Olfaction disorders: retrospective study

Braz J Otorhinolaryngol. 2014;80(1):11-17 Brazilian Journal of OTORHINOLARYNGOLOGY www.bjorl.org.br ORIGINAL ARTICLE Olfaction disorders: retrospective study Luciano Lobato Gregorio*, Fábio Caparroz, Leonardo Mendes Acatauassú Nunes, Luciano Rodrigues Neves, Eduardo Kosugi Macoto Department of Otorhinolaryngology and Head and Neck Surgery, Universidade Federal de São Paulo (UNIFESP-EPM), São Paulo, SP, Brazil Received 10 December 2012; accepted 12 October 2013 KEYWORDS Smell; Olfaction disorders; Olfactory perception Abstract Introduction: The smell, subjective phenomenon of great importance, is poorly understood and studied in humans. Physicians with more knowledge about smell disorders tend to consider the phenomenon important and to better manage the diagnosis and its treatment. Aims: First to describe a sample of patients presenting with main complaint of disturbances of smell. And second, to show our experience on management and treatment of this disease. Design: Retrospective cross-sectional cohort study. Materials and methods: Sample description and assessment of treatment response in patients with main complaint of hyposmia or anosmia from January 2005 to October 2011. Results: From 38 patients presented with main complaint of an olfactory disorder, 68.4% of the patients were presented with hyposmia and 31,5% with anosmia, with a mean duration of 30.8 months. The main etiologic diagnoses were idiopathic (31.5%), rhinitis (28.9%) and CRS with polyps (10.5%). Responses to treatment with topical steroids and alpha-lipoic acid were variable, as well as in the literature. Conclusion: Greater importance should be given to disorders of smell in practice of otolaryngologists, since its large differential diagnosis and the fact that could increase morbidity to patients, impacting on their quality of life. © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved. PALAVRAS-CHAVE Olfato; Transtornos do olfato; Percepção olfatória Distúrbios da olfação: estudo retrospectivo Resumo Introdução: O olfato, fenômeno subjetivo de grande importância, é pouco compreendido e estudado no ser humano. Médicos com maior conhecimento sobre os distúrbios desse sentido tendem a considerar a doença mais importante e manejar melhor o diagnóstico e o tratamento. Objetivo: Descrever a amostra dos pacientes com queixa principal de distúrbios do olfato e mostrar a experiência do serviço no manejo e tratamento. Delineamento: Estudo retrospectivo de coorte histórica com corte transversal. Materiais e métodos: Descrição da amostra e avaliação de resposta ao tratamento de pacientes com queixa principal de hiposmia ou anosmia atendidos no ambulatório de Rinologia no período de janeiro de 2005 a outubro de 2011. Please cite this article as: Gregorio LL, Caparroz F, Nunes LM, Neves LR, Macoto EK. Olfaction disorders: retrospective study. Braz J Otorhinolaryngol. 2014;80:11-7. * Corresponding author. E-mail: (L.L. Gregorio). 1808-8694/$ - see front matter © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved. DOI: 10.5935/1808-8694.20140005 12 Gregorio LL et al. Resultados: Dos 38 pacientes com distúrbio da olfação, 68,4% dos pacientes apresentaram queixa de hiposmia e 31,5% de anosmia, com duração média de 30,8 meses. Os diagnósticos etiológicos principais foram idiopática (31,5%), rinopatia alérgica (28,9%) e RSC com pólipos (10,5%). As respostas ao tratamento com corticosteroide tópico e ácido alfa-lipoico foram variáveis, assim como na literatura. Conclusão: Maior importância deve ser dada aos distúrbios do olfato na prática do otorrinolaringologista, uma vez que o diagnóstico diferencial é amplo e pode trazer grande morbidade ao paciente, com impacto na sua qualidade de vida. © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Publicado por Elsevier Editora Ltda. Todos os direitos reservados. Introduction Olfaction disorders have attained great importance in recent years. In humans, the sense of smell is probably the least understood, being mostly a subjective phenomenon.1 Anosmia and hyposmia are terms that refer to the complete and partial loss of smell, respectively. The term dysosmia, in turn, describes an altered sense of smell, both in response to environmental stimuli (an alteration termed parosmia) and spontaneous events (termed phantosmia).2 The loss or impairment of olfaction is a relatively common condition, especially in the elderly. Doty et al. estimated that approximately 75% of individuals older than 80 years and 50% of those between 65 and 80 years suffer from considerable decrease in olfactory function.3 However, the prevalence of olfaction disorders in the general population was and has been underestimated, as indicated by some recent studies. In a study with a representative sample of the population (n = 1,387) performed in Sweden, a prevalence of 19% was calculated for olfaction disorders in general.4 Moreover, it is well established that the sense of smell strongly contributes to taste perception, so that patients with hyposmia or anosmia have great difficulty in perceiving the taste of food, thus losing the appetite for and pleasure from food.1 The olfactory impulses propagate to the limbic system, as well as to the higher cortical areas. Certain olfactory stimuli may trigger diverse emotional responses and create different cortical associations with other senses; this process is connected to the individual’s memory and the perception of emotional stimulus quality, i.e., the feeling of being pleasant or unpleasant.1 Another factor to consider is that hyposmia may cause a significant impact on the quality of life of patients, bringing difficulties in activities of daily living, mood disorders, decreased appetite, and even work problems.5 Standardized olfactory tests were created in an attempt to objectify a subjective symptom since olfaction disorders are sources of several medical complaints and result in thousands of annual physician visits.6 In this sense, olfactory dysfunction has been investigated as one of the earliest pre-clinical signs in both Alzheimer’s disease (AD) and in sporadic Parkinson’s disease (PD).7 In a recent study performed with questionnaires applied to otolaryngologists (n = 231), it was observed that only 7.3% of participants reported using olfaction assessment tests in daily clinical practice. It was demonstrated that most physicians observed tests being applied and received training on testing for olfaction disorders during the residency period. In addition, physicians with greater knowledge about these disorders tend to consider the disease to be more important, and therefore achieve better diagnosis and treatment.8 This study aimed to describe the sample of patients with a complaint of olfaction disorders, report this service’s experience in the (...truncated)