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Diagnosis and management of olfactory disorders: survey of UK-based consultants and literature review

Published online by Cambridge University Press:  15 March 2007

E McNeill ,
Y Ramakrishnan  and
S Carrie
E McNeill*
Affiliation:
Department of Otolaryngology, Freeman Hospital, Newcastle-upon-Tyne, UK.
Y Ramakrishnan
Affiliation:
Department of Otolaryngology, Freeman Hospital, Newcastle-upon-Tyne, UK.
S Carrie
Affiliation:
Department of Otolaryngology, Freeman Hospital, Newcastle-upon-Tyne, UK.
*
Address for correspondence: Ms Emma McNeill, 54 The Drive, Gosforth, Newcastle-upon-Tyne NE3 4AJ, UK. Fax: 0191 223 1246 E-mail: emma_28_mc@hotmail.com
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Abstract

Background:

The diagnosis and management of olfactory disorders is an often neglected topic in otolaryngology. This article evaluates current clinical practice within the United Kingdom, and provides a literature-based review of the diagnosis, management and prognosis of olfactory pathology.

Design:

A questionnaire was sent to consultant and associate specialist members of the British Association of Otolaryngologists and Head and Neck Surgeons. The responses were documented to gain an impression of how olfactory disorders are managed in the United Kingdom. The literature relating to olfactory dysfunction was then evaluated and the findings summarised.

Conclusions:

Management of olfactory pathology varies across the United Kingdom. The literature suggests that chemosensory testing is optimal and that both forced-choice and threshold testing should be applied if objective evaluation is required. Imaging can be of value but the appropriate technique should be used. Olfactory function can recover following head injury, viral infection and chronic sinonasal disease, although varying degrees of dysfunction are likely to persist. There is a role for the use of corticosteroids, particularly when administered systemically. More research is needed to establish the appropriate dose and length of treatment.

Keywords

Olfaction DisordersSmellDiagnosisTherapy

Information

Type
Review Articles
Information
The Journal of Laryngology & Otology , Volume 121 , Issue 8 , August 2007 , pp. 713 - 720
Copyright
Copyright © JLO (1984) Limited 2007

