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Assessment of smell and taste in patients with allergic rhinitis.

We examined the senses of smell and taste in 240 patients with verified hypersensitivity reactions of the respiratory tract. Olfactometry was performed according to Elsberg and Levy's method and followed by electrogustometry. The examinations revealed that the incidence of smell and taste disorders in patients with allergic rhinitis is 21.4% and 31.2%, respectively. No significant relationships between smell and taste dysfunction were found. We evaluated statistically positive correlations between the olfactory and gustatory thresholds compared with 78 qualitative and quantitative factors assessed in the study. There was a statistically significant relationship between the olfactory thresholds and levels of eosinophils in blood and in nasal discharge. acid reaction of the nasal mucosa, coexisting nasal polyps and X-ray changes in the ethmoid sinuses. There was a positive influence of pharmacotherapy as well as specific desensitization and surgery on the impairment of the sense of smell in allergic rhinitis.

Adolescent↗

Studies on the attraction of Simulium damnosum s.l. (Diptera: Simuliidae) to its hosts. I. The relative importance of sight, exhaled breath, and smell.

Four traps used in capturing hunting female S. damnosum s.l. are discribed: the slat trap, the enclosure trap, the fan trap, and the sticky trap. In forest a man hidden inside a trap, but removing his exhaled breath through a long hose, attracted 4 times as many flies as did an unbaited trap. When the man exhaled normally into the trap the number of flies taken rose again by a further factor of 4. Carbon dioxide gas, emitted from inside the trap attracted some two-thirds as many flies as a man exhaling normally inside the trap. In both forest and Sudan-savanna environments the catches of a man stationed on an open stretch of land and fully exposed to view while his exhaled breath was removed through a long hose, were not substantially lower than those of a man in a similar situation who exhaled normally. In forest a motionless man, partly hidden among vegetation, attracted fewer flies than a moving man who was fully exposed to view (a) when both men removed their exhaled breath through long hoses, and (b) when they exhaled normally. In the forest a trap baited with CO2 gas (250 cc per min) caught more flies than a similar, unbaited trap, but the preformance of CO2-baited traps, as compared with that of human collectors, was highly variable. Catches in CO2-baited traps were uniformly low in the Sudan-savanna. In forest, removal of olfactory substances from the human skin, by vigorous washing and application of petroleum jelly, or by wearing impermeable clothing, greatly reduced the numbers of flies attracted. No such reduction was observed in Sudan savanna. In the forest, cloths, worn by men for several days and then used as bait, attracted about 10 times as many flies as did similar, unworn cloths. Addition of CO2 gas produced a 4-fold increase in the attractiveness of worn cloths and an 18-fold increase in that of unworn cloths. No corresponding experiments were done in the savanna. Fan traps could become contaminated by human handling during the assembly and setting-up procedures. They were thus rendered attractive to flies. In the Sudan-savanna, the catches of men positioned in front of warm rock surfaces were lower than those of men stationed on coller, sandy surfaces. This suggests that body heat may be an additional attractant factor. The results suggest that "forest" S. damnosum s.l. (presumably S. squamosum) females rely heavily on smell as an attractant and, to a lesser extent, on sight and exhaled breath. Smell appears to be the only obligatory attractant, and it can act by itself. This raises the possibility that a trap might be developed which incorporates only smell stimuli as bait. For "savanna" S. damnosum s.l. (presumably S. damnosum s.s.) neither smell nor exhaled breath appear to be important attractants, and some other factor, perhaps sight, appears to be the dominant attractant in this zone.

Air↗

[Smell dysfunction in nasal and paranasal sinus disease: a review of the literature (I)].

Substantial advances have been achieved during the last decade in our understanding of the biological bases of the sense of smell, as well as in the clinical identification, diagnosis, and management of dysosmia. Nasal obstruction can result from inflammatory, neoplastic, traumatic, and developmental alterations within the nasal cavity. All these processes, if they result in bilateral restriction of airflow to the olfactory neuroepithelium, presumably alter the ability to smell. Rhinitis, nasal polyposis, and rhinosinusitis are accompanied by decreased ability to smell. Benign and malignant neoplasms can obstruct the nasal chamber and thereby alter airflow to the olfactory receptors without damaging the olfactory neuroepithelium. The purpose of this synthesis is to provide an advanced review of the literature in order to describe the basis of smell alterations in nasal polyposis and chronic rhinosinusitis.

Anti-Inflammatory Agents↗

[Smell dysfunction in nasal and paranasal sinus disease: a review of the literature (II)].

