Anosmia

Anosmia

ICD-10	R43.0
ICD-9	781.1
MeSH	D000857

Anosmia (pronounced /ænˈɒzmiə/) is a lack of functioning olfaction, or in other words, an inability to perceive odors. Anosmia may be either temporary or permanent. A related term, hyposmia, refers to a decreased ability to smell, while hyperosmia refers to an increased ability to smell. Some people may be anosmic for one particular odor. This is known as "specific anosmia". The absence of the sense of smell from birth is called Congenital Anosmia.

Diagnosis

Anosmia can be diagnosed by doctors by using acetylcysteine tests. Psychophysical Assessment of order and taste identification can be used to identity anosmia. A nervous system examination is performed to see if the cranial nerves are damaged.^[1]

Presentation

Anosmia can have a number of harmful effects. Patients with sudden onset anosmia may find food less appetizing, though congenital anosmics rarely complain about this. Loss of smell can also be dangerous because it hinders the detection of gas leaks, fire, and spoiled food. The common view of anosmia as trivial can make it more difficult for a patient to receive the same types of medical aid as someone who has lost other senses, such as hearing or sight.

Losing an established and sentimental smell memory (e.g. the smell of grass, of the grandparents' attic, of a particular book, of loved ones, or of oneself) has been known to cause feelings of depression.^[2]

Loss of olfaction may lead to the loss of libido, though this usually does not apply to congenital anosmics.^[2]

Often people who have congenital anosmia report that they pretended to be able to smell as children because they thought that smelling was something that older/mature people could do, or did not understand the concept of smelling but did not want to appear different from others. When children get older, they often realize and report to their parents that they do not actually possess a sense of smell, often to the surprise of their parents.^[2]

Causes

A temporary loss of smell can be caused by a blocked nose or infection. In contrast, a permanent loss of smell may be caused by death of olfactory receptor neurons in the nose or by brain injury in which there is damage to the olfactory nerve or damage to brain areas that process smell (see olfactory system). The lack of the sense of smell at birth, usually due to genetic factors, is referred to as congenital anosmia. Anosmia may very occasionally be an early sign of a degenerative brain disease such as Parkinson's disease and Alzheimer's disease. Another specific cause of permanent loss could be from damage to olfactory receptor neurons because of use of certain types of nasal spray; i.e., those that cause vasoconstriction of the nasal microcirculation. To avoid such damage and the subsequent risk of loss of smell, vasoconstricting nasal sprays should be used only when absolutely necessary and then for only a short amount of time. Non-vasoconstricting sprays, such as those used to treat allergy related congestion, are safe to use for prescribed periods of time.^[3] Anosmia can also be caused by nasal polyps. These polyps are found in people with allergies, histories of sinusitis & family history. Individuals with cystic fibrosis often develop nasal polyps.

Causes of anosmia include:

• Upper respiratory tract infection (e.g., sinusitis or the common cold)^[4]
• Nasal polyps
• Idiopathic hypogonadotropic hypogonadism
• Hypothyroidism
• Head trauma, damage to the ethmoid bone^[5]
• Dementia with Lewy bodies
• Tumors of the frontal lobe
• Parkinson's disease^[6]
• Alzheimer's disease^[7]
• Toxins (especially acrylates, methacrylates^[8] and cadmium^[9][10])
• Old age^[11]
• Kallmann syndrome
• Post-perfusion syndrome
• Laryngectomy with permanent tracheostomy
• Esthesioneuroblastoma is an exceedingly rare cancerous tumor that originates in or near the olfactory nerve. Symptoms are anosmia (loss of sense of smell) often accompanied by chronic sinusitis.^[12]
• Intranasal drug use
• Samter's triad
• Foster Kennedy syndrome
• Cadmium poisoning
• Smoking
• Neurotropic virus^[13]
• Schizophrenia^[14]
• Pernicious anemia
• Zinc deficiency
• Idiopathic intracranial hypertension
• Suprasellar meningioma
• Refsum's disease
• Adrenergic agonists or withdrawal from alpha blockers (vasoconstriction)
• Sarcoidosis^[15]
• Zinc-based intranasal cold products
• Paget's disease of bone^[16]

This list is incomplete; you can help by expanding it.

Zicam controversy

On June 16, 2009, the U.S. Food and Drug Administration sent a warning letter to Matrixx Initiatives, manufacturer of an over-the-counter nasal spray for the common cold, Zicam. The FDA cited complaints that the product caused anosmia. The manufacturer strongly denies these allegations, but has recalled the product and has stopped selling it.^[17][18]

Associated conditions

• Dysosmia
• Kallmann syndrome
• Zinc deficiency
• Cadmium Poisoning
• Holoprosencephaly
• Primary amoebic meningoencephalitis caused by Naegleria fowleri
• Refsum disease
• CHARGE syndrome
• Ageusia

This list is incomplete; you can help by expanding it.