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References

1Alessandri, B, Vonau, MH, Classen, W. The use of an unbaited radial maze in neurotoxicology: II. Sensory inputs, general malaise and locomotor activity. Neurotoxicology 1994;15:359–70Google ScholarPubMed
2Nordin, S, Bramerson, A, Bende, M. Prevalence of self-reported poor odor detection sensitivity: the Skovde population-based study. Acta Otolaryngol 2004;124:1171–3CrossRefGoogle ScholarPubMed
3Snow, JB Jr. Clinical problems in chemosensory disturbances. Am J Otolaryngol 1983;4:224–7CrossRefGoogle ScholarPubMed
4Leopold, DA, Hummel, T, Schwob, JE, Hong, SC, Knecht, M, Kobal, G. Anterior distribution of human olfactory epithelium. Laryngoscope 2000;110:417–21CrossRefGoogle ScholarPubMed
5Deems, DA, Doty, RL, Settle, RG, Moore-Gillon, V, Shaman, P, Mester, AF et al. Smell and taste disorders, a study of 750 patients from the University of Pennsylvania Smell and Taste Center. Arch Otolaryngol Head Neck Surg 1991;117:519–28CrossRefGoogle ScholarPubMed
6Green, P, Rohling, ML, Iverson, GL, Gervais, RO. Relationships between olfactory discrimination and head injury severity. Brain Inj 2003;17:479–96CrossRefGoogle ScholarPubMed
7Ogawa, T, Rutka, J. Olfactory dysfunction in head injured workers. Acta Otolaryngol Suppl 1999;540:50–7Google ScholarPubMed
8Callahan, CD, Hinkebein, JH. Assessment of anosmia after traumatic brain injury: performance characteristics of the University of Pennsylvania Smell Identification Test. Journal of Head Trauma Rehabilitation 2002;17:251–6CrossRefGoogle ScholarPubMed
9Seiden, A. The initial assessment of patients with smell and taste disorders. In: Seiden, A ed. Taste and Smell Disorders, 1st edn. New York: Thieme, 1997;4–19Google Scholar
10Jones, N, Rog, D. Olfaction: a review. J Laryngol Otol 1998;112:11–24CrossRefGoogle ScholarPubMed
11Schiffman, SS, Gatlin, CA. Clinical physiology of taste and smell. Annual Review of Nutrition 1993;13:405–36CrossRefGoogle ScholarPubMed
12Sugiyama, K, Matsuda, T, Kondo, H, Mitsuya, S, Hashiba, M, Murakami, S et al. Postoperative olfaction in chronic sinusitis: smokers versus non-smokers. Ann Otol Rhinol Laryngol 2002;111:1054–8Google Scholar
13Doty, R, Bromley, S. Effects of drugs and olfaction and taste. Otolaryngol Clin North Am 2004;37:1229–54CrossRefGoogle ScholarPubMed
14Singh, N, Grewal, MS, Austin, JH. Familial anosmia. Arch Neurol 1970;22:40–4CrossRefGoogle ScholarPubMed
15Cain, WS. To know with the nose: keys to odor identification. Science 1979;203:467–70CrossRefGoogle ScholarPubMed
16Doty, RL. Studies of human olfaction from the University of Pennsylvania Smell and Taste Center. Chem Senses 1997;22:565–86CrossRefGoogle ScholarPubMed
17Doty, RL, Marcus, A, Lee, WW. Development of the 12-item Cross-Cultural Smell Identification Test (CC-SIT). Laryngoscope 1996;106:353–6CrossRefGoogle ScholarPubMed
18Kobal, G, Hummel, T, Sekinger, B, Barz, S, Roscher, S, Wolf, S. “Sniffin' sticks”: screening of olfactory performance. Rhinology 1996;34:222–6Google ScholarPubMed
19Doty, R, McKeown, D, Lee, W, Shaman, P. A study of the test-retest reliability of ten olfactory tests. Chem Senses 1995;20:645–56CrossRefGoogle ScholarPubMed
20Robson, AK, Woollons, AC, Ryan, J, Horrocks, C, Williams, S, Dawes, PJ. Validation of the combined olfactory test. Clin Otolaryngol Allied Sci 1996;21:512–18CrossRefGoogle ScholarPubMed
21Madan, R, Sawlani, V, Gupta, S, Phadke, RV. MRI findings in Kallmann syndrome. Neurol India 2004;52:501–3Google ScholarPubMed
22Yousem, DM, Oguz, KK, Li, C. Imaging of the olfactory system. Semin Ultrasound CT MR 2001;22:456–72CrossRefGoogle ScholarPubMed
23Welge-Luessen, A, Temmel, A, Quint, C, Moll, B, Wolf, S, Hummel, T. Olfactory function in patients with olfactory groove meningioma. J Neurol Neurosurg Psychiatry 2001;70:218–21CrossRefGoogle ScholarPubMed
24Ishimaru, T, Miwa, T, Nomura, M, Iwato, M, Furukawa, M. Reversible hyposmia caused by intracranial tumour. J Laryngol Otol 1999;113:750–3CrossRefGoogle ScholarPubMed
25Busaba, NY. Is imaging necessary in the evaluation of the patient with an isolated complaint of anosmia? Ear Nose Throat J 2001;80:892–6CrossRefGoogle ScholarPubMed
26Leopold, DA, Schwob, JE, Youngentob, SL, Hornung, DE, Wright, HN, Mozell, MM. Successful treatment of phantosmia with preservation of olfaction. Arch Otolaryngol Head Neck Surg 1991;117:1402–6CrossRefGoogle ScholarPubMed
27Leopold, D, Myerrose, G. Diagnosis and Treatment of Disordered Olfactory Perception. Tokyo: Springer-Verlag, 1994Google Scholar
28Reiter, ER, DiNardo, LJ, Costanzo, RM. Effects of head injury on olfaction and taste. Otolaryngol Clin North Am 2004;37:1167–84CrossRefGoogle ScholarPubMed
29Varney, NR, Bushnell, D. NeuroSPECT findings in patients with posttraumatic anosmia: a quantitative analysis. J Head Trauma Rehabil 1998;13:63–72Google ScholarPubMed
30Duncan, HJ, Seiden, AM. Long-term follow-up of olfactory loss secondary to head trauma and upper respiratory tract infection. Arch Otolaryngol Head Neck Surg 1995;121:1183–7CrossRefGoogle ScholarPubMed
