Anosmia is the complete loss of sense of smell. Hyposmia is the partial loss of sense of smell. Most patients with anosmia may taste salty sweet, sour and bitter substances normal, but do not distinguish between flavors, depends largely on the discrimination of olfactory function. Therefore, they often complain of a loss of taste sensation (ageusia) and lack of enjoyment while eating. A unilateral anosmia is often unrecognized. Etiology to a anosmia occurs when odors are denied by a mucosal swelling or other intranasal obstruction of access to the area olfactoria when the olfactory epithelium is destroyed or if olfactory nerve fibers, eyeballs, Nervenleitbahnen or central connections were destroyed (see table: causes of anosmia) , Causes of anosmia cause suspicious findings Diagnostic procedure Intranasal Ostruktion Allergic rhinitis Chronic allergic symptoms (eg. As constipation, clear rhinorrhea) in prehistory, no pain Clinical evaluation nasal polyps polyps usually visible in Clinical Investigation clarification Destruction of the olfactory neuroepithelium Atrophic rhinitis chronic rhinitis with atrophic and sclerotic mucous membranes, continuity of the nasal passages, crusting, bad smell Clinical evaluation Occasionally biopsy, the conversion of the normal zilienbesetzten epithelium to a stratified squamous epithelium (squamous) and reduced in terms of amount and vascularity lamina propria shows Chronic sinusitis Chronic mucopurulent discharge, documented infection Clinical evaluation CT panoramic photograph showing the roots of the teeth in the upper jaw, an abscessed tooth exclude Viral infections of the upper respiratory tract beginning after clinical infection Clinical evaluation tumors (rare cause) may only visual difficulties or anosmia CT MRI drugs (eg. , Amphetamines, enalapril, estrogen, naphazoline, phenothiazines, reserpine; prolonged use of decongestants) Typically exposure in the history Clinical evaluation toxins (z. B. cadmium, manganese) Typically exposure in the history Clinical evaluation destruction of the central pathway Alzheimer dementia Progressive confusion and loss of short term memory MRT Sequential memory tests degenerative neurological diseases (eg. as multiple Sclerosis) Intermittent episodes of other neurological symptoms (eg. As weakness, numbness, difficulty speaking, seeing or swallowing) MRI Occasionally lumbar puncture head trauma Unique history CT Intracranial surgery, infection or tumor surgery and CNS infection in prehistory tumors with or without other neurological symptoms CT or MRI Major causes are head trauma ( young adults) Viral infections and Alzheimer’s disease (older adults) in 14-26% of cases of hypo- or anosmia went ei ne upper respiratory infection advance (particularly by influenza virus). Drugs can contribute to anosmia in susceptible patients. Other causes include irradiation of head and neck, recently previous history of nasal or sinus surgery, nose and brain tumors, as well as toxins. The role of tobacco use is not clear. The investigation history history of disease progression should assess the time course of symptoms and their relationship to an infection of the upper respiratory tract or a head injury. Important associated symptoms include nasal congestion and / or cold. The type of rhinitis (z. B. watery, slimy, festering, bloody) should be clarified. In reviewing the organ systems should neurological symptoms, especially those that (z. B., double vision difficulty speaking or swallowing, tinnitus, dizziness) relate to the mental status (eg. As difficulty with short-term memory) and the cranial nerves, clarified become. The history should be the history of diseases of the paranasal sinuses, head trauma or surgery, allergies, medication and exposure to chemicals or vapors aufnehmen.Körperliche investigation, the nose should be examined for swelling, inflammation, discharge and polyps. By the patient breathes sequentially through each nostril (while the other is closed by hand), it can be established obstruction. There is a complete neurological examination, particularly in mental status and Hirnnerven.Warnzeichen The following findings are of particular importance: Former head injury neurological symptoms or complaints sudden onset interpretation of the findings A sudden onset of a significant head trauma or toxin exposure can this event as the cause accept. Chronic rhinosinusitis in prehistory is suspicious, especially when show in the investigation a significant constipation and / or polyps. However, since these findings are widely distributed in the population, the physician should always be careful not to overlook any other disease. In an elderly patient progressive confusion and a recent onset memory loss in Alzheimer’s disease indicate as the cause. The coming and going of neurological symptoms that affect multiple regions, suggests a neurodegenerative disease such as multiple sclerosis. A slowly progressive anosmia in an elderly patient without other symptoms or findings sets a normal aging process as the cause nahe.Tests A test of olfaction in practice can help to confirm an olfactory dysfunction. Typically, a nostril is fed presses, and a pungent smell, such as from a vial with coffee, cinnamon or tobacco is placed under the open nostril; if the patient can identify the substance, is to assume that the sense of smell is intact. The test is repeated with the other nostril to determine whether the reaction is reversible. Unfortunately the test is primitive and unreliable. When a anosmia present and in the clinical evaluation (see table: causes of anosmia) no cause is apparent, a CT scan should be (including sinuses) with contrast medium to eliminate a tumor or covert bone fracture of the anterior cranial fossa. To clarify an intracranial disease, including an MRI may be necessary, especially in patients without pathological findings of the nose or sinuses in CT. In a psychophysiological investigation, the smell and taste property as well as their limits (discriminative) are determined. This study usually involves the use of one or more commercially available test kits. A kit uses a scratch and sniff-test series of odors, while another kit contains several dilutions of an odorous chemical. Treatment is therapy, the specific cause. However, the sense of smell is not always recovered, even after successful treatment of sinusitis. Against anosmia there is no treatment. Patients who have retained some of their sense of smell may make the experience that the addition of concentrated flavors enhances the taste experience in the food. Smoke detectors, important in all apartments, are even more important for patients with anosmia. Affected should be the consumption of stored food and the use of gas for cooking or heating very carefully, as they may find it difficult to notice the food spoilage or a possible gas leak. Basics of geriatrics to a normal aging process has a significant loss of olfactory receptor neurons, resulting in a significant reduction of smell. Changes are noticeable in general at the age of 60 years and can be clearly pronounced in people over 70. Summary anosmia can be part of the normal aging process. Common causes include infections of the upper respiratory tract, sinusitis and head injuries. A brain imaging is usually required if the cause is not clear.


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