Hanyang Med Rev.  2014 Aug;34(3):107-115. 10.7599/hmr.2014.34.3.107.

Clinical Diagnosis and Treatment of Olfactory Dysfunction

• Cho SH

• KMID: 2284350
• DOI: http://doi.org/10.7599/hmr.2014.34.3.107

Abstract

Olfactory dysfunction is a relatively common disorder that is often under-recognized by both patients and clinicians. It occurs more frequently in older ages and men, and decreases patients' quality of life, as olfactory dysfunction may affect the emotion and memory functions. Three main causes of olfactory dysfunction are sinonasal diseases, upper respiratory viral infection, and head trauma. Olfactory dysfunction is classified quantitatively (hyposmia and anosmia) and qualitatively (parosmia and phantosmia). From a pathophysiological perspective, olfactory dysfunction is also classified by conductive or sensorineural types. All patients with olfactory dysfunction will need a complete history and physical examination to identify any possible or underlying causes and psychophysical olfactory tests are essential to estimate the residual olfactory function, which is the most important prognostic factor. CT or MRI may be adjunctively used in some indicated cases such as head trauma and neurodegenerative disorders. Functional MRI (fMRI) and psychophysiological tests (olfactory event-related potential, OERP) are also used in the research setting. Compared to rapid progress that has occurred in fields of basic science and diagnostic tools for the therapy of other diseases and disorders, treatments for olfactory loss are still in a state of unmet need. In most olfactory dysfunctions, there has been no well-designed randomized controlled study to justify or prove effective treatment modalities. Therefore, with more attention to the problem and further research we can expect breakthroughs in the treatment of smell loss in the near future.

Keyword

Smell; Olfaction; Olfaction Disorders; Diagnosis; Therapeutics

MeSH Terms

Craniocerebral Trauma
Diagnosis*
Evoked Potentials
Humans
Magnetic Resonance Imaging
Male
Memory
Neurodegenerative Diseases
Olfaction Disorders
Physical Examination
Quality of Life
Smell

Figure

• 

  Fig. 1 Types of psychophysical olfactory tests of University of Pennsylvania Smell Identification Test (UPSIT, 40 items), Connecticut Chemosensory Clinical Research Center Test (CCCRC, 10 items) and Korean Version of Sniffin's stick test (KVSS, 16 items). A graph (right-inferior panel) shows an example of odor threshold test in KVSS.

Reference

1. Nordin S, Bramerson A. Complaints of olfactory disorders: epidemiology, assessment and clinical implications. Curr Opin Allergy Clin Immunol. 2008; 8:10–15.

2. Frasnelli J, Landis BN, Heilmann S, Hauswald B, Huttenbrink KB, Lacroix JS, et al. Clinical presentation of qualitative olfactory dysfunction. Eur Arch Otorhinolaryngol. 2004; 261:411–415.

3. Muller A, Landis BN, Platzbecker U, Holthoff V, Frasnelli J, Hummel T. Severe chemotherapy-induced parosmia. Am J Rhinol. 2006; 20:485–486.

4. Seiden AM, Duncan HJ. The diagnosis of a conductive olfactory loss. Laryngoscope. 2001; 111:9–14.

5. Landis BN, Konnerth CG, Hummel T. A study on the frequency of olfactory dysfunction. Laryngoscope. 2004; 114:1764–1769.

6. Bonfils P, Avan P, Faulcon P, Malinvaud D. Distorted odorant perception: analysis of a series of 56 patients with parosmia. Arch Otolaryngol Head Neck Surg. 2005; 131:107–112.

7. Hoffman HJ, Ishii EK, MacTurk RH. 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). Ann N Y Acad Sci. 1998; 855:716–722.

8. White TL, Kurtz DB. The relationship between metacognitive awareness of olfactory ability and age in people reporting chemosensory disturbances. Am J Psychol. 2003; 116:99–110.

9. Bramerson A, Johansson L, Ek L, Nordin S, Bende M. Prevalence of olfactory dysfunction: the skovde population-based study. Laryngoscope. 2004; 114:733–737.

10. Nordin S, Bramerson A, Millqvist E, Bende M. Prevalence of parosmia: the Skovde population-based studies. Rhinology. 2007; 45:50–53.

11. Murphy C, Schubert CR, Cruickshanks KJ, Klein BE, Klein R, Nondahl DM. Prevalence of olfactory impairment in older adults. JAMA. 2002; 288:2307–2312.

12. Doty RL, Shaman P, Applebaum SL, Giberson R, Siksorski L, Rosenberg L. Smell identification ability: changes with age. Science. 1984; 226:1441–1443.

13. Seiberling KA, Conley DB. Aging and olfactory and taste function. Otolaryngol Clin North Am. 2004; 37:1209–1228. vii

14. Suzuki M, Saito K, Min WP, Vladau C, Toida K, Itoh H, et al. Identification of viruses in patients with postviral olfactory dysfunction. Laryngoscope. 2007; 117:272–277.

15. Hummel T. Perspectives in olfactory loss following viral infections of the upper respiratory tract. Arch Otolaryngol Head Neck Surg. 2000; 126:802–803.

16. Delank KW, Stoll W. Olfactory function after functional endoscopic sinus surgery for chronic sinusitis. Rhinology. 1998; 36:15–19.

