Parosmia symptoms. Semiotics of olfactory disorders

Loss of smell, or anosmia, is a fairly serious problem for a person, significantly impairing the quality of his life. AND we're talking about not only about aesthetic moments - the pleasure of inhaling the aroma of flowers or New Year's mood, associated with the smells of citrus and cinnamon. Decreased or lost sense of smell can be dangerous to your overall health. A pleasant smell stimulates the secretion of digestive juices, and the absence of its perception can cause digestive disorders. Many substances that are toxic to humans have an unpleasant odor and irritate the nasal mucosa, causing sneezing, and with anosmia they easily penetrate the body and have adverse effects.

The reader should understand that loss of smell, although often not a direct threat to life, still requires the patient to seek advice from a specialist. About why the sense of smell decreases and disappears and what are the principles of treatment for this condition, and we'll talk in our article.

Classification and causes of loss of smell

Both the loss of smell (or anosmia) and its decrease (or hyposmia) can be congenital or acquired.

Congenital lack of smell is a consequence of the complete absence of the respiratory tract or their partial underdevelopment. Often this pathology accompanies congenital anomalies of the nose or facial skull.

Acquired loss of smell can be of peripheral and central origin: peripheral occurs when the disorder is localized in the area of ​​the nose itself, and central - when there is organic damage to the central nervous system.

Peripheral anosmia, in turn, depending on the reasons that caused it, is divided into 4 types:

• functional (is a manifestation of viral infections, in this case it is a consequence of swelling of the nasal mucosa; can occur with neuroses and hysteria; after eliminating the cause of anosmia, the sense of smell is fully restored);
• respiratory (develops when air containing molecules of aromatic substances passes through the nasal passages, but for some reason cannot reach the peripheral part of the olfactory analyzer; often these reasons are hypertrophy of the nasal turbinates, and other benign and);
• senile, or age-related (result atrophic changes in the nasal mucosa, in particular the mucous epithelium, which leads to dryness of the nasal mucosa);
• essential (the result of damage to the immediate peripheral part of the olfactory analyzer, which arose in connection with the inflammatory process in this area, burns of the nasopharynx of any nature, household or surgical trauma to the nose/nasopharynx area, hypo- or atrophy of the olfactory epithelium, prolonged compression of the olfactory cavity by any tumor process , as well as toxic damage to it).

In most cases, the duration of peripheral anosmia is characterized by a decrease taste sensations in parallel with a deterioration in the sense of smell.

A decrease in the sense of smell of central origin, or cerebral anosmia, can occur with the following diseases:

• acute or chronic cerebrovascular accident of atherosclerotic or other nature;
• brain tumors in the anterior cranial fossa (meningioma, frontal lobe glioma);
• disseminated encephalomyelitis;
• traumatic brain injury of any severity;
• arachnoiditis;
• meningitis;
• inflammation of the ethmoid sinus -;
• Alzheimer's disease.

With cerebral anosmia, if the pathological process is localized in the area of ​​the cortical centers of smell, a person determines the presence of an odor, but cannot verify or determine its type.

Diagnosis of anosmia

To instrumentally confirm the patient’s complaints that he cannot smell, olfactometry is performed - measuring the acuity of smell with a special device - the Zwaardemaker olfactometer. The device is a hollow porous cylinder that contains an aromatic substance and into which a long glass tube with divisions is inserted. During the examination, this tube is gradually lowered into the cylinder - thus dosing the odorous substance entering the nose of the subject. The amount of immersion of the glass tube into the cylinder is expressed in centimeters according to the number of divisions immersed in the cylinder and is a unit of measurement of the acuity of smell - olfactia.

During the examination, a person first determines the appearance of some kind of odor - this value of olfactions is called the threshold of sensation. The tube continues to be lowered into the cylinder, and at a certain moment the subject learns what kind of aroma he is smelling - this is the threshold of recognition, which is always higher than the threshold of sensation that arises earlier. The recognition threshold directly depends on whether a person is familiar with the scent provided to him or not.

