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| {{Template:Anosmia}} | | {{Template:Anosmia}} |
| {{CMG}} | | {{CMG}} |
| == Epidemiology and Demographics == | | == [[Anosmia overview|Overview]] == |
| * In the United States, more than 2 million people suffer from anosmia
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| ==Causes==
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| A temporary loss of smell can be caused by a stuffy [[nose]] or infection. In contrast, a permanent loss of smell may be caused by death of [[olfactory receptor neuron]]s in the nose, or by [[brain injury]] in which there is damage to the [[olfactory nerve]] or damage to brain areas that process smell (see [[olfactory system]]). The lack of the sense of smell at birth, usually due to genetic factors, is referred as ''congenital anosmia.'' Anosmia may very occasionally be an early sign of degenerative brain diseases such as [[Parkinson's disease]] and [[Alzheimer's disease]]. Another specific cause of permanent loss could be from damage to olfactory receptor neurons due to use of certain types of [[nasal spray]], i.e. those that cause vasoconstriction of the nasal microcirculation. To avoid such damage and subsequent risk of loss of smell from vasoconstricting nasal sprays, they should be used for only a short amount of time and only when absolutely necessary. Non-vasoconstricting sprays, such as those used to treat allergy related congestion are safe to use for extended periods of time.<ref>{{cite web|url=http://www.coldcure.com/anosmia/anosmia.html|title=www.coldcure.com/anosmia/anosmia.html<!--INSERT TITLE-->}}</ref>
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| *Upper respiratory tract infection (e.g., [[sinusitis]] or the [[common cold]])<ref name="Doty2001">{{cite journal
| | == [[Anosmia classification|Classification]] == |
| | author=Doty RL, Mishra A
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| | title=Influences of nasal obstruction, rhinitis, and rhinosinusitis on the ability to smell
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| | journal=Laryngoscope
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| | volume=111
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| | pages=409–23
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| | year=2001 }}</ref>
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| *[[Nasal polyps]]
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| *[[tobacco smoking|Smoking]]
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| *Head trauma, damage to the [[ethmoid bone]]<ref name="Doty1997">{{cite journal
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| | author=Doty RL, Yousem DM, Pham LT, Kreshak AA, Lee WW
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| | title=Olfactory dysfunction in patients with head trauma
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| | journal=Arch Neurol
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| | volume=54
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| | pages=1131–1140
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| | year=1997 }}</ref>
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| *[[Dementia with Lewy bodies]]
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| *[[Parkinson's Disease]]<!--
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| --><ref name="Doty1988">{{cite journal
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| | author=Doty RL, Deems D, Stellar S
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| | title=Olfactory dysfunction in Parkinson's disease: A general deficit unrelated to neurologic signs, disease stage, or disease duration
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| | journal=Neurology
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| | volume=38
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| | pages=1237–44
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| | year=1988 }}</ref>
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| *[[Alzheimer's Disease]]<!--
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| --><ref name="Murphy1988">{{cite journal
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| | author=Murphy C
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| | title=Loss of olfactory function in dementing disease
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| | journal=Physiology & Behavior
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| | volume=66
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| | pages=177–182
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| | year=1999 }}</ref>
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| *Toxins (especially [[acrylate]]s, [[methacrylate]]s<ref name="Schwartz">{{cite journal
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| | author=Schwartz B, Doty RL, Frye RE, Monroe C, Barker S
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| | title=Olfactory function in chemical workers exposed to acrylate and methacrylate vapors
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| | journal=Am J Pub Health
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| | volume=79
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| | pages=613–618
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| | year=1989 }}</ref> and [[cadmium]]<ref name="Rose1992">{{cite journal
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| | author=Rose CS, Heywood PG, Costanzo RM
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| | title=Olfactory impairment after chronic occupational cadmium exposure
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| | journal=Journal of Occupational Medicine
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| | volume=34
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| | pages=600–605
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| | year=1992 }}</ref><ref name="Rydzewski1998">{{cite journal
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| | author=Rydzewski B, Sulkowski W, Miarzynaska M
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| | year=1998
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| | title=Olfactory disorders induced by cadmium exposure: A clinical study
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| | journal=Int J Occ Med Env Health