31Doty, RL, Yousem, DM, Pham, LT, Kreshak, AA, Geckle, R, Lee, WW. Olfactory dysfunction in patients with head trauma. Arch Neurol 1997;54:1131–40CrossRefGoogle ScholarPubMed
32Seiden, AM. Postviral olfactory loss. Otolaryngol Clin North Am 2004;37:1159–66CrossRefGoogle ScholarPubMed
33Sugiura, M, Aiba, T, Mori, J, Nakai, Y. An epidemiological study of postviral olfactory disorder. Acta Otolaryngol Suppl 1998;538:191–6Google ScholarPubMed
34Mott, AE, Leopold, DA. Disorders in taste and smell. Med Clin North Am 1991;75:1321–53CrossRefGoogle ScholarPubMed
35Jafek, BW, Murrow, B, Michaels, R, Restrepo, D, Linschoten, M. Biopsies of human olfactory epithelium. Chem Senses 2002;27:623–8CrossRefGoogle ScholarPubMed
36Hummel, T. Perspectives in olfactory loss following viral infections of the upper respiratory tract. Arch Otolaryngol Head Neck Surg 2000;126:802–3CrossRefGoogle ScholarPubMed
37Cullen, MM, Leopold, DA. Disorders of smell and taste. Med Clin North Am 1999;83:57–74CrossRefGoogle ScholarPubMed
38Doty, RL, Mishra, A. Olfaction and its alteration by nasal obstruction, rhinitis, and rhinosinusitis. Laryngoscope 2001;111:409–23 (erratum: Laryngoscope 2001;111:1673)CrossRefGoogle ScholarPubMed
39Damm, M, Eckel, H, Streppel, M, Jungehiilsing, M, Stennert, E. Relationship between nasal airflow and olfaction in patients with chronic rhinosinusitis [in German]. HNO 2000;48:436–43CrossRefGoogle ScholarPubMed
40Iro, H, Mayr, S, Wallisch, C, Schick, B, Wigand, ME. Endoscopic sinus surgery: its subjective medium-term outcome in chronic rhinosinusitis. Rhinology 2004;42:200–6Google ScholarPubMed
41Rowe-Jones, JM, Mackay, IS. A prospective study of olfaction following endoscopic sinus surgery with adjuvant medical treatment. Clin Otolaryngol Allied Sci 1997;22:377–81CrossRefGoogle ScholarPubMed
42Kimmelman, CP. The risk to olfaction from nasal surgery. Laryngoscope 1994;104:981–8CrossRefGoogle ScholarPubMed
43Landis, B, Giger, R, Bouayed, S, Hugentobler, M, Plouin-Gaudon, I, LaCroix, J-S. Olfactory dysfunction after endoscopic sinus surgery. Medecine et Hygeine 2004;62:2023–5Google Scholar
44Lee, SH, Lim, HH, Lee, HM, Park, HJ, Choi, JO. Olfactory mucosal findings in patients with persistent anosmia after endoscopic sinus surgery. Ann Otol Rhinol Laryngol 2000;109:720–5CrossRefGoogle ScholarPubMed
45Kern, RC. Chronic sinusitis and anosmia: pathologic changes in the olfactory mucosa. Laryngoscope 2000;110:1071–7CrossRefGoogle ScholarPubMed
46Hotchkiss, W. Influence of prednisone on nasal polyposis with anosmia. Ann Allergy Asthma Immunol 1956;24:278–83Google Scholar
47Jafek, BW, Moran, DT, Eller, PM, Rowley, JC 3rd, Jafek, TB. Steroid-dependent anosmia. Arch Otolaryngol Head Neck Surg 1987;113:547–9CrossRefGoogle ScholarPubMed
48Tos, M, Svendstrup, F, Arndnal, H, Orntoft, S, Jakobson, J, Borum, P et al. Efficacy of an aqueous and a powder formulation of nasal budesonide compared in patients with nasal polyps. Am J Rhinol 1998;12:183–9CrossRefGoogle Scholar
49Mott, AE, Cain, WS, Lafreniere, D, Leonard, G, Gent, JF, Frank, ME. Topical corticosteroid treatment of anosmia associated with nasal and sinus disease. Arch Otolaryngol Head Neck Surg 1997;123:367–72CrossRefGoogle ScholarPubMed
50Golding-Wood, DG, Holmstrom, M, Darby, Y, Scadding, GK, Lund, VJ. The treatment of hyposmia with intranasal steroids. J Laryngol Otol 1996;110:132–5CrossRefGoogle ScholarPubMed
51Blomqvist, EH, Lundblad, L, Bergstedt, H, Stjarne, P. Placebo-controlled, randomized, double-blind study evaluating the efficacy of fluticasone propionate nasal spray for the treatment of patients with hyposmia/anosmia. Acta Otolaryngol 2003;123:862–8CrossRefGoogle ScholarPubMed
52Heilmann, S, Huettenbrink, KB, Hummel, T. Local and systemic administration of corticosteroids in the treatment of olfactory loss. Am J Rhinol 2004;18:29–33CrossRefGoogle ScholarPubMed
53Stevens, MH. Steroid-dependent anosmia. Laryngoscope 2001;111:200–3CrossRefGoogle ScholarPubMed
54Aiba, T, Sugiura, M, Mori, J, Matsumoto, K, Tomiyama, K, Okuda, F et al. Effect of zinc sulfate on sensorineural olfactory disorder. Acta Otolaryngol Suppl 1998;538:202–4Google ScholarPubMed
55Henkin, RI, Schecter, PJ, Friedewald, WT, Demets, DL, Raff, M. A double blind study of the effects of zinc sulfate on taste and smell dysfunction. Amer J Med Sci 1976;272:285–99CrossRefGoogle ScholarPubMed
56Hummel, T, Heilmann, S, Huttenbriuk, KB. Lipoic acid in the treatment of smell dysfunction following viral infection of the upper respiratory tract. Laryngoscope 2002;112:2076–80CrossRefGoogle ScholarPubMed
57Quint, C, Temmel, AF, Hummel, T, Ehrenberger, K. The quinoxaline derivative caroverine in the treatment of sensorineural smell disorders: a proof-of-concept study. Acta Otolaryngol 2002;122:877–81CrossRefGoogle ScholarPubMed
58Jafek, BW, Linschoten, MR, Murrow, BW. Anosmia after intranasal zinc gluconate use. Am J Rhinol 2004;18:137–41CrossRefGoogle ScholarPubMed