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PubMed1981

Odor identification in young and elderly persons: sensory and cognitive limitations.

The investigation sought to uncover whether aging impairs ability to process olfactory information. College-age and elderly women first sought to discriminate among common odors. The elderly persons failed much more frequently than the young. Persons who achieved a high level of discrimination subsequently sought to identify 40 objects by smell and to use personality generated labels to name smells during repeated presentations. The older persons exhibited poorer ability in both tasks. Unlike young persons, the elderly failed to benefit from corrective feedback with their personally generated labels. Nevertheless, the elderly women did benefit from corrective feedback with the true names for the smells. Given enough practice with the true names, the elderly persons could possibly perform as well as the young. Processes that seem to facilitate identification include active encoding, active retrieval, and spontaneous use of verbal mediators. These cognitive operations seem compromised in elderly persons.

Adolescent↗

PubMed1999

Effects of middle turbinate medialization on olfaction.

OBJECTIVE/HYPOTHESIS: Turbinate medialization techniques have gained popularity in an attempt to prevent turbinate lateralization. Theoretically, adhesions between the septum and middle turbinate will prevent lateralization but may compromise airflow to the olfactory neuroepithelium and affect the sense of smell. No studies have addressed this issue. The objective of this study is to evaluate effects of middle turbinate medialization on olfaction. STUDY DESIGN: A prospective controlled study of olfaction before and after middle turbinate medialization using the University of Pennsylvania Smell Identification Test (UP-SIT) and patient questionnaires. METHODS: Fifty patients underwent endoscopic sinus surgery (ESS) with middle turbinate medialization and preservation. The caudal end of the middle turbinate and the opposing septal mucosa were abraded with a microdebrider for iatrogenic synechia formation in an attempt to avoid lateralization of the middle turbinate. Each of the patients underwent preoperative assessment with a questionnaire and UPSIT. All patients were reevaluated approximately 5 weeks after surgery by endoscopic examination, questionnaire, and the UPSIT. The preoperative and postoperative questionnaire responses were compared for subjective analysis. Objectively, the preoperative and postoperative UPSIT scores were compared using the Student t test. RESULTS: The questionnaires showed that the study population's subjective sense of smell either did not change or improved compared with the preoperative state. Objectively, there was a mean increase of UPSIT scores after surgery. This difference was not statistically significant (P = .4). CONCLUSION: Middle turbinate medialization has no detectable adverse effect on olfaction.

Adult↗

PubMed2001

Steroid-dependent anosmia.

OBJECTIVE: To document the response to steroids in patients remaining anosmic following endoscopic nasal and sinus polypectomy. STUDY DESIGN: A prospective study of 24 patients with nasal and sinus polyps who were anosmic prior to endoscopic nasal and sinus surgery. Those who remained anosmic after surgery were treated with steroids. Most patients had asthma, allergic rhinitis, or both. A few had aspirin sensitivity. METHODS: All 24 patients had testing of their sense of smell before and after surgery. Those who remained anosmic postoperatively were first treated with topical nasal and then oral steroids and then tested again. RESULTS: Twelve of the 24 remained anosmic after surgery and were found to be unresponsive to nasal steroids, but oral steroids were found to restore the sense of smell to normal in most patients. Few patients continued to take the medication for long periods of time mainly because of a fear of side effects. Recent studies have suggested the role of systemic steroids in olfactory secretion, which may explain the mechanism for this response. CONCLUSION: Patients who remain anosmic after the removal of nasal and sinus polyps can be treated with oral steroids resulting in improvement of their sense of smell. Further research is needed on a molecular level to determine the reason for this and also why oral but not nasal steroids are helpful in these patients.

Administration, Intranasal↗

PubMed2000

Comparison of the palatability of the oral suspension of cefdinir vs. amoxicillin/clavulanate potassium, cefprozil and azithromycin in pediatric patients.

