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Diagnosis and Treatment of Olfactory Dysfunction 포천중문의대이비인후과학교실 교수 홍 석 찬.

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Presentation on theme: "Diagnosis and Treatment of Olfactory Dysfunction 포천중문의대이비인후과학교실 교수 홍 석 찬."— Presentation transcript:

1 Diagnosis and Treatment of Olfactory Dysfunction 포천중문의대이비인후과학교실 교수 홍 석 찬

2 Physiologic or Anatomic Causes of Olfactory Dysfunction -Hyperosmia hunger, nausea, obesity, hunger, nausea, obesity, occupational, environmental, occupational, environmental, nasal cycle, gender nasal cycle, gender-Hyposmia satiety, menstrual cycle, aging satiety, menstrual cycle, aging

3 Causes of Intranasal Obstruction -Transport loss polyps, olfactory gliomas, meningiomas polyps, olfactory gliomas, meningiomas intranasal tumors (esthesioneuroblastoma, intranasal tumors (esthesioneuroblastoma, squamous cell carcinoma, etc.) squamous cell carcinoma, etc.) rhinosinusitis, atrophic rhinitis rhinosinusitis, atrophic rhinitis deviated nasal septum deviated nasal septum adenoid hypertrophy adenoid hypertrophy granulomas, nasopharyngeal ca. granulomas, nasopharyngeal ca.

4 Systemic Causes of Rhinitis and Olfactory Dysfunction Viral rhinitis (herpes simplex, influenza, hepatitis viruses) Allergic rhinitis Vasomotor rhinitis Drugs, chemicals Pregnancy Chemical pollutants Industrial dusts

5 Neurologic Causes of Olfactory Dysfunction Head trauma Vascular insufficiency Infections Intracranial tumors (frontal lobe tumors) Multiple sclerosis Neurodegenerative diseases (Parkinson’s disease, Alzheimer’s disease) (Parkinson’s disease, Alzheimer’s disease) Temporal lesions (hippocampal uncus)

6 Endocrine and Nutritional Causes of Olfactory Dysfunction -Endocrine disorders Addison’s disease, Cushing’s syndrome, Addison’s disease, Cushing’s syndrome, hypothyroidism, Turner’s syndrome, hypothyroidism, Turner’s syndrome, Kallmann’s syndrome, diabetes mellitus Kallmann’s syndrome, diabetes mellitus -Nutritional causes vitamin A deficiency, Korsakoff’s syndrome, renal failure, cirrhosis, Whipple’s disease, cystic fibrosis vitamin A deficiency, Korsakoff’s syndrome, renal failure, cirrhosis, Whipple’s disease, cystic fibrosis

7 Miscellaneous Causes 1. Surgery (intranasal and sinus surgery, craniofacial resection, laryngectomy) craniofacial resection, laryngectomy) 2. Radiation (NPC patients with radiotherapy) 3. Psychogenic causes hysteria hysteria schizophrenia schizophrenia

8 Drugs affecting olfaction Amebicides, antihelmintics, anesthetics, anticholesteremics, anticoagulants, antihistamines, antimicrobial agents, antiproliferatives, antirheumatics, opiates, antiseptics, antithyroid agents, diuretics, antihypertensives, hypoglycemic drugs, psychopharmacologics, vasodilators, sympathomimetics, muscle relaxants, etc.

9 Diagnostic Evaluation 1. Thorough history taking 2. Physical examination 3. Radiologic study 4. Olfactory function test 5. Additional laboratory evaluation 6. Biopsy of olfactory neuroepithelium

10 Thorough History Taking 1. Slow vs. abrupt progression 2. Long-term vs. intermittent loss 3. Coincident nasal symptoms 4. Attendant neurologic dysfunction 5. Histories of sinonasal inflammation 6. Occupational, nutritional problem 7. Previous surgery, radiation exposure 8. Use of alcohol, tobacco, and drugs

11 Physical Examination 1. Nasal endoscopy 2. Head and neck examination -ear -ear -eye -eye -oral mucosa -oral mucosa -neck examination -neck examination 3. Neurologic examination

12 Radiologic Study 1. Computed tomography (CT) 2. Magnetic resonance imaging (MRI) 3. Functional MRI (fMRI) 4. PET (Positron emission tomography) 5. MSI (Magnetic source imaging)

13 Olfactory Function Tests 1. Threshold detection test -Sniff or squeeze bottles filled with -Sniff or squeeze bottles filled with various concentrations of an aqueous various concentrations of an aqueous solution of an odorant such as butanol, solution of an odorant such as butanol, phenylethyl alocohol, or acetone are used. phenylethyl alocohol, or acetone are used. -ascending staircase method -ascending staircase method

14 2. Odor discrimination test -Whether two odors are same or different -Whether two odors are same or different is determined ; hit and false-alarm rate is determined ; hit and false-alarm rate -The odd stimulus is chosen from a set of -The odd stimulus is chosen from a set of stimuli that are identical. stimuli that are identical. -odor confusion matrix -odor confusion matrix

