patients, a traumatic event precedes the onset of the disorder, with repercussions on the olfactory channels and centres of the peripherical and/or central nervous system. The overall rate of anosmia following head injury is estimated to be around 7.5%. Among the principal causes of anosmia, those of medico-legal interest constitute 35% of the total. On the basis of our personal experience and of clinical studies conducted by other Authors, we propose that a bioptic investigation of the olfactory mucosa be added to the existing protocol. The olfactory neuroepithelium of patients suffering from post-traumatic anosmia, in fact, evidences some characteristic degenerative aspects. In conclusion, we report several comments regarding the quantification of the reduction of the olfactory function in different areas of medico-legal interest.

Adult↗
PubMed1990

Dietary evaluation of patients with smell and/or taste disorders.

The impact of smell and taste disorders on dietary habits and nutritional status has received limited research attention. This paper reports findings obtained from questionnaires and diet records completed by 40 healthy subjects and 118 patients with chemosensory dysfunction. Chemosensory disorders were frequently associated with decreases in food acceptability. Although dietary responses to these dysfunctions varied greatly, patients with distorted or phantom smell and/or taste sensations tended to report weight loss whereas those with simple sensory loss were more likely to report weight gain. Indices derived from diet records did not indicate that either group of patients was at substantial nutritional risk, but food frequency responses and estimates of body mass index were consistent with patient reports of changes in dietary patterns and weight. In addition, marked weight change and aberrant dietary practices were noted in individual patients. Thus, there were indications that chemosensory dysfunction may be associated with nutritionally important dietary alterations.

Adult↗
PubMed2006

Olfactory dysfunction as a predictor of neurodegenerative disease.

Olfactory dysfunction is present in patients diagnosed with Alzheimer's disease or idiopathic Parkinson's disease and can differentiate each of these disorders from related disorders with similar clinical presentations. The pathologic hallmarks of each disease are present in brain regions involved in processing olfactory input. Both the olfactory functional deficits and the corroborating pathologic lesions are present in asymptomatic subjects with increased risk of developing these diseases. Preclinical detection of neurodegenerative diseases is necessary to control their devastating effects on individuals and societies. We address whether olfactory dysfunction can be used to assess risk for developing Alzheimer's disease or Parkinson's disease in asymptomatic individuals. We argue that further characterization and a deeper understanding of olfactory deficits in these neurodegenerative diseases at the molecular, cellular, and systems levels will augment our acumen for preclinical detection and elucidate pathogenic mechanisms to guide the development of new therapeutic modalities.

Animals↗
PubMedDate not supplied

[Kallmann's syndrome. Apropos of 2 personal cases].

The Kallmann's syndrome is a rare nosological phenomenon characterized by hypogonadotropic hypogonadism and anosmia. In 1944, Kallmann first studied the genetic aspects of this syndrome in three different families in which 11 subjects suffered of deafness, syncinesis, brain disorders or skeletal anomalies along with olfactory dysfunction. In these patients histological studies revealed either a degeneration in the olfactory bulb tract or a generalized hypoplasia of the olfactory system. In the light of the presence of brain lesions and the possible association with several other endocrine pathologies, hypogonadism should be related to a diminished increase of releasing factors from the hypothalamus. At present the Kallmann's syndrome is considered a genetic syndrome linked to the X-chromosome. The hypothalamus is a genetic disorder target gland and its eventual close connection to the olfactory system could explain endocrine as well as olfactory pathology. Several recent studies carried out on mice by M. Schwanzel-Fukuda and D. Pfaff showed that neurons expressing Luteinizing hormone-releasing hormone (LH-RH) are located in the nervus terminalis, a cranial nerve that is a part of the accessory olfactory system and which projects directly from the nose to the septal-preoptic nuclei in the brain. Clinically, these data could explain the gonadotropin deficiency in association with olfactory dysfunction in the Kallmann's syndrome. In this paper the Authors report two cases of Kallmann's syndrome: a 41-year-old male with eunuchoidism and anosmia, and a 7-year-old child with hypospadia and anosmia.

Adult↗
PubMed2003

Olfactory dysfunction in degenerative ataxias.