With anosmia, the very fact of the absence of smell is determined, but only in some cases can it be determined what its origin is - central or peripheral. As mentioned above, with the loss of the sense of smell of a cerebral nature, the patient can sense the presence of an odor without the possibility of recognizing it; therefore, olfactometry makes it possible to determine a normal or increased threshold of sensation, but the recognition threshold is either sharply increased or not determined at all.

An olfactometric test can also be carried out using all kinds of odors, which includes 40 items of tasks for the patient (for example, identify a specific odor from 4 provided). The reliability of this test is quite high - about 0.95, but it is sensitive to gender and age differences. In patients suffering from complete loss of smell, the test result will be from 7 to 19 out of 40 points.

If a lack of smell is detected in a patient, further research should be aimed at establishing the reasons that caused it. Highest value at the same time, it has a computed tomography of the brain, which makes it possible to detect organic changes in the area of ​​the frontal lobe and other pathology. If changes in the brain are detected, in order to clarify the diagnosis, further examination and determine treatment tactics, the patient is advised to consult a neurologist and/or neurosurgeon.

Treatment for loss of smell

Treatment methods for anosmia and the possibility of restoring the sense of smell are, in principle, determined in each specific case individually and directly depend on the type of disease that caused the pathology of smell.

If the cause of anosmia is viral or bacterial rhinitis or sinusitis, the patient is prescribed local and general antiviral or antibacterial therapy, plus local anti-inflammatory and systemic or local antiallergic agents (the latter help reduce swelling of the nasal mucosa).

In allergic rhinitis, restoration of the sense of smell is facilitated by the administration of antihistamines (antiallergic) drugs locally and/or systemically, and in case of a severe allergic reaction or in the absence of effect from antihistamines, even corticosteroid hormones are prescribed, which are known to have a powerful anti-inflammatory effect.

If polyps are detected in the nasal cavity, the only thing effective method treatment that will lead to the restoration of smell is surgical removal of tumors. The same applies to other tumor formations in the nose, but in the case of their malignant nature, radiation or chemotherapy will also be added to the operation (of course, restoration of the sense of smell in the latter case is absolutely not guaranteed, but still possible).

If the nasal septum is deviated, the olfactory function of the nose will be restored only after successful surgery to straighten it.

For central anosmia caused by a tumor process in the brain, treatment is usually combined - surgical removal of the tumor plus chemotherapy and/or radiation therapy. However, in some cases, at advanced stages of the disease, radical treatment is not advisable, and only symptomatic treatment is carried out - it is impossible to restore the sense of smell.

Some doctors suggest adding zinc preparations to the complex treatment of the cause of anosmia, since its deficiency leads to deterioration and distortion of the sense of smell, and vitamin A, the lack of which in the body causes degeneration of the epithelium of the mucous membranes, including the nose, as a result of which the sense of smell decreases.

At the end of the article, I would like to repeat once again: despite the fact that most of the causes of loss of smell are not life-threatening for the patient, he should not let the disease take its course or self-medicate at home. It is worth seeking help from a specialist as soon as possible to find out what disease caused the anosmia - in the case of such an unpleasant finding as a tumor of the nasal cavity or brain area, the chances of its successful treatment are early stage much more than in a neglected one.

The program “About the Most Important Thing” talks about the loss of smell:

The sense of smell is one of the most important human senses. With its help, one can distinguish various odors around. These can be aromas of flowers or not very pleasant aromas from the combustion of any materials.

The olfactory organs consist of several complex systems receptors, each of which is responsible for its own unique odors. If any of them loses its properties, everyone can suffer. Sometimes, surprisingly, the sense of smell can distort the information received. Such anomalies include parosmia.

Parosmia: what is it?

There may be several reasons for the disappearance or deterioration of the perception of surrounding odors. Yes, and disorders are also different. In some cases, the perception of smells completely stops working; in others, the result may be a distorted perception of air.

Violations are conventionally divided into two types:

• quality;
• quantitative.

The first type includes parosmia, cacosmia, dysosmia. Quantitative include hyperosmia, hyposmia and anosmia, the main difference between which is the qualitative perception of odors around.

