Loss of smell (anosmia) is the complete loss of the sense of smell. The symptom is physiological in the elderly, but more often olfactory disorders occur in smokers, with various diseases of the nose and paranasal sinuses, and pathologies of the brain. To establish the root cause of anosmia, olfactometry, examination of ENT organs, X-ray and tomographic methods of brain imaging, and laboratory tests are used. Medications are prescribed taking into account the underlying disease after diagnostic measures.
A person smells thanks to the coordinated work of the receptor cells of the nasal mucosa, special nerve fibers and the olfactory center in the brain. If any link in this process is disturbed, olfactory disorders develop. Insensitivity to aromas is more often caused by pathologies from the nervous system or respiratory tract. Also, the symptom becomes a consequence of physiological changes in the olfactory apparatus or functional disorders. Less common is congenital anosmia (Kallman's syndrome).
Older people are characterized by a gradual loss of the ability to distinguish smells, which progresses over several years, and as a result leads to anosmia. This condition is due to atrophic processes - the death of cells of the nasal mucosa, which are responsible for the recognition of odorous substances. At first, the patient notices insensitivity to weak "subtle" aromas, as atrophy develops, the person ceases to distinguish even very pungent odors: garlic, spices, ammonia. Bilateral olfactory disturbances are typical for this condition.
Usually, a decrease in smell is not accompanied by other unpleasant manifestations, so patients consider their condition to be a variant of the norm and do not seek help for a long time. Taste disturbances are possible. A warning sign is the sudden loss of all odor perception by an elderly person, which often indicates a serious organic lesion. If the symptom is combined with constant headaches, forgetfulness, inability to concentrate, you should consult a doctor for a detailed examination.
Decreased sense of smell is common among smokers because nicotine negatively affects the olfactory nerve receptors in the nasal mucosa, first reducing their sensitivity and later leading to atrophy. Patients themselves very rarely pay attention to this symptom, which is due to constant smoking and the habit of a strong tobacco smell. Complete anosmia develops very slowly, over several years. Along with disorders of smell, taste sensations may be disturbed.
Benign growths of the mucous membrane (polyps) create mechanical obstacles to the passage of air, therefore, a gradual decrease in the sense of smell (hyposmia) is possible, up to its complete loss. Patients describe their condition as the inability to fully breathe through the nose, which is associated with insensitivity to odors. Complete anosmia may occur a long time after the onset of symptoms, but more often the ability to distinguish sharp odorous substances (ammonia, gasoline) is retained.
With inflammation of the paranasal sinuses, the loss of smell is usually determined only on the side of the lesion, in the future, with the progression of the disease, anosmia becomes bilateral. Due to the pronounced swelling of the mucosa, patients breathe only through one nostril, which aggravates the situation. The symptom is accompanied by pain in the cheekbones, forehead, increased discomfort when the head is tilted down. These signs are an indication for contacting an otolaryngologist, since without treatment, sinusitis can be complicated by severe inflammation of the brain.
With inflammatory processes in the nasal cavity, the decrease in smell is temporary. The disorder develops simultaneously with other clinical symptoms, moderate hyposmia persists for some time after recovery. Most of the time, the process is two-way. Sometimes a symptom is associated with the action of allergens (pollen, dust, pet hair). Loss of olfactory function is accompanied by nasal congestion, mucous or purulent discharge, headache. With anosmia proceed:
With traumatic injuries, the loss of smell occurs suddenly, more often immediately after the injury. Anosmia can be unilateral or bilateral, depending on the severity of the TBI and the site of impact. The severity and duration of symptoms does not depend on the strength of the blow - with moderate injuries (concussion without skull fractures), prolonged anosmia is possible. Since the olfactory nerve fibers are often completely torn in massive fractures of the bones in the forehead and nose, in such cases a permanent loss of sensitivity to all aromas is likely.
Anosmia accompanies many neurological diseases. The loss of smell in this case is associated with damage to the nerve cells of the brain responsible for recognizing various odors. These pathologies are characterized by the appearance of other symptoms: impaired coordination of movements, severe headaches, memory loss. Sometimes patients complain of a fetid odor that constantly “haunts” them, which occurs against the background of a decrease in sensitivity to familiar aromas. The weakening of the sense of smell accompanies such organic brain lesions as:
Loss of smell is one of the symptoms of intoxication of the body with damage to the nervous system. In this case, hyposmia is more often noted, a complete loss of the ability to distinguish odors is rare. Sometimes a symptom occurs when the dosages of narcotic drugs with neurotoxic properties are exceeded. Depending on the type of toxin, anosmia is accompanied by dyspeptic disorders, loss of consciousness, and damage to other organs. The olfactory disorder is caused by:
Loss of susceptibility to smells can develop against the background of long-term neuroses, severe emotional disturbances, including hysterical reactions. Typical is the presentation of a wide range of diverse complaints with their vivid description: a decrease or complete absence of smell, pursuing the sensation of the same unpleasant odor. Strengthening of symptoms is associated with stress, conflicts in the family, at work. With functional disorders, consultation with a specialist is mandatory, since without proper therapy these conditions turn into psychosomatic disorders.
Loss of smell is one of the side effects of hypertension therapy, hormonal correction in women. Persistent hyposmia is often observed in patients who use vasoconstrictor nasal drops for a long time (more than 1-2 weeks). When taking other medications, the symptom is temporary, usually the olfactory function is fully restored after the end of the course of treatment. Anosmia is provoked by the following groups of drugs:
Patients with complaints of loss of smell often turn to an otolaryngologist. Since anosmia can be associated both with damage to the upper respiratory tract and with pathology of the brain, a comprehensive diagnosis is carried out. The examination plan includes functional tests, instrumental and laboratory studies, which are aimed at determining the degree of decrease in olfactory sensitivity and identifying the root cause of the symptom. In diagnostic terms, the most informative:
After the exclusion of organic prerequisites for anosmia and physiological age-related changes in the receptor apparatus, according to indications, additional examination methods are prescribed - allergy tests, angiography of the cerebral vessels. With possible functional disorders of smell due to disorders of the emotional sphere, consultation with a neurologist or psychiatrist is necessary.
nasal endoscopy
In most cases, the loss of smell is transient, the ability to smell is restored after treatment of the underlying disease. To eliminate the accompanying unpleasant symptoms (dryness, burning) with physiological anosmia in the elderly, washing and irrigation of the nasal cavity can be used. Specific therapy for inflammatory, neurological and psychogenic disorders is prescribed by a specialist after a comprehensive examination of the patient.