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| | volume=11 | |
| | pages=235–245 }}</ref>)
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| *Old age<ref name="">{{cite journal
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| | author=Doty RL, Shaman P, Applebaum SL, Giberson R, Sikorsky L, Rosenberg L
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| | title=Smell identification ability: Changes with age
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| | journal=Science
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| | volume=226
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| | pages=1441–1443
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| | year=1984 }}</ref>
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| *[[Kallmann syndrome]]
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| *[[Laryngectomy]] with permanent [[tracheostomy]]
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| *Esthesioneuroblastoma is an exceedingly rare cancerous tumor that originates in or near the [[olfactory nerve]]. Symptoms are anosmia (loss of sense of smell) often accompanied by chronic [[sinusitis]].<ref>{{cite web|url=http://www.emedicine.com/med/topic748.htm|title=www.emedicine.com/med/topic748.htm<!--INSERT TITLE-->}}</ref>
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| Anosmia can also be caused by nasal polyps. These polyps are found in people with allergies, histories of sinusitis & family history. Individuals with Cystic Fibrosis often develop nasal polyps. | | == [[Anosmia pathophysiology|Pathophysiology]] == |
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| ==Associated conditions== | | == [[Anosmia causes|Causes]] == |
| * [[Cystic Fibrosis]]
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| * [[Kallmann syndrome]]
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| * [[Zinc#Zinc deficiency|Zinc deficiency]]
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| * [[Parkinson's disease]]
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| * [[Alzheimer's disease]]
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| * [[Cadmium Poisoning]]
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| * [[Holoprosencephaly]]
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| * [[Allergies]]
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| == Complete List of Differential Diagnoses == | | == [[Anosmia differential diagnosis|Differential Diagnosis]] == |
| * Central nervous system (CNS) disorders
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| * Congenital disorders
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| * Endocrine disorders
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| * Head/facial trauma
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| * Iatrogenic
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| * Illicit drugs
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| * Nasal and sinus disease
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| * Neoplasms
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| * Poisoning
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| * Post-upper respiratory viral infection
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| * [[Sjogren's Syndrome]]
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| * [[Vitamin]] deficiencies <ref>#kahan isbn=140510368X Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:15</ref>
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| ==Presentation== | | == [[Anosmia risk factors|Risk Factors]] == |
| * '''Anosmia''' can be either temporary or permanent.
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| *:* '''Temporary anosmia''' is caused by any condition that causes swelling and obstruction of the nasal passages and sinuses by irritation.
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| *:* '''Permanent anosmia''' is caused by damage or destruction of the olfactory neuroepithelium or part of the olfactory nerve
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| * A related term, [[hyposmia]], refers to a decrease in the ability to smell, while hyperosmia refers to an increased ability to smell. Some people may be anosmic for one particular [[odor]]. This is called "specific anosmia" and may be genetically based.
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| * While termed as a disability, anosmia is often viewed in the medical field as a trivial problem. This is not always the case—[[esthesioneuroblastoma]] is a very rare cancerous tumor originating in or near the olfactory nerve.
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| * Anosmia can have a number of detrimental effects. Patients with sudden onset anosmia may find food less appetizing, though congenital anosmics rarely complain about this. Loss of smell can also be dangerous because it hinders the detection of gas leaks, fire, body odor, and spoiled food. The common view of anosmia as trivial can make it more difficult for a patient to receive the same types of medical aid as someone who has lost other senses, such as hearing or sight.
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| * Losing an established and sentimental smell memory (e.g. the smell of grass, of the grandparents' attic, of a particular book, of loved ones, or of oneself) has been known to cause feelings of [[clinical depression|depression]].<ref>{{cite web|url=http://news.bbc.co.uk/2/hi/uk_news/magazine/6199605.stm|title=news.bbc.co.uk/2/hi/uk_news/magazine/6199605.stm<!--INSERT TITLE-->}}</ref>
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| * Loss of olfaction may lead to the loss of libido, even to the point of impotency, which often preoccupies younger anosmic men.<ref>{{cite web|url=http://news.bbc.co.uk/2/hi/uk_news/magazine/6199605.stm|title=news.bbc.co.uk/2/hi/uk_news/magazine/6199605.stm<!--INSERT TITLE-->}}</ref>
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| * Often people who have congenital anosmia report that they pretended to be able to smell as children because they thought that smelling was something that 'big people' could do, or did not understand the concept of smelling but did not want to appear different from others. When children get older, they often realize and report to their parents that they do not actually possess a sense of smell, much to the surprise of their parents.