ENT performs diagnostics

Parosmia is characterized by the perception of non-existent odors. A person perceives a smell that is not really there. Such deviations often occur, but after properly selected treatment, the sense of smell is normalized, and relapses are possible.

Symptoms

Emergence distorted perception appears like this:

• a person perceives a smell that is unusual for a given object, most often it is unpleasant;
• eating food distorts its smell and taste, the meal turns into real torture.

These symptoms may indicate the initial stage of a mental disorder, but there are a number of other reasons that provoke the disease.

Causes

Qualitative disturbances in the functioning of the olfactory organs can occur for various reasons:

1. Complication after various viral and infectious diseases nasal cavity and nasopharynx.
2. Tetracycline, chloramphenicol and other similar drugs taken uncontrolled over a long period.
3. Serious injuries to the epithelium of both mechanical and chemical origin. This includes head injuries, poisoning with drugs containing narcotic substances inhaled through the nose.
4. Air pollution at enterprises producing toxic substances and various poisons.
5. Neoplasms, tumors and metastases in the nasal cavity, which can change the structure of perception receptors.
6. Surgical interventions can temporarily distort the perception of odors or lead to temporary loss.
7. Various diseases associated with the endocrine system, hormonal imbalances.
8. Disorders and diseases of a psycho-neurological nature.

Reception large quantity drugs may cause a disturbance in the sense of smell

In addition, cases of parosmia have been reported in women during menopause.

Diagnosis

Parosmia is not difficult to identify. If you have several symptoms, you should definitely visit a specialist who can determine the cause of the deviation.

To do this, the patient is given a variety of substances to sniff and the reaction is observed. A deviation from the norm will quickly make itself felt; based on this, the doctor may suggest taking several tests to confirm.

Treatment

After confirming the presence of a malfunction in the functioning of the receptors, they begin to normalize the condition. To do this, it is necessary to eliminate the root cause, and here treatment depends on many factors.

1. If the root cause lies in the presence of inflammatory processes, you should first neutralize them with medicines or traditional medicine recipes.
2. Injuries and surgical interventions will require a different technique. Here you just need to wait for the restoration of normal receptor functions.
3. Oncological diseases will require additional treatment of the formations themselves.
4. You can get rid of symptoms due to hormonal disruptions of the endocrine system only by normalizing the background. The psyche also needs to be put in order.
5. If the cause is clogged air at the enterprise, then, most likely, it is better to change the place of work.

Sometimes parosmia does not go away for a long period, sometimes it can remain with a person forever. But it is better to prevent an anomaly than to eliminate it. To do this, walk more fresh air, eat right, strengthen your body.

Treatment for deterioration of smell depends on the cause that caused it.

Complete loss of smell is called anosmia, partial loss is called hyposmia, and changes in the perception of smells are called parosmia and dysosmia. One of the types of dysosmia is cacosmia, a feeling unpleasant odor, which occurs during acute sinusitis, treatment with tetracycline or streptomycin, restoration of the sense of smell after anosmia caused by influenza or traumatic brain injury. Parosmia, or olfactory hallucinations, occurs in schizophrenia and temporal lobe epilepsy.

Causes of deterioration of sense of smell

Deterioration of the sense of smell can occur with any disease in which the flow of air to the cribriform plate of the ethmoid bone is disrupted. This anosmia is called respiratory or transport anosmia. Thus, the sense of smell often deteriorates with nasal polyps and severe chronic sinusitis.

Unilateral anosmia usually goes unnoticed.

Anosmia in the absence of obstruction of the nasal passages can be caused by damage to the olfactory epithelium (receptor anosmia) or the central part of the olfactory analyzer (central anosmia). Common reasons complete loss of smell - respiratory viral infections and severe traumatic brain injuries, as well as poisoning with certain industrial poisons (for example, formaldehyde) and lead, vitamin A deficiency, smoking and radiation therapy.

Sometimes the cause of slowly increasing anosmia is meningioma of the anterior cranial fossa. Rare causes of anosmia - diabetes, hypothyroidism, Addison-Birmer disease, amphetamine use.

