Ebook Smell and taste disorders: Part 2
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Ebook Smell and taste disorders: Part 2
Non-neurodegenerative Disorders of OlfactionChemosensory disorders arc common in the general population. Olfactory impairment, which is more prevalent Ebook Smell and taste disorders: Part 2t than taste dysfunction, affects 1-2% of people below the age of 65 years and more than 50% in those above this age (Doty et al., 1984; Hoffman et al., 1998; Murphy et al., 2002). Of 750 consecutive patients presenting to the University of Pennsylvania Smell and Taste Center with chemosensory compl Ebook Smell and taste disorders: Part 2aints, 68% reported decreased quality of life, 46% changes in appetite or body weight, and 56% adverse influences on daily living or psychological welEbook Smell and taste disorders: Part 2
l-being (Deems et al., 1991). In another study of 445 such patients, at least one significant hazardous event (e.g., food poisoning or failure to deleNon-neurodegenerative Disorders of OlfactionChemosensory disorders arc common in the general population. Olfactory impairment, which is more prevalent Ebook Smell and taste disorders: Part 2d smell function), 32.8% of those with moderate hyposmia, 24.2% of those with mild hyposmia, and 19.0% of those with normal olfactory function. It is particularly noteworthy that a number of longitudinal studies have found mortality risk to be much higher in older non-demented persons with smell ide Ebook Smell and taste disorders: Part 2ntification deficits than in those with a normal sense of smell (Wilson et al., 2010; Gopinath et al., 2012; Pinto et al., 2014; Devanand et al., 2015Ebook Smell and taste disorders: Part 2
). In the most definitive of these studies, the increased risk of death progressively increased as olfactory dysfunction increased over a four-year peNon-neurodegenerative Disorders of OlfactionChemosensory disorders arc common in the general population. Olfactory impairment, which is more prevalent Ebook Smell and taste disorders: Part 2e in those with the highest UPS1T scores.A recurrent confusion in the minds of patients and many of their medical advisors is the fact that individuals with smell impairment complain regularly of loss of taste. This can lead to unnecessary evaluations such as extensive gastrointestinal investigation Ebook Smell and taste disorders: Part 2s, and reflects a lack of understanding of the important role olfaction plays in producing food flavor. When we ingest food, there is taste appreciatiEbook Smell and taste disorders: Part 2
on from taste buds over the tongue and pharynx but, simultaneously, odorants released from food escape into the retropharyngeal space and enter the naNon-neurodegenerative Disorders of OlfactionChemosensory disorders arc common in the general population. Olfactory impairment, which is more prevalent Ebook Smell and taste disorders: Part 2taste and smell, unless it is an odorless tastant that evokes only sweet, sour, salt, bitter, or umami taste perceptions. Sensations such as chocolate, meat sauce, strawberry, cola, lime, walnut, and lemon are mediated principally by smell, not taste. Only on rare occasions will a patient suffer imp Ebook Smell and taste disorders: Part 2airment of both smell and taste. Gustatory problems, per sc, can be ascertained in many cases by asking patients if they can still detect the sweetnesEbook Smell and taste disorders: Part 2
s of sugar, the sourness of grapefruit, or the saltiness of potato chips, although these questions are surprisingly insensitive when compared to objecNon-neurodegenerative Disorders of OlfactionChemosensory disorders arc common in the general population. Olfactory impairment, which is more prevalent Ebook Smell and taste disorders: Part 2e, the major non-neurodegenerative diseases influenced by such182Non-neurodegenerative Disorderdisorders, including head injury, tumor, infection and inflammation, endocrine disease, epilepsy, and multiple sclerosis. Non-neurodegeneralive taste disorders are similarly reviewed in Chapter 6, and neur Ebook Smell and taste disorders: Part 2odegenerat ivc diseases, such as Alzheimer’s, Parkinson’s disease, and related syndromes, are discussed in chapter 7.Classification of Types of OlfactEbook Smell and taste disorders: Part 2
ory DisordersOlfactory disorders can be classified according to their behavioral or psychological manifestations. The most common terms used in such cNon-neurodegenerative Disorders of OlfactionChemosensory disorders arc common in the general population. Olfactory impairment, which is more prevalent Ebook Smell and taste disorders: Part 2 to describe some impairment which may be complete or partial or related to just one odor. Similar confusion is mirrored by other neurological words, such as aphasia and dysphasia, alexia and dyslexia, etc. specific anosmia refers to the inability to detect one or a few related odorants while still Ebook Smell and taste disorders: Part 2being able to delect other odors in a normal fashion. Patients with specific anosmias generally do not recognize their problem and do not present clinEbook Smell and taste disorders: Part 2
