Health histories and medical evaluations of patients with complaints of chemosensory dysfunction

Key elements for understanding, assessing, and treating a patient with a complaint of chemosensory dysfunction include establishing a relevant medical history and performing a focused medical examination. This age-old medical approach combines the utilization of associated tests and the results of chemosensory testing to establish a diagnosis and plan for medical management. Chemosensory testing is critical to establish the degree of dysfunction, the veracity and accuracy of a patient's self-report, the efficacy of treatments, and the degree to which spontaneous recovery occurs. In common with most medical disorders, it is incumbent upon the physician to determine, as best as possible, the time of onset of the symptom, its severity, precipitating factors, comorbidities, and fluctuations over time to understand the underlying pathophysiology. Importantly, distinguishing between "taste" loss due to decreased flavor sensations secondary to olfactory system compromise and "taste" loss due to true taste bud-mediated sensory alterations is critical. Unfortunately, this distinction is often underappreciated by medical professionals and laypersons alike, resulting in needless referrals within the medical community, including those related to imaging and gastroenterological testing. This chapter outlines the basic elements of the medical history and assessment of patients with complaints of chemosensory dysfunction, including a discussion on how to detect malingering.