Partial loss of smell (hyposmia) that occurs during pregnancy disappears after childbirth.

Congenital and hereditary causes of anosmia include Turner syndrome, pseudohypoparathyroidism, and Kallmann syndrome. The sense of smell often weakens with age.

If no changes are detected during examination of the nose, the cause of anosmia can usually be determined based on anamnesis, x-ray and laboratory tests.

Treatment of impaired sense of smell

Anosmia that develops after respiratory viral infections goes away on its own. Recently, it has been proposed to prescribe oral zinc supplements for persistent anosmia, but their effectiveness has not been proven.

It is very important to advise the patient to install in the apartment fire alarm, do not overuse perfumes and colognes, take showers more often, use deodorants and pay attention to the expiration dates of food products.

Prof. D. Nobel

The sense of smell is the ability to distinguish odors from each other. Unlike men, women have a more acute sense of smell. It is especially aggravated during a hormonal surge in the body, for example, during pregnancy or ovulation. Impaired sense of smell occurs due to inflammatory processes in the nose and injuries to the mucous membrane. This pathology can be caused by vitamin deficiency, head injuries and intoxication of the body. Allergies and genetic mutations are common causes of loss of smell.

Types of pathology

Impaired sense of smell is pathological condition, in which access of any aromatic substances to the olfactory neuroepithelium is difficult, a special receptor zone is severely damaged, or the central olfactory tract is damaged.

Impaired sense of smell may be three types. Each of them has its own characteristics.

1. Transport. This type of disorder occurs due to severe swelling of the mucous membrane. This condition is typical for rhinitis, sinusitis, and various tumors in the nose. Viral and bacterial infections can cause swelling of the mucous membrane. Disturbances in the production of mucosal secretions can also lead to such a pathology. In this case, the cilia of the epithelium are literally immersed in a viscous secretion.
2. Sensory. This disorder occurs due to the destruction of the neuroepithelium by various pathogens. Pathology can occur when toxic substances are inhaled and radiation therapy is performed on areas adjacent to the head.
3. Neural. This type of disorder occurs with head injuries when the base of the front of the skull or the cribriform plate is damaged. Neurosurgery and head tumors can also lead to this.

In addition, a decrease in the sense of smell is differentiated by the ability to detect odors. Based on patient complaints or examination results, doctors identify the following disorders:

• Complete anosmia - in this case, the patient does not distinguish odors at all.
• Partial anosmia - the patient perceives some aromas.
• Partial hyposmia is reduced sensitivity to certain odors.
• Dysosmia - in this case, a person cannot normally identify odors. The sense of smell is perverted.
• Complete hyperosmia - the patient has a very developed sense of smell.
• Partial hyperosmia - in this case, special sensitivity is observed only to certain odors.

Only a doctor can determine the type of pathology in a particular case. For this purpose, a complete examination of the patient is carried out.

Impaired sense of smell cannot be called a serious symptom, but sometimes it indicates serious pathologies of the central nervous system.

Causes

A change in the sense of smell may be due to pathological disorders in the nasal cavity, as well as pathologies of the central nervous system. The sense of smell is impaired during colds, because the nose swells greatly and odors cannot reach special olfactory receptors. Since the perception of smell also affects the perception of taste, this explains the tastelessness of food during a cold. Sometimes the olfactory cells are damaged by viruses, so a person does not smell or taste for several days after complete recovery.

Sometimes the loss of smell lasts for months or becomes irreversible. Cells can be severely damaged by frequent viral infections or during radiation therapy.

The main causes of impaired sense of smell in people include the following pathologies and conditions:

• Taking medications that affect the ability to correctly perceive odors. These include amphetamines, zinc-based drugs, some hormones and nasal drops for long-term use.
• Respiratory and allergic diseases.
• Blockage of the nasal passages by polyps and other neoplasms.
• Deformation of the nasal septum.
• Endocrine disorders.
• Neurological diseases, including Alzheimer's disease.
• Lack of vitamins and nutrients in the body.
• Injuries to the skull and nose.
• Surgical intervention in the nasal cavity.
• Consequences of radiation therapy.