Notable anosmic individuals

• Arjen Lucassen
• Selma Bouvier (Fictional Character)
• Dennis Brain
• Ben Cohen
• Dewey Cox (Fictional Character)
• Mary Baker Eddy
• Michael Hutchence
• Justin Hayward (for a period in the 1990s)^[19]
• Simon Katich
• Scott Kurtz (author of webcomic PvP)^[20]
• Bill Pullman
• Harry Redknapp^[21]
• Simon Tatham
• Benjamin Urrutia
• Stevie Wonder
• William Wordsworth
• Kevin Schoettler

See also

• Hyperosmia
• Hyposmia
• Parosmia
• Richard Doty, Ph.D (researcher in the field of olfactory functioning and dysfunction)

References

1. ^ "Anosmia / Loss Of Smell". http://www.medindia.net/patients/patientinfo/anosmia_diagnosis.htm. 
2. ^ ^{a b c} "Sense and scent ability". BBC News. December 27, 2006. http://news.bbc.co.uk/2/hi/uk_news/magazine/6199605.stm. Retrieved April 25, 2010. 
3. ^ http://web.archive.org/web/20060101000005/http://www.coldcure.com/anosmia/anosmia.html
4. ^ Doty RL, Mishra A (2001). "Influences of nasal obstruction, rhinitis, and rhinosinusitis on the ability to smell". Laryngoscope 111 (3): 409–23. doi:10.1097/00005537-200103000-00008. PMID 11224769. 
5. ^ Doty RL, Yousem DM, Pham LT, Kreshak AA, Lee WW (1997). "Olfactory dysfunction in patients with head trauma". Arch Neurol 54 (9): 1131–40. PMID 9311357. 
6. ^ Doty RL, Deems D, Stellar S (1988). "Olfactory dysfunction in Parkinson's disease: A general deficit unrelated to neurologic signs, disease stage, or disease duration". Neurology 38 (8): 1237–44. PMID 3399075. 
7. ^ Murphy C (1999). "Loss of olfactory function in dementing disease". Physiology & Behavior 66 (2): 177–182. doi:10.1016/S0031-9384(98)00262-5. PMID 10336141. 
8. ^ Schwartz B, Doty RL, Frye RE, Monroe C, Barker S (1989). "Olfactory function in chemical workers exposed to acrylate and methacrylate vapors". Am J Pub Health 79 (5): 613–8. doi:10.2105/AJPH.79.5.613. 
9. ^ Rose CS, Heywood PG, Costanzo RM (1992). "Olfactory impairment after chronic occupational cadmium exposure". Journal of Occupational Medicine 34 (6): 600–5. PMID 1619490. 
10. ^ Rydzewski B, Sulkowski W, Miarzynaska M (1998). "Olfactory disorders induced by cadmium exposure: A clinical study". Int J Occ Med Env Health 11: 235–245. 
11. ^ Doty RL, Shaman P, Applebaum SL, Giberson R, Sikorsky L, Rosenberg L (1984). "Smell identification ability: Changes with age". Science 226 (4681): 1441–3. doi:10.1126/science.6505700. PMID 6505700. 
12. ^ eMedicine - Esthesioneuroblastoma : Article by Pavel Dulguerov
13. ^ Study Examines Treatment For Olfactory Loss After Viral Infection
14. ^ Rupp CI, Fleischhacker WW, Kemmler G, et al. (May 2005). "Olfactory functions and volumetric measures of orbitofrontal and limbic regions in schizophrenia". Schizophr. Res. 74 (2–3): 149–61. doi:10.1016/j.schres.2004.07.010. PMID 15721995. 
15. ^ Isolated neurosarcoidosis presenting as anosmia and visual changes
16. ^ http://www.ncbi.nlm.nih.gov/pubmed/7490390
17. ^ www.zicam.com
18. ^ "FDA warns against using 3 popular Zicam cold meds - CNN.com". CNN. June 16, 2009. http://www.cnn.com/2009/HEALTH/06/16/zicam.fda.warning/index.html. Retrieved April 25, 2010. 
19. ^ Papers the cure that smells wimbledonclinic.co.uk
20. ^ https://twitter.com/pvponline/status/18713967929
21. ^ Harry-Redknapp-interview sport-magazine.co.uk

Further reading

• Blodgett, Bonnie (2010). Remembering Smell: A Memoir of Losing - and Discovering - the Primal Sense. Houghton Mifflin Harcourt. 
• Tafalla, Marta (2010) (in Spanish). Nunca sabrás a qué huele Bagdad (You will never know the smell of Bagdad). Autonomous University of Barcelona.  - Novel dealing with congenital anosmia.

External links

• An online survey for people with acquired anosmia, i. e. who lost their sense of smell throughout their lives
• What does the lack of a sense of smell do to flavour perception? Guardian.co.uk
• Cardiff University Anosmia resource site