17. Kern RC, Conley DB, Haines GK 3rd, Robinson AM. Pathology of the olfactory mucosa: implications for the treatment of olfactory dysfunction. Laryngoscope. 2004; 114:279–285.

18. Rydzewski B, Pruszewicz A, Sulkowski WJ. Assessment of smell and taste in patients with allergic rhinitis. Acta Otolaryngol. 2000; 120:323–326.

19. Cowart BJ, Flynn-Rodden K, McGeady SJ, Lowry LD. Hyposmia in allergic rhinitis. J Allergy Clin Immunol. 1993; 91:747–751.

20. Jiang RS, Chai JW, Chen WH, Fuh WB, Chiang CM, Chen CC. Olfactory bulb volume in Taiwanese patients with posttraumatic anosmia. Am J Rhinol Allergy. 2009; 23:582–584.

21. Wu AP, Davidson T. Posttraumatic anosmia secondary to central nervous system injury. Am J Rhinol. 2008; 22:606–607.

22. Schechter PJ, Henkin RI. Abnormalities of taste and smell after head trauma. J Neurol Neurosurg Psychiatry. 1974; 37:802–810.

23. Devanand DP, Michaels-Marston KS, Liu X, Pelton GH, Padilla M, Marder K, et al. Olfactory deficits in patients with mild cognitive impairment predict Alzheimer's disease at follow-up. Am J Psychiatry. 2000; 157:1399–1405.

24. Temmel AF, Quint C, Schickinger-Fischer B, Klimek L, Stoller E, Hummel T. Characteristics of olfactory disorders in relation to major causes of olfactory loss. Arch Otolaryngol Head Neck Surg. 2002; 128:635–641.

25. Shoenfeld N, Agmon-Levin N, Flitman-Katzevman I, Paran D, Katz BS, Kivity S, et al. The sense of smell in systemic lupus erythematosus. Arthritis Rheum. 2009; 60:1484–1487.

26. Gaines AD. Anosmia and hyposmia. Allergy Asthma Proc. 2010; 31:185–189.

27. Hummel T, Barz S, Lotsch J, Roscher S, Kettenmann B, Kobal G. Loss of olfactory function leads to a decrease of trigeminal sensitivity. Chem Senses. 1996; 21:75–79.

28. Doty RL, Brugger WE, Jurs PC, Orndorff MA, Snyder PJ, Lowry LD. Intranasal trigeminal stimulation from odorous volatiles: psychometric responses from anosmic and normal humans. Physiol Behav. 1978; 20:175–185.

29. Huart C, Eloy P, Collet S, Rombaux P. Chemosensory function assessed with psychophysical testing and event-related potentials in patients with atrophic rhinitis. Eur Arch Otorhinolaryngol. 2012; 269:135–141.

30. Gudziol V, Lotsch J, Hahner A, Zahnert T, Hummel T. Clinical significance of results from olfactory testing. Laryngoscope. 2006; 116:1858–1863.

31. Doty RL, Shaman P, Dann M. Development of the University of Pennsylvania Smell Identification Test: a standardized microencapsulated test of olfactory function. Physiol Behav. 1984; 32:489–502.

32. Rombaux P, Bertrand B, Keller T, Mouraux A. Clinical significance of olfactory event-related potentials related to orthonasal and retronasal olfactory testing. Laryngoscope. 2007; 117:1096–1101.

33. Reden J, Mueller A, Mueller C, Konstantinidis I, Frasnelli J, Landis BN, et al. Recovery of olfactory function following closed head injury or infections of the upper respiratory tract. Arch Otolaryngol Head Neck Surg. 2006; 132:265–269.

34. Blomqvist 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; 123:862–868.

35. Stevens MH. Steroid-dependent anosmia. Laryngoscope. 2001; 111:200–203.

36. Raviv JR, Kern RC. Chronic sinusitis and olfactory dysfunction. Otolaryngol Clin North Am. 2004; 37:1143–1157. v–vi.

37. Henkin RI, Schecter PJ, Friedewald WT, Demets DL, Raff M. A double blind study of the effects of zinc sulfate on taste and smell dysfunction. Am J Med Sci. 1976; 272:285–299.

38. Jafek BW, Linschoten MR, Murrow BW. Anosmia after intranasal zinc gluconate use. Am J Rhinol. 2004; 18:137–141.

39. Reden J, Maroldt H, Fritz A, Zahnert T, Hummel T. A study on the prognostic significance of qualitative olfactory dysfunction. Eur Arch Otorhinolaryngol. 2007; 264:139–144.

40. Gudziol V, Buschhuter D, Abolmaali N, Gerber J, Rombaux P, Hummel T. Increasing olfactory bulb volume due to treatment of chronic rhinosinusitis--a longitudinal study. Brain. 2009; 132:3096–3101.

41. Kern RC, Quinn B, Rosseau G, Farbman AI. Post-traumatic olfactory dysfunction. Laryngoscope. 2000; 110:2106–2109.

42. Hummel T, Rissom K, Reden J, Hahner A, Weidenbecher M, Huttenbrink KB. Effects of olfactory training in patients with olfactory loss. Laryngoscope. 2009; 119:496–499.