STUDY - Technical - New Dacian's Medicine
Anosmia
(Classical / Allopathic Medicine)
Although it's
usually an insignificant consequence of nasal congestion or
obstruction, anosmia - absence of the sense of smell -
occasionally heralds a serious defect. (See Understanding the
sense of smell.)
Temporary anosmia
can result from any condition that irritates and causes
swelling of the nasal mucosa and obstructs the olfactory area
in the nose, such as heavy smoking, rhinitis, or sinusitis.
Permanent anosmia usually results when the olfactory
neuroepithelium, or any part of the olfactory nerve, is
destroyed. Permanent or temporary anosmia can also result from
inhaling irritants, such as cocaine or acid fumes, that
paralyze nasal cilia. Anosmia may also be reported - without
an identifiable organic cause - by patients suffering from
hysteria, depression, or schizophrenia.
Anosmia is
invariably perceived as bilateral; unilateral anosmia can also
occur but is seldom recognized by the patient. Because
combined stimulation of taste buds and olfactory cells
produces the sense of taste, anosmia is usually accompanied by
ageusia, loss of the sense of taste.
HISTORY:
Ask the patient about the onset and duration of anosmia and its related signs and symptoms: stuffy nose, nasal discharge or bleeding, postnasal drip, sneezing, dry or sore mouth and throat, ageusia, loss of appetite, excessive tearing, and facial or ocular pain.
Review the patient's medical history for nasal disease, allergies, and head trauma.
Ask the patient if he smokes and, if so, how often.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Understanding the sense of smell
Our noses can distinguish the odors of thousands of chemicals, thanks to a highly developed complex of sensory cells. The olfactory epithelium contains olfactory receptor cells, along with olfactory glands and sustentacular cells — both of which secrete mucus to keep the epithelial surface moist. The mucus covering the olfactory cells probably traps airborne odorous molecules, which then fit into the appropriate receptors on the cell surface. In response to this stimulus, the receptor cell transmits an impulse along the olfactory nerve (cranial nerve I) to the olfactory area of the cortex, where it's interpreted. Any disruption along this transmission pathway, or any obstruction of the epithelial surface due to dryness or congestion, can cause anosmia.
Ask the patient about the onset and duration of anosmia and its related signs and symptoms: stuffy nose, nasal discharge or bleeding, postnasal drip, sneezing, dry or sore mouth and throat, ageusia, loss of appetite, excessive tearing, and facial or ocular pain.
Review the patient's medical history for nasal disease, allergies, and head trauma.
Ask the patient if he smokes and, if so, how often.
Obtain a drug history, including prescription and over-the-counter drugs, herbal remedies, and recreational drugs. Also, ask the patient about alcohol intake.
Understanding the sense of smell
Our noses can distinguish the odors of thousands of chemicals, thanks to a highly developed complex of sensory cells. The olfactory epithelium contains olfactory receptor cells, along with olfactory glands and sustentacular cells — both of which secrete mucus to keep the epithelial surface moist. The mucus covering the olfactory cells probably traps airborne odorous molecules, which then fit into the appropriate receptors on the cell surface. In response to this stimulus, the receptor cell transmits an impulse along the olfactory nerve (cranial nerve I) to the olfactory area of the cortex, where it's interpreted. Any disruption along this transmission pathway, or any obstruction of the epithelial surface due to dryness or congestion, can cause anosmia.
PHYSICAL
ASSESSMENT:
Inspect and palpate nasal structures for obvious injury, inflammation, deformities, and septal deviation or perforation.
Observe the contour and color of the nasal mucosa.
Note the source and character of nasal discharge.
Palpate the sinus areas for tenderness and contour.
Inspect and palpate nasal structures for obvious injury, inflammation, deformities, and septal deviation or perforation.
Observe the contour and color of the nasal mucosa.
Note the source and character of nasal discharge.
Palpate the sinus areas for tenderness and contour.
SPECIAL
CONSIDERATIONS:
Although permanent anosmia usually doesn't respond to treatment, vitamin A given orally or by injection occasionally provides improvement.
Although permanent anosmia usually doesn't respond to treatment, vitamin A given orally or by injection occasionally provides improvement.
PEDIATRIC
POINTERS:
Anosmia in children usually results from nasal obstruction by a foreign body or enlarged adenoids.
Anosmia in children usually results from nasal obstruction by a foreign body or enlarged adenoids.
PATIENT
COUNSELING:
If anosmia results from nasal congestion, instruct the patient to use a local decongestant or antihistamine, along with a vaporizer or humidifier. Advise the patient to avoid excessive use of local decongestants, which can lead to rebound nasal congestion.
If anosmia results from nasal congestion, instruct the patient to use a local decongestant or antihistamine, along with a vaporizer or humidifier. Advise the patient to avoid excessive use of local decongestants, which can lead to rebound nasal congestion.
Bibliography:
1. Rapid Assessment, A
Flowchart Guide to Evaluating Signs & Symptoms, Lippincott
Williams & Wilkins, 2004.
2. Professional Guide to
Signs and symptoms, Edition V, Lippincott
Williams & Wilkins, 2007.
3. Guide to common
symptoms, Edition V, McGraw - Hill, 2002.
Dorin,
Merticaru (2010)