BACKGROUND: Patient adherence to therapeutic regimens is extremely important to successful treatment of acute otitis media. Among pediatric patients medication palatability, particularly that of oral suspensions, is essential for patient acceptance, therapeutic compliance and successful outcome. METHODS: A series of six randomized, single blind, crossover trials were conducted, each comparing cefdinir oral suspension with one of the following antibiotic oral suspensions: amoxicillin/clavulanate potassium; cefprozil; or azithromycin. Each medication comparison was evaluated in a single center and multicenter study. Subjects 4 to 8 years of age were asked to taste and smell each medication and assign preference using a visual "smile-face" scale. Ratings were converted to a numeric score ranging from 5 ("really good") to 1 ("really bad"). RESULTS: Among the 715 subjects 85% rated the taste of cefdinir as good or really good, the highest possible ratings; 63% of subjects assigned the same ratings to amoxicillin/clavulanate potassium, cefprozil or azithromycin. Seventy-one percent rated the smell of cefdinir as good or really good; 64% assigned the same ratings to the comparators. CONCLUSIONS: Based on the findings from these trials, children 4 to 8 years of age preferred the taste and smell of cefdinir oral suspension to that of the comparator agents.

Administration, Oral↗

PubMedDate not supplied

Quantitative assessment of olfactory experience during pregnancy.

Results of the National Geographic Smell Survey were used to investigate the effects of pregnancy on olfactory perception and odor-related behavior. The responses to test odors and survey questions of 13,610 pregnant and 277,228 nonpregnant U.S. women between 20 and 40 years of age were analyzed. In comparison to nonpregnant women, pregnant women rated their own sense of smell lower, more often rated the test odors less pleasant smelling, more often classified the test odors as inedible, were less likely to report odor-evoked memories, and used perfume and cologne less frequently. Differences in odor detection and intensity rating did not favor either group.

Adult↗

PubMed2005

Objective assessment of terbinafine-induced taste loss.

OBJECTIVES: Terbinafine (Lamisil), a widely prescribed oral antifungal agent, reportedly induces taste loss in 0.6% to 2.8% of those taking the drug. However, many so-called taste problems reflect olfactory problems, and the sole empirical study published on this topic, based on whole-mouth testing of a single subject, found no terbinafine-related deficit. In this study, we quantitatively assessed, using well-validated taste and smell tests, chemosensory function in six patients complaining of taste disturbance after terbinafine treatment and compared their test scores to those of six age-, race-, and sex-matched normal controls. METHODS: Taste function was measured using a 96-trial regional test that assesses sweet, sour, bitter, and salty taste perception within the anterior (cranial nerve [CN] VII) and posterior (CN IX) lingual taste bud fields. Smell function was bilaterally evaluated using the 40-item University of Pennsylvania Smell Identification Test. RESULTS: Taste function for sweet-, sour-, and bitter-tasting stimuli was significantly depressed in both the anterior and posterior lingual regions. For sodium chloride, the decrements were confined to the posterior region. Olfactory function was within normal limits. CONCLUSION: These findings 1) support anecdotal case reports of taste loss after terbinafine use, 2) demonstrate that all four major taste qualities are affected, and 3) suggest that olfactory dysfunction is not involved. Because self-report markedly underestimates chemosensory deficits, more extensive quantitative testing of patients receiving terbinafine will likely reveal a much higher prevalence of terbinafine-induced taste loss than currently reported. Since being older than 65 years of age and having a low body mass index are reportedly risk factors for terbinafine-induced taste loss, physicians should be particularly on the alert for elderly persons taking this medication who may become depressed or alter their food intake in response to decreased taste sensation.

Adult↗

PubMed2006

A study comparing SPECT and MRI in patients with anosmia after traumatic brain injury.

PURPOSE: The initial or first clinical presentation of altered sensation of smell is directly linked to the degree of impaired sensitivity. We took the opportunity to examine normal and nonspecific MRI findings in 6 patients with known anosmia after traumatic brain injury with perfusion SPECT brain imaging. MATERIAL AND METHODS: Patients included those with primary loss of smell after head injury. All patients underwent standard testing by the Taste & Smell Center. Normal or nonspecific near normal brain MRI studies were subsequently referred for SPECT perfusion neuroimaging. RESULTS: MRI studies were negative in 3 cases. In the remaining studies, one case showed nonspecific white matter change, another low signal in the left frontal gyrus, and the sixth case merely some cortical atrophy. All 6 cases demonstrated lesions on SPECT involving the frontal, temporal, and temporoparietal cortex. CONCLUSION: This study identified altered blood perfusion pattern in otherwise normal anatomic structures on MRI.