The most common cause of smell disorder is considered to be traumatic brain injury, which often happens in car accidents. In this case, the fibers of the special olfactory nerve, which comes from the center of smell, are torn in the area of ​​the ethmoid bone, which separates the nose and the cavity of the cranium.

Sometimes there are cases when a person is already born with an impaired sense of smell. This indicates congenital neurological pathologies or genetic predisposition.

Diagnostics

To test a person’s sense of smell, they resort to various products and substances with a strong odor. Can be used essential oils, some types of soap and aromatic spices such as cinnamon or cloves. In addition, they check how correctly the patient determines taste. For this you can use sugar, salt, lemon juice and aloe juice.

The doctor will carefully examine the nose and the surrounding area. To clarify the diagnosis, the following studies may be prescribed:

• CT scan.
• Magnetic resonance imaging.

In addition, the doctor carefully collects anamnesis. It is clarified for the patient when the disturbance in the sense of smell became noticeable and under what circumstances this occurred.

When diagnosing a pathology, the doctor must pay attention to whether the patient has oral diseases that are accompanied by a lack of saliva.

Treatment

Depending on the cause that caused this pathology, the doctor prescribes treatment. If the disorder is associated with taking certain medications, they should be discontinued. After suffering from a respiratory illness or flu, you should wait a couple of weeks. If during this time the odors are still not felt, then you need to consult a doctor.

In most cases, such disorders are reversible. To quickly restore your lost sense of smell, you must follow these recommendations:

To restore normal sense of smell, you need to quit smoking. It has already been proven that the disturbance in the perception of smells in heavy smokers is reversible; the restoration of the sense of smell occurs, albeit slowly, but surely.

It is worth understanding that it will not be possible to completely restore the sense of smell in older people. The sense of smell in 80-year-old people is half that of a 30-year-old.

What to pay attention to

If a person does not smell and taste food, then this is not a problem. What should be alarming is that a person often learns about impending danger by recognizing odors. If the perception of odors is persistently impaired, you must adhere to the following recommendations:

If a person cannot recognize odors after suffering a respiratory illness, then there is no need to worry about this; after a week everything will be restored without any treatment.

With respiratory diseases and flu, the sense of smell is almost always impaired. This is due to severe swelling of the mucous membrane and the inability of aromas to reach special receptors in the nose. This condition is reversible and does not require treatment. With head injuries, the impairment in odor recognition may be irreversible. Age-related changes in the nose cannot be corrected either.

Hyperosmia is a violation of the sense of smell, in which even weak, barely discernible ordinary person odors become pronounced and intense.

Increased sensitivity to aromas is a painful condition and often accompanies certain diseases. But first things first.

How does the human sense of smell work?

The olfactory analyzer, which consists of an olfactory epithelium consisting of several types of cells (olfactory, supporting and basal), is responsible for the perception and recognition of odors.

Olfactory cells are located in the mucous membrane of the nasal cavity and end on the surface with olfactory cilia, which capture odorous molecules.

Each such cell is “attached” to nerve fibers, which are united into bundles called axons.


It is through them that impulses are sent to the corresponding parts of the brain, which are instantly interpreted.

As a result of the analysis of the main characteristics of the aroma (intensity, quality, identity), its recognition and classification occurs (pleasant, unpleasant, disgusting).

Hyperosmia - what is it? Symptoms of the disease

Hyperosmia is a strong sensitivity to odors present in the environment. A patient who has a heightened sense of smell is able to perceive and recognize subtle aromas.

This condition can lead to headaches, severe migraines, dizziness, pain in the paranasal sinuses, depression and emotional instability, and mental disorders.


Hyperosmia imposes many restrictions, since an acute reaction to the odors present around will inevitably lead to irritability, nervousness and depression.

Attention

Hyperosmia can become a source of problems when a person, trying to find the cause of a painful condition, constantly asks the question: “I smell strongly, why?”

Despite the fact that it seems to an outsider that the problem is far-fetched, people suffering from a heightened sense of smell experience real physical pain and strive to get rid of the disease by any means.

