ANOSMIA OR UNUSUAL ODORS

Ask the following questions:

1. Is it acute or chronic? Acute loss of smell would certainly suggest an acute upper respiratory infection (URI). It would also suggest recent exposure to toxic fumes or recent head injury. If the anosmia or unusual odor is intermittent, then one should consider psychomotor epilepsy.
2. Is there a history of trauma? A skull fracture, particularly if it involves the cribriform plate, may interrupt the olfactory nerves and cause anosmia.
3. Is there a history of drug use or overuse of nasal sprays? Captopril and penicillamine may cause anosmia. Overuse of alcohol or tobacco may also be the problem. Antirheumatic and antiproliferative drugs are also known to cause anosmia.
4. Is the anosmia unilateral or bilateral? If there is unilateral anosmia, one should consider an olfactory groove meningioma.
5. Are there other neurologic signs? Multifocal neurologic signs should suggest multiple sclerosis, and additional neurologic signs such as memory loss should suggest an olfactory groove meningioma or parietal lobe tumor.
6. Are there signs of a systemic disease? Many systemic diseases may cause anosmia, including hypothyroidism, diabetes, renal failure, hepatic failure, and pernicious anemia.

DIAGNOSTIC WORKUP

If the disorder is acute and associated with a URI, nothing need be done. However, if the condition has been of gradual onset, the nasopharyngeal examination is negative, and the history of drugs is negative, then a CT scan of the brain should be done. If this is negative, a workup for systemic disease should be done, and that should include a CBC and chemistry panel, thyroid profile, serum B ₁₂ and folic acid, glucose tolerance test, and liver profile. If the anosmia or unusual odors are intermittent, a wake-and-sleep EEG should be done.

Book Source Details

• Book Title: Algorithmic Diagnosis of Symptoms and Signs
• Author(s): R. Douglas Collins
• Year of Publication: 2003
• Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2003 Lippincott Williams & Wilkins.

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Copyright Details: Algorithmic Diagnosis of Symptoms and Signs, Copyright © 2008 Williams & Wilkins.

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More About This Book: Title: Algorithmic Diagnosis of Symptoms and Signs Authors: R. Douglas Collins Publisher: Lippincott Williams & Wilkins Copyright: 2003 ISBN: 0-7817-3805-9

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