Olfactory Disorders - PowerPoint PPT Presentation

1 / 42
About This Presentation
Title:

Olfactory Disorders

Description:

B. Wayne Blount, MD, MPH History Unilateral or bilateral ? If unilateral, think of olfactory groove or parietal lobe tumor Other Neurologic signs or sx : Multiple ... – PowerPoint PPT presentation

Number of Views:492
Avg rating:3.0/5.0
Slides: 43
Provided by: fpmEmoryE
Learn more at: https://med.emory.edu
Category:

less

Transcript and Presenter's Notes

Title: Olfactory Disorders


1
Olfactory Disorders
  • B. Wayne Blount, MD, MPH

2
What commercial product has caused 130 cases of
anosmia in the last decade and for which the FDA
just (this week) asked the manufacturer to
voluntarily withdraw ?
3
Perspective
4
Objectives
  • Know the overall epidemiology of olfactory
    dysfunction (OD)
  • Understand the olfactory circuitry
  • List the main presentations types of smell
    dysfxcn
  • Name the main tests of olfactory function
  • Review several of the major causes of OD, their
    w/u possible treatments

5
Epidemiology
  • Age lt 65 about 2 ( No really good population
    study) (Hint, hint)
  • Age 65 80 50
  • Age gt 80 75

6
The Circuitry
  • 6 million receptor cells in roof of nasal chamber
  • Axons project thru the cribiform plate of the
    ethmoids
  • Join to form the olfactory bulbs at base of
    frontal lobe
  • These project to the olfactory cortex in the
    subventricular zone
  • CN I

7
(No Transcript)
8
(No Transcript)
9
(No Transcript)
10
Types of Smell Disorders
  • A redneck died and left his entire estate to his
    beloved widow
  • But she cant touch it until shes 14.
  • Did you hear theyve raised the minimum age for
    alcohol for rednecks to 32 years.
  • They want to keep alcohol out of high school.

11
Types of Smell Disorders
  • Anosmia NO smell
  • Hyposmia decreased smell
  • Also called microsmia partial anosmia
  • Dysosmia distortion
  • Phantosmia smell w/o stimulus
  • Hyperosmia Abnormally acute
  • Olfactory agnosia
  • Bilateral or unilateral

12
Smell Disorders
13
Presentation
  • As per type of smell disorder No smell, less
    smell, weird smells
  • Taste problems
  • One of earliest sx/sign of
  • Alzheimers
  • Parkinsons
  • Can it be lethal ?
  • Yes ! When ?
  • Cant smell Spoiled food, Fire, gas leak (45
    of pt.s)

14
How can you tell if someone has a real olfactory
disorder?
  • The ideal test Needs to assess for
  • Any sense
  • What level of sense
  • Different smells
  • Malingering
  • Laterality (bi- or uni-)
  • U Penn Smell ID Test (UPSIT)
  • Threshold Olfactory Tests

15
Smell Test
16
The UPSIT
  • Commercial
  • Most used
  • Self-administered in 10-15 minutes
  • Scored in lt 1 minute by non-med person
  • Available in various languages
  • 40 scratch sniff patches
  • Pt. chooses from 4 answers must choose 1
  • Can detect malingering

17
The UPSIT
  • Dysfunction classified as Mormosmia, anosmia,
    mild, moderate or severe microsmia, or probable
    malingering

18
Threshold olfactory tests
  • A dilutional series of a stimulus odor
  • Uses an ascending concentration trial
  • Must answer yes or no

19
Other Tests
  • Pocket Smell test
  • Brief Smell ID Test
  • Squeeze bottle odor threshold test
  • All commercial

20
  • How do you know when yourre staying in a redneck
    hotel?
  • When you call the front desk and tell the mgr, I
    gotta leak in my sink. and he says,
  • Go ahead.

21
Causes of Smell Disorders(Name some of them)
22
Age
  • Decreased smell occurs in the normal elderly
  • The greatest correlation with olfactory decline
  • More severe in men than women (Any conjecture on
    why?)
  • Multifactorial causes

23
Upper Respiratory Infections
  • Most Common cause of permanent smell problems
  • Damage olfactory epithelium possibly central
    structures
  • Common cold, hepatitis, influenza, HSV, rabies
    and a bunch Ive never heard of
  • thus dont care about

24
Toxins
  • Herbicides
  • Pesticides
  • Solvents
  • Heavy Metals, esp cadmium, nickel, chromium
    manganese
  • Damage olfactory epithelium
  • Enter brain, esp. cadmium, gold manganese