Accidents, Traffic↗

PubMed1998

Olfactory evoked responses and identification tests in neurological disease.

UNLABELLED: To assess the value of smell testing we used olfactory evoked potentials (OEP) and an identification test in multiple sclerosis, Parkinson's disease, motor neuron disease and Alzheimer's disease. METHODS: The OEP to H2S (20 ppm) was obtained using an olfactometer designed to stimulate olfactory nerve endings only. Odor recognition was assessed by the University of Pennsylvania Smell Identification Test (UPSIT). In all instances the disease was 'definite' based on standard diagnostic criteria. Controls were derived from 156 healthy people. RESULTS: 1) Multiple Sclerosis: 11/72 patients (15%) were abnormal on UPSIT. For OEP there was significant increase of latency and decrease in amplitude in 6/26 patients (23%). 2) Parkinson's Disease: 126/155 (81%) patients had an abnormal UPSIT score. 12/37 (32%) had prolonged latency with normal amplitude measurement on OEP, but 27 had absent or unclear readings. 4/10 with normal UPSIT displayed abnormality on OEP. 3) Motor Neuron Disease: 9/58 (16%) were abnormal on UPSIT. There was significant delay in 1/10 (10%) patients on OEP. 4) Alzheimer's Disease: UPSIT scores were abnormal in all 8 patients examined. OEP was normal in 4 of these who could be tested. CONCLUSION: Smell dysfunction was found in all 4 conditions but most severely in Parkinson's Disease (over 80%). The UPSIT in general showed abnormality more frequently than OEP. The olfactory defect probably involves peripheral structures in all diseases tested except Alzheimer's. A patient with normal olfaction is unlikely to have idiopathic Parkinson's disease.

Adolescent↗

PubMed1998

Age-related changes in the prevalence of smell/taste problems among the United States adult population. Results of the 1994 disability supplement to the National Health Interview Survey (NHIS).

Information about the prevalence of disorders of the chemical senses has been limited. In the late 1970s, the consensus among experts convened by the National Institutes of Health (NIH) was that more than 2 million adults in the United States had a disorder of smell or taste. A large, nonrandom survey conducted by the National Geographic Society in 1987 found that 1% of their 1.2 million respondents could not smell 3 or more of 6 odorants using a 'scratch and sniff' test. Age was an important factor, with a decline beginning in the second decade of life. No comparable data have been available for taste, although it has been suggested that the sense of taste remains more robust with age. The National Institute on Deafness and Other Communication Disorders (NIDCD), NIH, began collaborating with the National Center for Health Statistics (NCHS) in 1993 to acquire information on the prevalence of smell/taste problems using the Disability Supplement to the National Health Interview Survey (NHIS). This survey was administered to approximately 42,000 randomly-selected households (representing about 80,000 adults over 18 years of age) in 1994. Adjusted national estimates derived from this survey showed a prevalence of 2.7 million (1.4%) U.S. adults with an olfactory problem. Also, 1.1 million (0.6%) adults reported a gustatory problem. When smell or taste problems were combined, 3.2 million (1.65%) adults indicated a chronic chemosensory problem. The prevalence rates increased exponentially with age. Almost 40% with a chemosensory problem (1.5 million) were 65 years of age or greater. In a multivariate analysis, the individual's overall health status, other sensory impairments, functional limitations (including difficulty standing or bending), depression, phobia, and several other health-related characteristics were associated with an increase in the rate of chemosensory disorders.

Adolescent↗

PubMed1999

Long-term effects on the olfactory system of exposure to hydrogen sulphide.

OBJECTIVE: To study chronic effects of hydrogen sulphide (H2S) on cranial nerve I (nervi olfactorii), which have been only minimally described. METHODS: Chemosensations (smell and taste) were evaluated in eight men who complained of continuing dysfunction 2-3 years after the start of occupational exposure to H2S. Various bilateral (both nostrils) and unilateral (one nostril at a time) odour threshold tests with standard odorants as well as the Chicago smell test, a three odour detection and identification test and the University of Pennsylvania smell identification test, a series of 40 scratch and sniff odour identification tests were administered. RESULTS: Six of the eight patients showed deficits of various degrees. Two had normal scores on objective tests, but thought that they continued to have problems. H2S apparently can cause continuing, sometimes unrecognised olfactory deficits. CONCLUSION: Further exploration into the extent of such problems among workers exposed to H2S is warranted.