15 3. Odor identification test -UPSIT (University of Pennsylvania -UPSIT (University of Pennsylvania Smell Identification Test), CC-SIT Smell Identification Test), CC-SIT -CCCRC test (Connecticut Chemosensory -CCCRC test (Connecticut Chemosensory Clinical Research Center test) Clinical Research Center test) -T & T Olfactometer -T & T Olfactometer -Sniffin’Sticks test, KVSS test -Sniffin’Sticks test, KVSS test -Le Nez du Vin test -Le Nez du Vin test

16 4. Electrophysiologic tests -EOG (Electro-olfactogram) -EOG (Electro-olfactogram) -OEP (Olfactory evoked potential) -OEP (Olfactory evoked potential) -MEG (Magnetoencephalography) -MEG (Magnetoencephalography) -CNV (Contingent Negative Variation) -CNV (Contingent Negative Variation)

17 Additional Laboratory Evaluation 1. Endocrine function tests (thyroid and adrenal) 2. Allergic evaluation, nasal cytology 3. Serum glucose 4. Complete blood count, ESR 5. Renal function tests 6. CSF examination 7. Autoimmune studies (autoantibodies)

18 Biopsy of Olfactory Neuroepithelium 1. Additional information regarding the status of the receptor cells can be given. status of the receptor cells can be given. 2. Information is enhanced with the use of immunohistochemical or electron immunohistochemical or electron microscopic techniques. microscopic techniques. 3. Biopsies should be obtained from more than one site and probably only on one side. than one site and probably only on one side.

19 Treatment of Olfactory Dysfunction 1. Medical therapy -for allergic rhinitis, -for allergic rhinitis, topical or systemic corticosteroid topical or systemic corticosteroid cromolyn cromolyn immunotherapy immunotherapy -for bacterial infections, -for bacterial infections, systemic antibiotics systemic antibiotics

20 -for patients with nasal polyps, -for patients with nasal polyps, oral corticosteroids oral corticosteroids (continued treatment with the possibility (continued treatment with the possibility of long-term side effects) of long-term side effects) -For olfactory impairment by non-sinonasal -For olfactory impairment by non-sinonasal origin, systemic steroid can be applied origin, systemic steroid can be applied with some side effects (Yang KH, 2000). with some side effects (Yang KH, 2000).

21 -for hypothyroidism, appropriate thyroid treament appropriate thyroid treament -for Whipple’s disease, responds well to vitamin A therapy responds well to vitamin A therapy -for phantosmia, cocainization of the olf. neuroepithelium cocainization of the olf. neuroepithelium or localized excision of the neuroepithelium or localized excision of the neuroepithelium

22 2. Surgical intervention -FESS for chronic sinusitis or nasal polyposis -FESS for chronic sinusitis or nasal polyposis -septoplasty for deviated nasal septum -septoplasty for deviated nasal septum -craniotomy and resection of the olfactory -craniotomy and resection of the olfactory bulbs for paroxysmal dysosmia following bulbs for paroxysmal dysosmia following head injury head injury

23 -polypectomy and maintenance on oral steroids, improvement of olfactory function improvement of olfactory function -FESS and long-term topical steroids, significant improvement in olfaction significant improvement in olfaction -Local injection of dexamethasone acetate suspension into the nasal mucosa suspension into the nasal mucosa (Fukazawa K, et al., 1999) (Fukazawa K, et al., 1999)

24 3.Miscellaneous treatment -Zinc sulfate -Zinc sulfate -Vitamin A and beta carotene -Vitamin A and beta carotene -Phosphodiesterase inhibitors -Phosphodiesterase inhibitors (theophylline and methyl xanthines) (theophylline and methyl xanthines) -Supplementation of glutamate or aspartate -Supplementation of glutamate or aspartate -Caroverine (NMDA antagonist) -Caroverine (NMDA antagonist)

25 -Auricular acupuncture stimulation ( Tanaka O, Mukaino Y, 1999) ( Tanaka O, Mukaino Y, 1999) -Nasal airflow-inducing maneuver (“polite yawning”) in laryngectomee (“polite yawning”) in laryngectomee ( Hilgers FJ, et al., 2000) ( Hilgers FJ, et al., 2000)

26 References Kimmelman CP. Disorders of taste and smell. A self-instructional package. AAO-HNS. 1996. A self-instructional package. AAO-HNS. 1996. Chemosensory Bioresponses in Man II. Abstracts. Chemical Senses 25: 781-801, 2000. Chemical Senses 25: 781-801, 2000. Kettenmann B. Multiple olfactory activity in the human neocortex identified by magnetic source human neocortex identified by magnetic source imaging. Chemical Senses 22: 493-502, 1997. imaging. Chemical Senses 22: 493-502, 1997.


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