Substantial advances have been achieved during the last decade in our understanding of the biological bases of the sense of smell, as well as in the clinical identification, diagnosis, and management of dysosmia. Nasal obstruction can result from inflammatory, neoplastic, traumatic, and developmental alterations within the nasal cavity. All these processes, if they result in bilateral restriction of airflow to the olfactory neuroepithelium, presumably alter the ability to smell. Rhinitis, nasal polyposis, and rhinosinusitis are accompanied by decreased ability to smell. Benign and malignant neoplasms can obstruct the nasal chamber and thereby alter airflow to the olfactory receptors without damaging the olfactory neuroepithelium. The purpose of this synthesis is to provide an advanced review of the literature in order to describe the basis of smell alterations in chronic rhinitis, nasal malformations and tumors.

Chronic Disease↗

[Occupations and the sense of smell].

Olfactometric fitness examinations in relation to the place of work are required since the olfactory organ has support and protective functions. Smelling disorders result at work from trauma, hypersensitivity, acute and chronic intoxications, but most frequently from chemical and physical substances taken up by inhalation. They are different due to their expression (slight hyposmia till to anosmia, parosmia), latency, localization (respiratory, epithelial, nerval, central), and a combination with other disorders. In order to examine rhinologically the patient, the nasal mucosa has to be assessed. Its lesion does not necessarily correlate to the smell disorder. 475 patients were exposed to a total of 10 different substances or classes of substances. It was demonstrated that disorders of the whole nasal physiology can be caused by toxic and nontoxic substances, e.g. calcium carbide when taking effect for a longer period, even below their legally required "maximum absorption concentration". The treatment is started after ending the exposition. The expert's opinion is based on the clinical findings, a standardized investigation of smelling, the patient's history incl. the history of occupation, and an analysis of the place-of-work conditions. The degree of bodily defect is related to the single types of disorder. In case of a complete anosmia it is 20%. It is assumed that a growing number of occupation-related smell disorders become known and, hence, have to be assessed.

Environmental Exposure↗

Evaluation and treatment of smell dysfunction.

We gave 63 patients with symptoms of smell dysfunction a full evaluation by age-adjusted olfactory threshold and odor identification testing, rhinomanometry, nasal cytology, nasal endoscopy, computed tomographic (CT) scan and a trial of medical treatment. CT scans were valuable for identifying ethmoid sinus disease and nasal endoscopy for inspecting olfactory epithelium. A trial of prednisone served as a diagnostic modality to identify correctable causes of smell dysfunction. Given that there are 2 million people in the United States with a smell dysfunction, that the average physician knows little about its diagnosis and treatment and that the psychosocial impact to an afflicted person is great, we urge a greater awareness of smell dysfunction, its diagnosis and its treatment.

Adult↗

Changes in smell acuity induced by radiation exposure of the olfactory mucosa.

The effects of ionizing radiation on smell acuity were assessed in 12 patients in whom the olfactory mucosa was exposed to radiation in the course of treatment for nasopharyngeal carcinoma or pituitary adenoma. Olfactory detection thresholds for two odorants (amyl acetate and eugenol) were determined before the start of radiation therapy, within a week of termination of therapy, and 1, 3, and 6 months later. The results show clearly that smell acuity is profoundly affected by therapeutic irradiation. Thresholds had increased in all 12 patients by the end of treatment and were still high one month later. Varying degrees of recovery were noted in most patients three to six months after cessation of treatment. The fate of the sense of smell deserves more attention when considering the disability caused by irradiation to certain head and neck tumors.

Humans↗

On being led into temptation: "counterregulation" of dieters after smelling a "preload".

In the present study, it was found that dieters lost control over their food intake and "counterregulated" after merely smelling a "preload," while dieters without a "preload" were able to maintain control over their food intake. Nondieters, however, even ate marginally less after smelling a "preload" than they did in a no-preload condition. Apparently, actually breaking one's diet and such subsequent thoughts as "I've blown my diet, I might as well continue to eat" is not necessary for counterregulation to occur. The observation that merely smelling a "preload" is sufficient to produce "counterregulation" in dieters but not in nondieters challenges the explanatory power of the widely held cognitive explanation of experimental counterregulation in preloaded dieters. An explantation in terms of conditioning is put forward.

Adult↗

Workshop on taste and smell in the elderly: an overview.

The purpose of the workshop entitled Taste and Smell in the Elderly: Behavioral and Nutritional Consequences was 1) to review the current state of knowledge in the area of taste and smell, with emphasis on age-related changes, 2) to identify existing gaps in our knowledge, and 3) to develop future research strategies. There was general agreement that the majority of scientific studies have found impairments in taste and smell acuity in the elderly. These losses may result from normal aging, certain disease states especially Alzheimer's disease, medications, surgical interventions, and environmental exposure. However, there are gaps in our knowledge of the basic mechanisms by which aging and environmental factors may impair the chemical senses in the elderly. Further research is also required in a variety of areas including chemosensory test procedures, food intake, and nutrition to understand fully the impact of chemosensory dysfunction on older individuals.

