Chapter 13: Olfactory disorders

Decreased sense of smell can lead to significant impairment of quality of life, including taste disturbance and loss of pleasure from eating with resulting changes in weight, and difficulty in avoiding health risks such as spoiled food or leaking natural gas. Recent epidemiological reports have shown that despite fairly low self-reported prevalence of these disorders in large population studies, when validated smell identification or threshold tests are used they reveal quite a high prevalence of hyposmia and anosmia in certain groups, especially the elderly. Several different pathophysiological processes, such as head trauma, aging, autoimmunity, and toxic exposures, can contribute to smell impairment, with distinct implications concerning prognosis and possible treatment. Otolaryngologists are most likely to see this symptom in patients with chronic rhinosinusitis, and this now appears to be caused more by the mucosal inflammation than by physical airway obstruction.