ically with concerns, unlike patients with general anosmia. Most specific anosmics actually can smell the substance to which they are anosmic if it isNon-neurodegenerative Disorders of OlfactionChemosensory disorders arc common in the general population. Olfactory impairment, which is more prevalent Ebook Smell and taste disorders: Part 2mal individual loses the ability to recognize an odor, yet maintains the ability to perceive and distinguish it from other odors in a normal fashion. Extremely few cases of olfactory agnosia have been identified, which is surprising in view of the well-recognized forms of agnosia in the visual and a Ebook Smell and taste disorders: Part 2uditory spheres. In one case report, agnosia was described in a 53-year-old male patient with predominantly right inferior temporal lobe atrophy (presEbook Smell and taste disorders: Part 2
umably degenerative) in association with prosopagnosia, i.e., agnosia for familiar faces. This results usually from disorder of the fusiform gyrus whiNon-neurodegenerative Disorders of OlfactionChemosensory disorders arc common in the general population. Olfactory impairment, which is more prevalent Ebook Smell and taste disorders: Part 2eral olfactory agnosia (with normal olfactory thresholds) associated with complex partial seizures localized to the right medial temporal lol>e (Ix'hrner et al., 1997). The prediction that patients with semantic dementia (SD) would have difficulty in naming smells in the presence of normal discrimin Ebook Smell and taste disorders: Part 2ation was confirmed in a study of eight patients with SD, as dcscrilxrd in more detail in Chapter 7 (I.uzzi el al., 2007).HyposmiaHyposmia refers to dEbook Smell and taste disorders: Part 2
ecreased sensitivity to odors. Like anosmia, such decrements can exist on one or both sides of the nose. Since hyposmia is classically associated withNon-neurodegenerative Disorders of OlfactionChemosensory disorders arc common in the general population. Olfactory impairment, which is more prevalent Ebook Smell and taste disorders: Part 2ification and threshold tests are, in general, highly correlated (Doty, 1995). Unilateral microsmia is regularly overlooked in clinical practice - a point of considerable relevance, for example, in diagnosis of an olfactory groove meningioma (which is often one-sided). Temporary hyposmia can occur a Ebook Smell and taste disorders: Part 2s a result of accelerated or prolonged adaptation, as in cases of chronic exposure to some workplace chemicals like acrylates or hydrogen sulfide (SchEbook Smell and taste disorders: Part 2
wartz et al., 1989).184Smell and Taste Disorders______________________________________________________________________________IHyperosmiaThis is definNon-neurodegenerative Disorders of OlfactionChemosensory disorders arc common in the general population. Olfactory impairment, which is more prevalent Ebook Smell and taste disorders: Part 2t this condition show no such alterations. Tn some cases, hyperosmia is associated with hyper-reactivity rather than a true change in sensitivity. Hyper-reactivity can reflect a liberal response criterion, i.e., greater willingness to report the presence of an odor or simply an emotional response to Ebook Smell and taste disorders: Part 2 a smell in the absence of any change in sensitivity to that odor. Although rarely reported in humans, the concept of hyperosmia now has a more scientEbook Smell and taste disorders: Part 2
ific footing as a result of gene knockout experiments. Mice with gene-targeted deletion of the Kv 1.3 channel had a 1,000- to 10,000-fold lower threshNon-neurodegenerative Disorders of OlfactionChemosensory disorders arc common in the general population. Olfactory impairment, which is more prevalent Ebook Smell and taste disorders: Part 2supersmcller” mice (1-adool et al., 2004). According to Menashe et al. (2007), hypersensitivity to the odor isovaleric acid (sweaty socks smell) may relate to polymorphisms in the human olfactory receptor gene, OR11ĨĨ7P.DysosmiaThis refers to any form of distorted smell perception, sometimes termed Ebook Smell and taste disorders: Part 2parosmia and, when it has a fetid character, cacosmia. Dysosmias can be either stimulated or unstimulated, i.e., appear in the presence or the absenceEbook Smell and taste disorders: Part 2
of an identifiable odor. The latter type of dysosmia is often termed phantosmia or olfactory hallucination. Phantosmias can be experienced by both heNon-neurodegenerative Disorders of OlfactionChemosensory disorders arc common in the general population. Olfactory impairment, which is more prevalent Ebook Smell and taste disorders: Part 2 several hours after they have left the area and may have temporary decrements in olfactory' function (Hisamitsu et al., 2011). Traditional teaching holds that most hallucinations, including the olfactory variety, indicate organic disease within the uncinate region that make up the aura of a complex Ebook Smell and taste disorders: Part 2 partial epileptic attack. In fact, most dysosmias reflect degeneration or attempts at regeneration in the olfactory' neuroepithelium. Moreover, lesioEbook Smell and taste disorders: Part 2
ns of the orbito-frontal cortex, an olfactory association area, may also produce olfactory illusions, hallucinations, autonomic signs, or gestural autGọi ngay
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