Aged↗

The influence of aging on oral health and consequences for taste and smell.

Oral diseases that are commonly seen in older adults can impair chemosensory function. Many stomatological conditions are preventable and treatable, yet unmanaged, they can cause significant morbidity and a diminished quality of life. Importantly, many oral diseases are not necessarily an inevitable consequence of growing old, and are frequently attributed to systemic diseases and their treatment. Although gustation may undergo mild age-related decrements, olfaction declines dramatically with greater age. The oral-facial region is intimately involved in the sensations of taste and smell, and diseases affecting this region in an older person could adversely affect an already compromised chemosensory system. Older adults with impaired taste and/or smell should be thoroughly evaluated for oral and pharyngeal diseases. It is reasonable to expect that a healthy adult can grow older with good oral health and function, and can continue to experience the hedonic pleasures of taste and smell associated with eating and drinking.

Aged↗

Sniffing and smelling: separate subsystems in the human olfactory cortex.

The sensation and perception of smell (olfaction) are largely dependent on sniffing, which is an active stage of stimulus transport and therefore an integral component of mammalian olfaction. Electrophysiological data obtained from study of the hedgehog, rat, rabbit, dog and monkey indicate that sniffing (whether or not an odorant is present) induces an oscillation of activity in the olfactory bulb, driving the piriform cortex in the temporal lobe, in other words, the piriform is driven by the olfactory bulb at the frequency of sniffing. Here we use functional magnetic resonance imaging (fMRI) that is dependent on the level of oxygen in the blood to determine whether sniffing can induce activation in the piriform of humans, and whether this activation can be differentiated from activation induced by an odorant. We find that sniffing, whether odorant is present or absent, induces activation primarily in the piriform cortex of the temporal lobe and in the medial and posterior orbito-frontal gyri of the frontal lobe. The source of the sniff-induced activation is the somatosensory stimulation that is induced by air flow through the nostrils. In contrast, a smell, regardless of sniffing, induces activation mainly in the lateral and anterior orbito-frontal gyri of the frontal lobe. The dissociation between regions activated by olfactory exploration (sniffing) and regions activated by olfactory content (smell) shows a distinction in brain organization in terms of human olfaction.

Adult↗

[Drug therapy for disturbances of smelling].

Disorders of the sense of smell are frequent. This severely can affect the quality of live. Appropriate testing is needed to determine the nature of the patient's complaints. Following the pathogenesis, two main groups of smell disorders are discernable: The conductive-respiratory smell disorders, where the odour can not reach the receptor and the senso-neuronal disorders where perception or transduction is affected. Therefore two different therapeutical approaches are described.

Adrenal Cortex Hormones↗

The effects of aging on the human sense of smell and its relationship to food choice.

Olfaction plays a significant role in the perception of foods. For the most part, taste is limited to sweet, sour, bitter, and salty. The sensory experiences during consumption of complex foods and drinks cannot be constructed from these units. Indeed, much of the taste of a meal derives from olfactory stimulation. Hence, factors that influence olfactory perception should affect treatment of food-related odors. This article initially reviews previously published observations on the effects of age on olfaction and food preferences and then presents the results of original analyses of data derived from a substantial database formed as a result of the National Geographic Smell Survey. Included in the Survey form were topics relevant to the present article. They include the following question: Would you eat something that smelled like this? Two of the odors in the Survey were food related and two were fragrance related. Hence, in addition, we assessed responses to the following question: Would you apply something that smelled like this to your body? Answers were affected in part by the age and gender of the respondent and by the perceived pleasantness and intensity of the odor.

Aging↗

Smell of danger: an analysis of LP-gas odorization.

LP-gas derives warning properties from the odorants ethyl mercaptan or thiophane. Laboratory tests have implied that the average person has the ability to smell the odors before leaking LP-gas reaches one-fifth its lower limit of flammability. Generally, however, laboratory tests ignore or discard persons with a poor sense of smell, especially the elderly and persons with certain types of hyposmia. Some persons who apparently can smell the warning agents when directed may otherwise fail to notice or identify them. Elderly men seem particularly vulnerable to instances of incidental anosmia and olfactory agnosia. Psychophysical testing of the warning agents has been rather unsophisticated. There exists neither a standard protocol for testing nor adequate specification of the perceptual properties that might make one warning agent better than another. Without such developments, improvement in warning agents will fail to occur. Possible improvements include increases in concentration, the use of blends to insure more uniform delivery of agent and, to decrease the perceptual vulnerability of relatively insensitive people, use of agents with favorable psychophysical (stimulus-response) functions and use of agents with favorable adaptation characteristics. Even without a change in existing products, it seems advisable to learn more about the vulnerability of LP-gas users and to employ educational means to reduce risks.