Olfactory hallucinations are sometimes observed when the patient notes: “I smell something that doesn’t exist!” Any disturbances in olfactory function require immediate consultation with a specialist.

Increased sensitivity to odors: causes

The sense of smell is a kind of boundary that filters aromas coming from outside. And if for some reason a failure occurs at one of the stages, then olfactory dysfunction develops.

An increased sense of smell may be a consequence of:

inflammatory processes occurring in the nasal cavity. In this case, a respiratory type of smell disorder develops, in which the passage of air through the nasal passages becomes difficult. This pathology may be a complication of a recent acute respiratory viral infection, injury, tumor of the nose or brain;

the appearance of problems with the functionality of the olfactory analyzer. This is a neurosensory type of increased sensitivity to odors, which develops as a result of reasons not related to nasopharyngeal disease and pathological intracranial processes.

For example, an increased sense of smell can be caused by taking certain medications (amphetamines, thiazide drugs) over a long period of time. Avoiding the use of such medicines leads to complete restoration of olfactory function.
Source: website Hyperosmia is often the first symptom of any mental disorder personalities:

• depression;
• schizophrenia;
• neurasthenia;
• hysteria.

One of the chronic diseases can affect a person’s sensitivity to odors:

• hypothyroidism (diffuse toxic goiter);
• diabetes;
• hepatitis;
• Turner syndrome.

The sensitivity of the same person to different aromas varies throughout the day. There is a minimum threshold of perception at which a certain concentration of odorous molecules provokes adequate reaction olfactory analyzer.

In women, on the contrary, they are more often observed hormonal changes throughout life and they are more susceptible to hyperosmia.

It has been noticed that a child has a lower threshold of olfactory perception compared to an adult, so children react sharply to unpleasant aromas and more often show emotions in relation to smells.

Increased sense of smell during pregnancy

Increased sensitivity to odors during pregnancy is associated with changes in a woman's hormonal levels. In this case, irritation can be caused by both individual aromas (partial, selective hyperosmia) and absolutely all odorous substances (complete hyperosmia).

After the birth of a child, when the balance of hormones is normalized, acute sensitivity to odors disappears without a trace.

Increased sense of smell during menstruation

In completely healthy women, the reaction to odors changes within one menstrual cycle. This is due to natural hormonal changes.

Most often, women have a heightened sense of smell before menstruation or during ovulation (in the middle of the cycle). The acuity of smell also increases when taking oral contraceptives or undergoing hormonal therapy.

Treatment of heightened sense of smell (hyperosmia) with medications

Hyperosmia is very often one of the manifestations of a disease, so the main treatment is aimed at eliminating the root cause.

If the exacerbation of the sense of smell is caused by acute infectious or pathological processes in the nasopharynx, then therapy should be aimed at restoring the respiratory function of the nose and eliminating the source of inflammation.

Treatment of neurological problems with the help of effective pharmacological drugs that have a sedative and psychotropic effect on the patient’s body will eliminate hyperosmia.


To successfully cure the underlying disease and, accordingly, heightened sense of smell, it is necessary to constantly adjust the treatment regimen with a neurologist and psychiatrist.

Restoring the functionality of the thyroid gland will require taking medications to compensate for the deficiency of certain hormones.

In severe cases, surgery may be necessary. Restoring hormonal levels will also eliminate painful reactions to odors.

Severe hyperosmia with such unpleasant symptoms as severe headache, dizziness, migraine is an indication for endonasal novocaine blockade, which temporarily reduces the susceptibility of olfactory receptors to odors.

Treatment with folk remedies

Since diffuse toxic goiter is considered one of the main manifestations of hyperosmia, then ethnoscience offers the following recipe: place young willow leaves in a saucepan, pour cold water, boil until the liquid thickens a little and turns into a concentrated resin.

The willow mass should be lubricated on the goiter at night, and the method should be used as an auxiliary therapy.


For internal use, a mixture of 200 g of honey, chopped nuts and ground buckwheat is recommended. The resulting remedy is eaten within one day, and repeated on days 3 and 9.