Adult↗

PubMed1991

The nature and course of olfactory deficits in Alzheimer's disease.

OBJECTIVE: The aim of this study was to determine the specific nature and course of olfactory deficits in Alzheimer's disease. Previous studies had noted impaired odor identification, but there was no unanimity about the presence of odor detection deficits. METHOD: Odor identification was tested in 55 patients with Alzheimer's disease and 57 elderly control subjects by using the University of Pennsylvania Smell Identification Test. Odor detection was assessed in 46 subjects with Alzheimer's disease and 40 control subjects by using a forced-choice threshold test with geraniol as the odorant. RESULTS: Significant deficits in olfactory identification were present in subjects who were in the earliest stages of cognitive impairment, and these deficits increased as Alzheimer's disease progressed. There was some overlap in individual smell identification test scores between cognitively impaired patients and normal elderly subjects. On the other hand, odor detection deficits did not appear until Alzheimer's disease was relatively advanced. Smell identification test scores were correlated with Mini-Mental State scores, but geraniol detection was not. CONCLUSIONS: Odor identification is impaired early in Alzheimer's disease and may be more influenced by cognitive status than is acuity of odor detection, which is not altered until later in the disorder. The pattern of hyposmia in Alzheimer's disease suggests that the disorder may not "begin in the nose," as has been theorized previously. Further refinement of olfactory testing may be useful in the diagnostic evaluation of early dementia.

Aged↗

PubMed2001

Cerebral hemodynamic response to unpleasant odors in the preterm newborn measured by near-infrared spectroscopy.

Newborn infants in intensive care units are exposed to several unfamiliar smells, mostly related to the nosocomial environment. How the preterm baby perceives these olfactory stimulations remains unclear. Near-infrared spectroscopy can be performed noninvasively above the olfactory cortex to monitor changes of cerebral blood flow as an indicator of cortical activation. The aim of this study was to explore by near-infrared spectroscopy how odorous substances routinely used in the neonatal intensive care unit influence bilateral cortical hemodynamics in the olfactory region of the brains of preterm infants. Specifically, a detergent (Neomidil) and an adhesive remover (Remove) have been tested. Twenty preterm neonates of gestational age 30-37 wk (mean 33.7 +/- 2.3 SD) and postconceptional age 32-37.3 wk (mean 35.5 +/- 2.75 SD) were monitored by near-infrared spectroscopy. Two optode pairs were placed above the anterior orbitofrontal gyri, which is involved in olfactory processing, on each side of the skull. Fifteen babies were exposed to the smell of a disinfectant and five babies to that of a detergent, both applied to small cotton pads. Changes of oxygenated Hb and deoxygenated Hb were recorded before, during, and after a 10-s stimulus. In 17 out of 20 babies, there was a decrease in oxygenated Hb and total Hb after the exposure to the substances. The decrease was significantly greater in the right side than in the left side. This change was different from that observed in our previous study after exposure to colostrum and the pleasant smell of vanilla, which elicited an increase in blood oxygenation in the same region. The biologic significance of this finding is unknown. We conclude that cortical hemodynamic modifications occur in the preterm newborn after exposure to preparations commonly used in the neonatal intensive care unit. A lateralization seems to occur in processing unpleasant olfactory cues.

Cerebrovascular Circulation↗

PubMed2004

Altered olfactory acuity in the morbidly obese.