Several lines of evidence suggest that the cerebellum may play a role in higher-order olfactory processing. In this study, we administered the University of Pennsylvania Smell Identification Test (UPSIT), a standardised test of olfactory function, to patients with ataxias primarily due to cerebellar pathology (spinocerebellar ataxias and related disorders) and to patients with Friedreich ataxia, an ataxia associated mainly with loss of afferent cerebellar pathways. UPSIT scores were slightly lower in both patient groups than in the control subjects, but no differences were noted between the scores of the Friedreich and the other ataxia patients. Within the Friedreich ataxia group, the smell test scores did not correlate with the number of pathologic GAA repeats (a marker of genetic severity), disease duration, or categorical ambulatory ability. UPSIT scores did not correlate with disease duration, although they correlated marginally with ambulatory status in the patients with cerebellar pathology. This study suggests that olfactory dysfunction may be a subtle clinical component of degenerative ataxias, in concordance with the hypothesis that the cerebellum or its afferents plays some role in central olfactory processing.

Adult↗
PubMed2006

Olfactory dysfunction in leprosy.

Leprosy (Hansen's disease) is associated with a high incidence of nasal pathology. Despite this fact, the influence of this disorder on the sense of smell is poorly understood. In this study, we administered a standardized 12-item odor identification test to 77 patients with three types of leprosy: tuberculoid (n = 9), borderline (n = 42), and lepromatous (n = 26). All three types exhibited significantly lower test scores than their respective age-, sex-, and smoking-habit-matched controls. Patients with lepromatous leprosy exhibited significantly lower test scores than those with the other two types. Only patients with lepromatous leprosy exhibited meaningful improvement in smell function after treatment. No association between disease duration, per se, and the severity of the olfactory deficit was present. Overall, 100% of the patients exhibited olfactory dysfunction, suggesting that earlier prevalence estimates based on nonstandardized olfactory testing have underestimated the prevalence of this problem.

Adult↗
PubMed2004

Clinical assessment of patients with smell and taste disorders.

Clinical assessment of the patient who has smell and taste disorders requires understanding of the etiology of the olfactory and gustatory disorders. Available clinical tests of olfactory and gustatory systems allow detecting and measuring the degree of the sensory loss, but are unable to determine the cause and give neither prognostic information nor therapeutic guidance. With physical examination, however, clinical history can help to establish the diagnosis and guide the treatment if available. A clinician evaluating a patient who has smell and taste loss must understand that "taste" complaints usually are symptoms of an olfactory dysfunction. The distinction between true gustatory loss (bitter, sweet, salty, sour, or umami) and olfactory loss, the inability to perceive complex flavors of food, will help clarify the patient's diagnosis. Easy-to-administer tests are available for olfactory (eg, UPSIT) and gustatory testing (eg, spatial tests, taste sticks, tasting tablets). In rare circumstances, imaging studies (eg, MRI, CT) are indicated.

Aging↗
PubMed2006

Olfactory toxicity: long-term effects of occupational exposures.

OBJECTIVE: To present and discuss the results of research on olfactory function impairments related to chronic occupational exposure to industrial chemicals. METHODS: This review is mainly focused on the results of epidemiological studies on olfactory function, evaluated using quantitative testing methods, in workers chronically exposed to airborne industrial chemicals. Papers published in peer-reviewed scientific journals were mainly considered. RESULTS: The prevalence of olfactory impairments related to occupational exposure to chemicals is unknown: frequencies ranging 0.5-5% of all olfactory dysfunctions have been proposed, considering both exposure to chemicals and the use of pharmaceutical drugs, but the real relevance of this problem is possibly overlooked, especially considering that occupational exposure may account for a significant part of "idiopathic" smell disorders, i.e., the 10-25% of all olfactory problems within the general population. An adverse effect has been reported in workers chronically exposed to some metals as cadmium, chromium, manganese, arsenic, mercury, and organic lead, and to other chemicals as acrylates, styrene, and solvent mixtures. The results of relevant studies are discussed. A problem in the evaluation of data is that different methods have been applied in different studies, affecting the comparability of results. CONCLUSIONS: To date, knowledge of the effect of chronic occupational exposure to industrial chemicals on olfactory function is largely incomplete, but supports the hypothesis that olfactory neuroepithelium is susceptible to environmental exposures to chemicals. Occupational-related olfactory impairment is usually sub-clinical, and can be only detected using adequate quantitative olfactory function testing procedures. Available data show the need for further good quality research in this field.