Diffusion↗

Confusing tastes and smells: how odours can influence the perception of sweet and sour tastes.

This study investigated the relationship between perception of an odour when smelled and the taste of a solution to which the odour is added as a flavorant. In Experiment 1 (E1) sweetness, sourness, liking and intensity ratings were obtained for 20 odours. Taste ratings were then obtained for sucrose solutions to which the odours had been added as flavorants. Certain odours were found to enhance tasted sweetness while others suppressed it. The degree to which an odour smelled sweet was the best predictor of the taste ratings. These findings were extended in Experiment 2 (E2), which included a second tastant, citric acid, and employed four odours from E1. The most sweet smelling odour, caramel, was found to suppress the sourness of citric acid and, as in E1, to enhance the sweetness of sucrose. Again, odours with low sweetness suppressed the sweetness of tasted sucrose. The study demonstrated that the effects of odours on taste perception are not limited to sweetness enhancement and apply to sour as well as sweet tastes. The overall pattern of results is consistent with an explanation of the taste properties of odours in terms of prior flavour-taste associations.

Adult↗

Smell intensity monitoring using metal oxide semiconductor odor sensors during intravenous olfaction test.

The intravenous olfaction test using prosultiamine (PST) solution is simple to perform and has been used clinically in Japan. We monitored intranasal intensity of smell continuously in real time under various conditions of administration using metal oxide semiconductor odor sensors and established an optimal PST injection procedure. In this study, we found that 1) although there was fluctuation in the pattern of intensity of increase in smell in the PST original solution test, the pattern of increase in intranasal smell intensity could be stabilized by prolonging the injection time to 40 s and 2) dilution of PST with physiological saline was effective in preventing angialgia during intravenous injection. It appears that PST administration is best performed by adding 10 ml of saline to 10 mg (2 ml) of PST and injecting the resulting 12-ml solution (6x dilution) and that the best respiratory cycle for testing is once in every 2 s.

Adult↗

Utility of a three-item smell identification test in detecting olfactory dysfunction.

OBJECTIVE: Physicians rarely assess smell function, largely because of time considerations. Therefore, there is clinical need for very brief cranial nerve I screening tests. Although a few such tests exist, none have been adequately validated. The goal of this study was to empirically assess the utility of a three-item microencapsulated odor identification test in detecting olfactory dysfunction. SETTING: Smell and taste center at a university medical center. METHODS: The test was administered to 224 consecutive patients (98 men and 126 women ranging in age from 15-88 years). As part of their overall assessment, the well-validated 40-item University of Pennsylvania Smell Identification Test (UPSIT) was also administered. Sensitivity, specificity, and both negative and positive predictive values of the three-item test were established relative to UPSIT dysfunction categories. Test-retest reliability was determined in a subset of 39 patients. RESULTS: The three-item test was abnormal in 99% (67/68) of patients with anosmia, 85% (35/41) of those with severe microsmia, 76% (31/41) of those with moderate microsmia, and 50% (17/34) of those with mild microsmia. Of the 40 normosmic patients, 62.5% (25/40) correctly identified all odors, 25% (10/40) two odors, and 12.5% (5/40) one odor. None of the normosmic patients missed all three items. Using a cut-off score of 2, the test's sensitivity and specificity were 99% and 40%, respectively, for detecting total anosmia. The corresponding negative and positive predictive values were 98% and 43%. For detecting anosmia and severe microsmia, these values were 93%, 45%, 88%, and 63%. For detecting any olfactory pathology, they were 82%, 63%, 42%, and 91%. The test-retest reliability was 0.87. CONCLUSION: The brief three-item test used in this study was found to be highly sensitive in identifying olfactory loss in patients with chemosensory complaints, particularly those with severe dysfunction. Although only moderately specific, its high reliability and negative predictive value suggests it may be an appropriate screening test for olfactory loss.

Adolescent↗

Incorporating the sense of smell into patient and haptic surgical simulators.

It is widely recognized that the sense of smell plays an important role in the field of medicine. The sense of smell not only assists the physician in the diagnosis of certain disorders, but it also plays a surgical role as well. Historically, learning this skill was mostly contingent upon some level of clinical exposure to medically related odors. The advent of computerized scent production devices could change this. This article proposes a surgical simulation model that incorporates olfactory technologies into existing patient and haptic surgical simulators. If incorporated into virtual educational settings such as these, computerized scent production devices could be used not only as a novel way to enhance the virtual experience, but also as a way for medical students to begin to recognize the important role that the sense of smell plays during both diagnosis and surgery.

Computer Simulation↗