BACKGROUND: Obese individuals have been reported to have a heightened desire for and ability to identify sweets when compared with leaner persons. Smell, like taste, may also be altered in obese persons compared with leaner subjects. This study was designed to determine if the sense of smell is different between morbidly obese and moderately obese individuals. METHODS: 101 adult volunteers undergoing preoperative evaluation completed the 12-item Cross-Cultural Smell Identification Test (CC-SIT) before surgical intervention. Age, BMI, and smoking history were also obtained. RESULTS: 101 subjects completed the preoperative CC-SIT (87 female, 14 male). Mean age of the subjects was 40 +/- 12 years. Mean BMI was 42.5 +/- 12.5 kg/m(2). 46 subjects (46%) had a BMI >45. 21 were smokers (21%). 9 subjects (9%), all female non-smokers, had a CC-SIT score representing olfactory dysfunction. Subjects with BMI >45 were more likely to have olfactory dysfunction than subjects with BMI <45 (16% vs 4%, P <0.05). CONCLUSION: Morbidly obese individuals are more likely than moderately obese individuals to demonstrate CC-SIT scores consistent with olfactory dysfunction. The reason for this is unclear but is probably related to metabolic changes occurring in morbidly obese individuals.

Adult↗

PubMed2003

Characteristics of electroencephalographic responses induced by a pleasant and an unpleasant odor.

More than sensory stimuli, odorous stimuli were employed to facilitate the evocation of emotional responses in the present study. The odor-stimulated emotion was evaluated by investigating specific features of encephalographic (EEG) responses produced thereof. In this study, the concentrations of the same odor were altered; viz., the changes in odor-induced emotional level were compared with the concurrently monitored EEG response features. In addition, we performed the mental task to evoke the arousal state of the brain and investigated the resemblance of response characteristics of the resting state to the post-mental task resting state. Subjects having no abnormalities in the sense of smell included 12 male undergraduate and graduate students (age range: 22-26 years). Experiment I involved 2 types of odors that induced favorable odorous stimuli (pleasant induction); test-solutions were either diluted 150 (easily perceptible odorous sensation) or 500 (slightly perceptible odorous stimuli) times. Experiment II had 2 types of odors that evoked unfavorable odorous stimuli (unpleasant induction), and test-solutions with dilution rates similar to those of pleasant induction were prepared. Odorless distilled water was used as the control in both experiments. From results of rating the odorous stimuli of our compounds used, the candidates were respectively found to be appropriate in inducing the pleasant and unpleasant smell sensations. The analyses of EEG responses on inducing pleasant and unpleasant smell sensations revealed that the EEG activities of the left frontal region were enhanced. This finding may establish the hypothesis of a relationship prevailing between the positive approach-related emotion evoked by the visual sensation and the left hemisphere (Davidson, 1992; Tomarken et al., 1989). In other words, it can be interpreted that the negative withdrawal-related emotion may be associated with activities of the right hemisphere. However, this hypothesis may not be applicable to the unpleasant odors, as the unpleasant emotions are activated by the unpleasant odors not only in the bilateral frontal regions but also over an extensive area of the brain. As such, the pleasant emotions are evoked in the left frontal brain region while the unpleasant emotions are incited in the bilateral frontal and extensive regions in the brain with the odorous stimuli. Moreover, intrinsic EEG activities in response to the pleasant and unpleasant inputs were not observed after performing the mental tasks. In other words, EEG responses reflecting central nervous system activities elevated by loading of the mental tasks as a result of exposure to the pleasant and unpleasant odors may not apparently be observed.

Adult↗

PubMed2006

Intranasal corticosteroids for nasal polyposis : biological rationale, efficacy, and safety.

Nasal polyposis, occurring in about 2% of the general population, is the ultimate form of inflammation of the upper airways. For unknown reasons, polyps develop preferentially in subtypes of inflammatory diseases and are associated with perennial non-allergic rhinitis, asthma, intolerance of aspirin (acetylsalicylic acid)/NSAIDs, allergic fungal rhinosinusitis, cystic fibrosis, and primary ciliary dyskinesia. In contrast to common beliefs, IgE-mediated allergy does not seem to play an etiological role in nasal polyposis.The polyps originate from the mucosa around the clefts of the lateral nasal wall, especially in the region of the ostiomeatal complex. The factors that determine the localization of the disease to a few square centimeters of the airways are not known.Polyps are edematous bags covered by respiratory epithelium and contain very few nerves, blood vessels, and glands that have undergone cystic degeneration. They contain degranulated mast cells, have a very high concentration of histamine, and are characteristically infiltrated by eosinophils. These cells accumulate due to the release of proinflammatory cytokines (in particular, interleukin-5).Nasal polyposis is preceded by a prolonged history of rhinitis accompanied by severe and persistent nasal blockage; typically, the sense of smell is seriously impaired when polyps develop. The diagnosis is based on anterior rhinoscopy or, preferably, endoscopy.Nasal polyposis is medically treatable. Surgical treatment is carried out when medication fails. Intranasal corticosteroids reduce rhinitis symptoms, improve nasal breathing, reduce the size of polyps, and prevent, in part, their recurrence, but this treatment has little effect on the sense of smell. Intranasal corticosteroids can, as basic long-term therapy, be used alone in mild cases or together with systemic corticosteroids and/or surgery in severe cases. Systemic corticosteroids administered for 2-3 weeks have a beneficial effect on all observed symptoms and pathology, including the sense of smell. When nasal blockage is a problem in spite of medical treatment, surgery is recommended. Simple polypectomy can be performed, but endoscopic surgery is recommended in more severe and persistent cases.

