Parosmia and Dysgeusia after Intravenous Propofol?Based General Anesthesia: A Case Report

Various drugs, including anesthetic agents, can cause parosmia in the perioperative period. There are reported cases of patients with alterations of smell and taste due to local anesthetics, nerve damage, or as a side effect of general anesthesia. We present a case of a 58?year?old male who developed parosmia and dysgeusia in the postoperative period after radical nephrectomy and inferior vena cava thrombectomy. The anesthetics used were fentanyl and propofol for general anesthesia and ropivacaine for epidural analgesia. Clinical examination did not reveal any pathology

Characteristics of Smell Identification Test in Patients With Parkinson Disease

OBJECTIVES: Parkinson disease (PD) is frequently associated with olfactory disorder at early stage, which is caused by deposition of Lewy bodies emerging from the olfactory bulb to higher olfactory centers. Early detection of olfactory disorder in the patients with PD may lead to the early diagnosis and treatment for this refractory disease. METHODS: Visual analog scale (VAS), Jet Stream Olfactometry, and Japanese smell identification test, Open Essence (OE), were carried out on 39 patients with PD. Thirty-one patients with postviral olfactory disorder (PVOD), which was caused by the olfactory mucosal dysfunction, were also enrolled in this study as control. RESULTS: There were no significant differences in detection thresholds (2.2 vs. 1.4, P=0.13), recognition thresholds (3.9 vs. 3.5, P=0.39) and OE (4.8 vs. 4.2, P=0.47) between PVOD and PD, while VAS scores of PVOD and PD were significantly different (2.0 and 6.2, P<0.01). In OE, significant differences were observed in the accuracy rates of menthol (68% vs. 44%, P=0.04) and Indian ink (42% vs. 15%, P=0.01) between PVOD and PD. Of particular interest, patients with PVOD tended to select “no detectable,” while patients with PD tended to select wrong alternative other than “no smell detected.” CONCLUSION: Discrepancy between VAS and OE, and high selected rates of wrong alternative other than “undetectable” in OE might be significant signs of olfactory dysfunction associated with PD.

Work-related olfactory disorder: a case series and review

BACKGROUND: The olfactory bulb is anatomically exposed and thus can be directly damaged by external stimulation. This can occur as an occupational injury owing to contact with organic solvents or other causes. We present cases of eight patients who sustained occupation-related exposure to potentially toxic substances and later presented with signs and symptoms of anosmia. We examined the occupational and medical characteristics of the patients and evaluated their work-relatedness. CASE PRESENTATION: Case 1: A 50-year-old man performed high-frequency heat treatments for approximately 11 years. He experienced decreased senses for olfaction and taste during the later years culminating in the diagnosis of anosmia after 3 years (high work-relatedness). Case 2: A 54-year-old man whose work involved exposure to various organic solvents, such as spray painting and application of paint and thinners for approximately 4 years, was subsequently diagnosed with anosmia based on rhinorrhea, headache, and loss of olfaction (high work-relatedness). Case 3: A 44-year-old-man who performed spray painting for approximately 17 years developed anosmia (high work-relatedness). Case 4: A 44-year-old man was involved in ship engine cleaning once a month, for approximately 7 h per cleaning session; he was diagnosed with anosmia based on loss of olfaction (low work-relatedness). Case 5: A 41-year-old man worked in ship building block construction for approximately 13 years; anosmia diagnosis was based on loss of olfaction (low work-relatedness). Case 6: A 47-year-old woman performed product inspection and labeling at a plant manufacturing automobile parts; anosmia diagnosis was based on decreased olfaction and taste (low work-relatedness). Case 7: A 50-year-old woman performed epoxy coating in a plant manufacturing automobile parts; anosmia diagnosis was based on diminishing olfaction (low work-relatedness). Case 8: A 57-year-old woman performed cleaning of the area where mobile phone parts were manufactured; anosmia diagnosis was based on diminishing olfaction (low work-relatedness). CONCLUSION: The study results confirmed work-relatedness when the subject was young, and the duration of exposure was long without any other cause of anosmia. Regarding compensation for occupational diseases, work-relatedness can be recognized as a relative concept.

The influence of smoking on olfactory disorder in patients with Parkinson's disease / 临床神经病学杂志

Objective To explore the influence of smoking on olfactory disorder in Parkinson's disease (PD). Methods According to smoking or not, 167 PD patients ( PD group) and 100 normal controls ( normal control group) were divided into smoking subgroups and non-smoking subgroups.The olfactory identification threshold was tested by T&T olfactory assessment.Results Compared with normal control group, the scores of MMSE and montreal cognitive assessment in PD group were significantly decreased ( all P0.05 ) .The olfactory identification threshold in PD group was significantly higher than normal control group (t=6.785, P=0.000).Compared with PD smoking subgroup, the olfactory identification threshold in non-smoking subgroup was significantly higher (t=-3.000, P=0.003).The olfactory identification threshold in normal control smoking subgroup was significantly lower (t=0.784, P=0.435). The olfactory identification threshold of PD smokers had no correlation with smoking pack-years or duration ( r=-0.104, P=0.441;r=-0.156, P=0.246) .Conclusion Smoking may protect olfactory disorder in PD patients, and it has no correlation with smoking pack-years or duration.

A Case of Post-Traumatic Olfactory Disorder Presenting Negative Results of Schneider Test due to Trigeminal Nerve Injury / 대한이비인후과학회지

There has been a considerable increase in the number of patients with olfactory disorder due to head and facial injuries. Conventional olfactory function evaluation methods, such as T&T olfactometer, the Schneider test and the Alinamin test have been widely used in clinical practice. Among these, the Schneider test can determine whether the patient is a malingerer. A woman who sustained head and facial injuries visited our department with the chief complaint of anosmia. The patient underwent conventional olfactory function tests, including T&T olfactometer and the Schneider test. T&T olfactometer revealed olfactory loss, but the Schneider test did not. Thus, she was diagnosed with malingering. However, her diagnosis of olfactory disorder and concurrent trigeminal nerve injury was made definite during the follow-up period. We herein report a 30-year-old female patient with olfactory disorder who was misdiagnosed with olfactory malingering based on the negative result of the Schneider test. A brief review of the literature has been included.

Postviral Olfactory Disorder / 대한이비인후과학회지

Postviral olfactory disorder (PVOD) is a sensorineural olfactory loss following an upper respiratory tract infection (URTI) and there is a close temporal connection between PVOD and URTI. PVOD is more common in women over 50 years of age. A thorough otolaryngologic evaluation including history, physical examination, neurologic assessment, and olfactory function test is mandatory to diagnose PVOD. Spontaneous recovery might occur in some patients from 6 months to several years. Although many drugs have been tried to treat it, no effective medical treatment exists. Patients should be counseled regarding safety issue and quality of life issue.