Air Pollutants, Occupational↗
PubMed2004

Isolated congenital anosmia with morphologically normal olfactory bulb in two Iranian families: a new clinical entity?

Congenital total loss of the sense of smell occurs as a part of a syndrome or isolated anosmia. Kallmann syndrome is the most well known congenital anosmia associated with hypogonadotropic hypogonadism. Isolated congenital anosmia (ICA) is a very rare condition and appears to be due to changes in the olfactory epithelium or to aplasia of the olfactory nerve, bulb, and tract. Here we report two unrelated Iranian families with ICA. One family consisted of nine affected members, and the other family contained three affected members. Clinical history, physical examination, and smell testing by intravenous injection of combined vitamins (Alinamin trade mark, Takeda Pharmaceutical Co. Ltd., Japan) confirmed the disease in each affected member. No signs of hypogonadism or other neurological disorders were observed in any affected members. Family analysis with the complete ascertainment method under assumption of the same condition in the two families suggested that the disease is not inconsistent with an autosomal dominant mode with incomplete penetrance. The inheritance in one family appears unusual, i.e., there were no affected individuals in the third generation. When only two upper generations in the family are concerned, the segregation ratio was 0.39 +/- 0.11. Male-to-male transmissions were observed and both sexes were affected in both families. Magnetic resonance imaging (MRI) of the olfactory bulb and sulcus revealed no evidence of morphological changes in all affected members, suggesting that these patients have either a defect in the olfactory epithelium or a functional defect in the olfactory cortex.

Female↗
PubMed2005

Correlation between nasosinusal symptoms and topographic diagnosis in chronic rhinosinusitis.

Rhinitis and sinusitis concern roughly a quarter of the population in the Western world. They are associated with a wide range of symptoms: nasal obstruction, anterior and posterior nasal discharge, sneezing episodes, facial pain or congestion, and taste and smell disorders. The aim of this prospective study was to evaluate the clinical significance of these various symptoms as a function of the topographic diagnosis of chronic rhinosinusitis. The study involved 474 patients with signs of chronic perennial and persistent rhinosinusitis. The disorders of the nasal cavities and paranasal sinuses were classified into three main diagnostic categories: chronic rhinitis, localized sinusitis (mainly, anterior sinusitis), and diffuse rhinosinusitis (ie, nasal polyposis). A principal components analysis was performed. The symptom patterns of the three main clinical entities differed greatly. Most of the following clinical signs--nasal obstruction, anterior and posterior nasal discharge, sneezing, and facial congestion--are found in all diagnostic categories and hold no specific clinical significance. By contrast, four symptoms seem to have a substantial differentiating potential: anosmia and complete loss of flavor for diffuse rhinosinusitis, cacosmia for localized anterior sinusitis, and severe facial pain for localized sinusitis. This study proposes a new analysis of the relationship between symptoms of chronic rhinosinusitis and findings on a sinus computed tomography scan.

Adolescent↗
PubMed2006

Detection of preclinical Parkinson's disease along the olfactory trac(t).

The association of Parkinson's disease (PD) with an impaired sense of smell was first reported about thirty years ago. Since then, it has become quite firmly established that olfactory dysfunction is one of the first and most prevalent clinical manifestations of this disorder. Recent data from an ongoing prospective study indicate that otherwise unexplained hyposmia in first degree relatives of patients with sporadic PD is associated with an increased risk of developing clinical PD of at least 13%. In particular, a combination of impaired olfactory function and reduced striatal [123I]beta-CIT binding on a baseline SPECT scan appears to be a strong predictor of a subsequent diagnosis of PD. Pathological studies support these observations by demonstrating that the anterior olfactory structures may be one of the induction sites of PD pathology. Considering that there is a doubling rather than a loss of dopaminergic neurons in the olfactory bulb in PD patients, the pathophysiology of olfactory dysfunction in PD is far from being elucidated. Studying prodromal manifestations of PD, such as olfactory dysfunction, and their underlying pathophysiology may greatly contribute to the development of treatment strategies that focus on preclinical detection and slowing down disease progression.

Humans↗