Adrenal Cortex Hormones↗

PubMed1994

Correlation of functional alteration with lesion extent after olfactory bulbectomy in rats.

The effect of unilateral versus bilateral olfactory bulbectomy on ability to smell was studied behaviorally (food finding task) in two groups of rats. The trained animals in the first group were unilaterally and in the second group bilaterally bulbectomized. After 6 days of postoperative recovery the rats were retested in the same task. The unilaterally bulbectomized rats showed no significant changes in their smelling. After complete bilateral bulbectomy the significant failure to retrieve the hidden food has been observed. However, even small olfactory bulb remnants provided significant preservation of smelling. Histological findings also confirmed the obtained behavioral results.

Animals↗

PubMed2000

Preference of female students for "tempe" preparations composed of glandless cottonseed and defatted soybean or corn at various ratios.

Cottonseed kernels are rich in protein, but they have not been effectively utilized as a foodstuff because of the occurrence of glands that secrete gossypol. a toxic yellow pigment. Glandless cottonseeds (GLCS) are now available. and their kernels or flour are sold as a foodstuff. For this reason, a GLCS-tempe was prepared after the pattern of a traditional food called "Tempe" in Indonesia (fermented with Rhizopus oligosporus), and any gossypol remaining in GLCS proved to be lost in the process. Corn has not yet been used for tempe because of its difficulty to dehull: nevertheless, corn tempe was satisfactorily made from corn grits. Although GLCS-tempe was good. it smelled slightly unique just at swallowing. The preference for GLCS-tempe was correlated to the smell and taste. A combination of GLCS and defatted soybeans or corn at ratio of 1 : 1 led to many good effects on GLCS-tempe: e.g., favorable improvement in smell, taste, amino acid score, nutrient balance, and decrease of oligosaccharides related to the flatulence of the GLCS-tempe. Thus GLCS-tempe containing defatted soybeans or corn half of what can be expected to serve as a nutritious tasty food.

Cottonseed Oil↗

PubMed2003

Olfaction as a traumatic reminder in posttraumatic stress disorder: case reports and review.

BACKGROUND: Memory for odors that are associated with intense emotional experiences is often strongly engraved. Odors are claimed to be more closely connected to affect than other sensory experiences. They can serve as potent contextual cues for memory formation and emotional conditioning and can also serve as cues for olfactory flashbacks. Though trauma-related smells have long been noted by clinicians to be precipitants of traumatic memories in patients with posttraumatic stress disorder (PTSD), very few reports have been published that document this. CASE REPORTS: We review olfactory memories and olfactory flashbacks by presenting 3 cases that illustrate the role of olfaction in PTSD. In these cases olfaction is either a precipitant of PTSD symptoms or an important component of reexperiencing. DISCUSSION: In PTSD, seemingly nonspecific cues have the potential to precipitate traumatic memories with strong emotional components. These conditioned responses in PTSD are hypothesized to be mediated by specific brain areas, i.e., amygdala, hippocampus, and orbitofrontal cortex. Questions about smells as a traumatic reminder should be part of the routine assessment of intrusive memories in PTSD. In addition, smells may have the potential to provide cues to exposure situations in therapy or to facilitate de novo conditioning.

Adult↗