25
Epilepsy
  • Right-sided foci gt left-sided
  • Anti-seizure meds can correct problems

26
Neurodegenerative Diseases
  • Alzheimers Parkinsons
  • Usually ASX, but present (Kevin, er Homer)
  • in 85-90 of pts
  • Doesnt respond to
  • meds
  • Magnitude not assoc
  • with disease stage

27
Neurodegenerative Diseases
  • Downs Syndrome
  • Huntingtons Disease
  • Multiple Sclerosis
  • Jacob-Creutzfeld

28
Head Trauma
  • About 20 of all chemosensory
  • disorders
  • Directly related to degree of trauma
  • Also related to strong deceleration injury
  • Occipital and side injury more than frontal
  • If recovery, occurs within 1st year of injury

29
Other Disorders
  • Cerebellar Degeneration
  • Schizophrenia
  • Migraine
  • Hyperemesis gravidarum hyperosmia
  • A number of systemic diseases
  • Some Medicines
  • Congenital anosmia

30
(No Transcript)
31
OK So whats the work-up?
  • H.P.I.
  • Location Unilateral or bilateral
  • Onset Acute or Chronic
  • Context Occurs only with Sz, HA, after head
    trauma constant or intermittent
  • Assoc Sx URI, memory loss, neuro sx
  • Quality All smells, some smells, taste
  • Severity Complete or partial
  • Modifying factors What have you tried what
    makes it worse?

32
History
  • Social Hx
  • Tobacco or Etoh or intranasal cocaine
  • Family Hx
  • Olfactory disorder Rheumatic dz, Huntingtons,
    PD, Alzheimers
  • PMH
  • Sz, M.S., allergic rhinitis, Alzheimers, PD,
    Huntingtons, Anemia, RHEUMATIC Dz, DM,
    Hypothyroid, renal or liver problems
  • Meds
  • R.O.S. Complete ,looking for any systemic dz

33
So whats the History tell us?
  • Recent URI More acute presentation
  • Exposure to toxins More acute presentation
  • Recent head injury More acute presentation
  • Hx of epilepsy? Intermittent or phantosmia
  • Medicines Captopril , DMARDS, penicillamine
    (Anosmia) and about 50 others (See AFP article
    in references.)
  • Tobacco Use? Anosmia or hyposmia

34
History
  • Unilateral or bilateral ?
  • If unilateral, think of olfactory groove or
    parietal lobe tumor
  • Other Neurologic signs or sx Multiple Sclerosis
  • Memory loss? Think Alzheimers
  • Any of 3 cardinal signs of PD? Think PD
  • Any signs of a systemic disease? Hypothyroidism,
    diabetes, renal failure, hepatic failure,
    pernicious anemia

35
Physical Exam ?
  • Grossly check CN I
  • Soap, coffee, cologne, gum, breath mint,
    chocolate, alcohol, old penny
  • Do unilaterally by occluding one side at a time
  • Do a neuro exam
  • Do a complete head neck exam
  • Do a more detailed exam of a system(s) depending
    on hx.
  • Do a quick survey of rest of body looking for
    systemic dz stigmata

36
Laboratory
  • If acute with recent URI, none
  • If on med that can cause ,
  • none
  • If gradual onset and exam is negative,
  • Get head CT
  • If CT is negative, then
  • W/U for systemic dz cbc, cmp, tsh, LFTs, FBS
    other labs as indicated for Rheumatic dz or toxin
    exposure
  • If phantosmia or intermittent, do an EEG

37
Treatment
  • If find a treatable cause, Treat it. DUH!
  • Sinusitis, allergic rhinitis, DM, Hypothyroidism,
    nasal polyps, neoplasm, vitamin deficiency,
    misuse of drugs, causative medicine, acute toxin
    exposure

38
Treatment
  • Some diseases with which olfactory disorders are
    associated, you can treat the disease, but not
    cure the olfactory problem Rheumatic Dz,
    Alzheimers, PD, head trauma

39
Treatment
  • If Cannot find a treatable cause,
  • Refer to E.N.T. for specialized testing

40
Summary
  • A common, under-recognized set of disorders
  • The common presentations
  • The common causes
  • Can be worked up, diagnosed and treated in
    primary care
  • Specialized testing is done in E.N.T.

41
References
  • Doty R. The Olfactory System and Its Disorders.
    www.medscape.com/viewarticle/588523
  • Bromley S. Smell Taste Disorders A Primary
    Care Approach. AFP 200061427-36.
  • Diagnosis of Anosmia. Online Medical Books.
    www.wrongdiagnosis.com/a/anosmia/diagnosis.htm
  • Wilson RS, et al. Olfactory identification
    incidence of mild cognitive impairment in older
    age. Arch Gen Psychiatry 200764802-8.

42
(No Transcript)
Write a Comment
User Comments (0)
About PowerShow.com