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Anosmia Diagnosis

Last Updated on Sep 06, 2014
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Diagnosis

Diagnostic evaluation of anosmia begins with a detailed elicitation of history. The doctor asks for important associated symptoms like nasal congestion, rhinorrhoea, or both.

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Diagnostic evaluation of anosmia begins with a detailed elicitation of history. The doctor asks for important associated symptoms like nasal congestion, rhinorrhoea, or both. The nature of nasal discharge in rhinorrhoea is important. Relation of anosmia to any upper respiratory infections or head injury is deeply excavated into. A history of sinus disorders; head trauma or surgery; allergies; exposure to drugs; chemicals or fumes is important. Physical examination is done to identify swelling, inflammation, discharge, and polyps. Making the patient breathe through each nostril separately (by manually occluding the other) helps to identify obstruction. Unilateral anosmia is often unrecognised. Test for olfaction is performed. Patient is made to smell pungent odor such as from a vial containing coffee, cinnamon, or tobacco from each nostril separately. This can also help to identify unilateral anosmia.

Psychophysical assessment of odor and taste identification may be performed using commercially available testing kits. One such kit may contain sequential dilutions of an odorous chemical. Kit using a scratch-and-sniff battery of odours is also available.

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A nervous system examination may be performed so as to know if any of the cranial nerves are damaged. Diplopia, difficulty speaking or swallowing, tinnitus, vertigo are asked for. A detailed mental status examination is vital, especially in the elderly; Alzheimer’s disease is a common cause for anosmia in them. When the cause is not obvious a CT of the head (including sinuses) or MRI are ordered for.

Anosmia may be part of normal aging. A slowly progressive loss of smell in an elderly patient with no other symptoms or findings may be normal. Anosmia may walk in by the age of 60 or 70. Significant head trauma or toxin exposure results in sudden onset of anosmia. Progressive confusion and recent memory loss point to Alzheimer’s disease in the elderly. Neurodegenerative diseases such as multiple sclerosis are suspected in cases with waxing and waning neurologic symptoms.

References

  1. Cecil Medicine, 23rd Ed.
  2. The Merck Manual of Patient Symptoms.

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Comments

med705

I'm not sure if it's just my constant allergies but I seem to have on and off issues with smell throughout my life... Thanks for the info I'm going to discuss this with my doctor.

Boog

I'm 46 year old white male and as far back as I can remember I have not had a sense of smell. Sometimes I'm grateful I don't but most of the time I really wish I did. I work in Law Enforcement and it is a sense that would really come in useful most of the time. I don't have a loss of apatite. I am more drawn to sweet foods than most other types of foods. I had an extreme case of chicken pox as a kid...far worse than most people. As a matter of fact the Doctors in the emergency room I went to took pictures of me because they had not seen a case as severe as mine. I have had severe sinusitis as a young adult 25-33. I had surgery that opened up all my sinuses and removed some huge polyps be hind my right eye. I was getting horrible head aches as a result of my chronic sinus problems. Since that time I haven't had anymore problems. I used to smoke for about 14 or so years but have not smoked for about 15-16 years. I would love to be able to smell my wife's perfume, her cooking, or on the job I'd love to be able to detect the smell of alcohol and drugs. Is there any hope of gaining a sense of smell? Where would I go to get answers>

pppdha

I am a 32-year-old male who has been suffering from anosmia for the past 10 years. Initially, I had sinusitis problems and has been undergoing different kinds of treatments without any significant relief. one of those was the ayurvedic treatment of nasya for approximately 10 days, which made my life a hell, where I lost my smell and consulted an ENT and was told was due to mucus infection and had undergone again various treatments resulting in polypoidectomy too, but everything was in vain. Ultimately, these treatments have provided nothing, but depression, a life without taste, smell, nothing more than a hell, it just continues. Right now, I am undergoing homeopathic treatment, but that too without any success. It should be noted that once in a while, for a fraction of second, I do get smell, and it vanishes for ever. Please may I know kindly if there is any remedy for me to regain my smell and taste back, so that my life will be of some meaning to me. Please do guide me as to which physician I need to consult. Of note, I had CT scan about 5 years ago, which did not reveal anything of significance.

goharpearl

A patient with complete anosmia wil still respond to inhalation of; 1. coffee 2. ammonia 3. vanilla 4. garlic

Advancells

I also have the problem of getting the right smell especially during winters! I have consulted a few doctors, but my situation haven't improved much. Can anyone suggest remedies for this problem of mine?

@Guest

are you sure? I have anosmia and I can't sense coffee. My friend tested me. And ammonia, as in when you let your pee sit in the toilet without flushing? Yea, I definitely can't smell that. Docs tested me with an alcohol pad too and I couldn't identify that, so wherever you're getting your information, please review it's authenticity

babeyorange

I could never smell as long as I remember..does anyone else have this same issue? I guess being born not able to smell. I've been reading that people had smell but lost it due to a sickness or medicines. etc. thanks

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