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| It should be emphasized that there are no more than 6 distinctive tastes: salty, sour, sweet, bitter, [[umami]] and possibly fatty acids. The 10,000 different scents which humans usually recognize as 'tastes' are often actually 'flavor', which many people who can smell confuse with taste. This sense of 'flavor' is greatly diminished by a loss of the sense of smell, often causing those with sudden onset anosmia a great deal of concern when all food suddenly loses its flavor. Congenital anosmics often have a much more developed sense of taste than those who could smell at some point in their lives, and can enjoy food just as much as someone who could smell.
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| == History and Symptoms == | | == [[Anosmia natural history|Natural History, Complications and Prognosis]] == |
| * Detailed history
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| == Physical Examination == | | == Diagnosis == |
| * Complete physical including head and neck exam, and neurologic exam
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| === Ear Nose and Throat ===
| | [[Anosmia history and symptoms|History and Symptoms]] | [[Anosmia physical examination|Physical Examination]] |[[Anosmialaboratory tests|Laboratory tests]] | [[Anosmia electrocardiogram|ECG]] | [[Anosmia electroencephalogram|EEG]] | [[Anosmia chest x ray|Chest X Ray]] |[[Anosmia CT|CT]] | [[Anosmia MRI|MRI]] |[[Anosmia echocardiography or ultrasound|Echocardiography or Ultrasound]] |[[Anosmia other imaging findings|Other imaging studies]] | [[Anosmia other diagnostic studies|Alternative diagnostics]] |
| * Anosmia can be diagnosed by doctors by using scratch-n-sniff odor tests or by using commonly available odors such as [[coffee]], lemon, grape, [[vanilla]] and [[cinnamon]].
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| == Laboratory Findings ==
| | == Treatment == |
| * [[CBC]] ([[complete blood count]])
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| * [[Glucose]]
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| * [[Blood urea nitrogen]] ([[BUN]])/[[creatinine]]
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| * [[LFT]]s ([[liver function test]]s)
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| * Thyroid profile
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| * [[Vitamin B12]]
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| * [[ESR]] ([[erythrocyte sedimentation rate]])
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| * Blood toxicology
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| * Urine toxicology
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| * Antobody testing (Sjogren's)
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| === Electrolyte and Biomarker Studies ===
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| * Electrolytes
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| === MRI and CT ===
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| * [[MRI]] and head [[CT]] if indicated
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| === Other Diagnostic Studies ===
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| * Allergy testing
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| * Nasal discharge testing
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| ==Treatment== | |
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| * No cure for permanent anosmia
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| * Treat underlying disease (in hopes of treating anosmia due to CNS or endocrine diseases)
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| == Pharmacotherapy ==
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| === Acute Pharmacotherapies ===
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| * Temporary anosmia:
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| *:* [[Corticosteroid]]s
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| *:* [[Antibiotic]]s
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| *:* [[Antihistamine]]s
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| *:* [[Decongestant]]s
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| === Chronic Pharmacotherapies ===
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| * Supplemental vitamins for patients with vitamin deficiencies
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| == Surgery and Device Based Therapy ==
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| * Polypectomy and sinus surgery
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| === Indications for Surgery ===
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| * Initial therapy for temporary anosmia is ineffective.
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| | [[Anosmia medical therapy|Medical therapy]] | [[Anosmia surgery|Surgical options]] | [[Anosmiaprevention|Prevention]] | [[Anosmia cost-effectiveness of therapy|Financial costs]]| [[Anosmia future or investigational therapies|Future therapies]] |
| ==See also== | | ==See also== |
| * [[Parosmia]] | | * [[Parosmia]] |
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| ==References==
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| {{Reflist}}
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| ==External links==
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| *[http://www.anosmia-blog.blogspot.com Anosmia Blog]
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| *[http://www.anosmiafoundation.org Anosmia Foundation]
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| *http://www.emedicine.com/med/topic748.htm
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| *[http://www.anosmia.net/ The Congenital Anosmia Forums]
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| *[http://www.scienceofsmell.com/scienceofsmell/index.cfm?action=promo&pc=sathome3 The Smell and Taste Treatment & Research Foundation]
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| == Acknowledgements == | | == Acknowledgements == |