[Home accidents associated with anosmia]. / Accidents domestiques chez 57 patients ayant une perte sévère de l'odorat.

OBJECTIVE: To assess the risk of home accidents related to severe hyposmia. METHODS: A questionnaire, completed by 57 hyposmic patients and 49 control subjects with a normal sense of smell, asked about four specific types of olfactory-related home accidents: undetected fires, undetected gas leaks, consumption of spoiled food, and incidents of food burning. Level of olfactory function was determined by olfactory testing (Biolfa). RESULTS: Olfactory testing revealed that 60% of the patients were anosmic and 40% had severe hyposmia. They reported cooking-related accidents most often (63%), followed by eating spoiled food (51%), inability to detect a gas leak (47%) and inability to smell a fire (26%). All these accidents were significantly more frequent than in the control population (p<10(-4)). DISCUSSION AND CONCLUSION: This paper, the first in the European literature and the second in the international literature, shows that patients with severely impaired olfaction are more likely to experience related accidents than those with normal olfactory function.

Olfactory evaluation in children: application to the CHARGE syndrome.

OBJECTIVE: To find an efficient tool for testing olfactory function in children and use it to investigate a group of children with CHARGE (coloboma, congenital heart disease, choanal atresia, mental and growth retardation, genital anomalies, and ear malformations and hearing loss) syndrome. METHODS: We adapted for children an olfaction test that had just been validated in an adult French population and investigated a control group of 25 healthy children aged 6 to 13 years. We then tested the olfactory capacity of a group of 14 children with CHARGE syndrome, aged 6 to 18 years. A questionnaire was completed with the parents about their children's feeding difficulties and their ability to recognize odors in everyday life. We recorded and scored the histories of feeding behavior anomalies, the visual and auditory status, and current intellectual levels. MRI of the olfactory tracts and bulbs was analyzed for 9 of 14 children. RESULTS: We showed that healthy children have similar olfactory function to that of the adult control group, which was representative of the general population, without any difference for either gender or age. We also showed that all children with CHARGE syndrome had olfactory deficiency. Half of them were anosmic, and the others had olfactory residual function (hyposmic). We found no association between olfactory deficiency and feeding behavior, visual or auditory impairment, or intellectual level. Parental subjective evaluations were accurate for only half of the group. All of the MRIs showed anomalies of the olfactory tracts and bulbs varying from moderate hypoplasia to complete aplasia, without any relation between the radiologic and the functional results. CONCLUSIONS: Olfaction can be assessed in children, even the young and disabled. Our results support the proposition that rhinencephalon anomalies should be included as a major criterion for the diagnosis of CHARGE syndrome.

Distorted odorant perception: analysis of a series of 56 patients with parosmia.

OBJECTIVE: To characterize the self-reported olfactory and gustatory symptoms, olfactory function, and causes in parosmia. DESIGN: Assessment of olfactory symptoms and function in patients with a chief complaint of parosmia. SETTING: A university hospital clinic and research facility. PATIENTS: Fifty-six consecutive patients presented to the ORL Clinic, European Hospital Georges Pompidou, with a chief complaint of parosmia between October 2001 and November 2003. MAIN OUTCOME MEASURES: Subjective olfactory symptom analysis and olfactory function test results. RESULTS: The mean duration of parosmia was 63.0 months. Forty patients (71.4%) reported associated hyposmia and 16 (28.6%) reported anosmia. Olfactory testing revealed moderate to severe olfactory loss in all patients. Quantitative and qualitative alterations occurred simultaneously in 32 patients (57.1%); parosmia onset occurred within 3 months after quantitative dysosmia in 19 patients (33.9%) and after 3 months in 5 patients (8.9%). The sensation of parosmia was always unpleasant. The main odorant triggers eliciting parosmia are described. The mean severity of flavor dysfunction of the population, evaluated using a 10-cm visual analog scale, was 6.4. Thirty-one patients (55.4%) viewed their olfactory alteration as severely affecting their quality of life. The main clinical association of parosmia was upper respiratory tract infection, found in 42.8% of the patients. Others clinical associations are described. CONCLUSION: The series of patients with parosmia presented herein, the largest in the literature, permits a clinical description of this rare olfactory abnormality.

Screening of olfactory function using the Biolfa olfactory test: investigations in patients with dysosmia.

OBJECTIVE: To present a statistical evaluation of a new olfactory test, Biolfa. MATERIAL AND METHODS: The olfactory test was carried out in individuals with normal olfactory function (n=67; 31 males; mean age 27.4 years) and in patients with mild, moderate or severe hyposmia (n=155; 61 males; mean age 54.6 years). The main diagnoses of the hyposmic patients were upper respiratory tract infection (32%), nasal polyposis (24%), head trauma (8%), idiopathic (8%), old age (5%) and chronic rhinitis (5%). In the first part of the test, olfactory thresholds were measured for three different substances (eugenol, aldehyde C14 and phenyl ethyl alcohol). The second part comprised an odor identification test for determining olfactory function for a large panel of common odors of Southern European countries. RESULTS: Mean olfactory thresholds were determined for subjects with normal olfaction and hyposmic patients; there was a statistically significant relationship between olfactory thresholds and degree of olfaction (mild to moderate hyposmia versus severe hyposmia). For the odor identification test, a global score was determined to allow the differentiation of normosmic subjects from patients with mild, moderate or severe hyposmia. The principles of decision theory (i.e. analysis of the receiver operating characteristic curve) were applied to the problem of evaluating the ability of Biolfa to distinguish subnormal subjects from hyposmic subjects. CONCLUSION: This study provides a basis for the routine clinical use of Biolfa.

Olfactory cleft disease: an analysis of 13 cases.

OBJECTIVES: Olfactory cleft disease was defined as (1) an olfactory disability related with a clinical and/or radiologic abnormality of the olfactory cleft and (2) a pathologic process limited to or predominating in the olfactory cleft. The objectives of this study were to describe the clinical and radiologic findings of this entity and to report the effect of medical therapy on the sense of smell. STUDY DESIGN AND SETTING: Thirteen patients with the criteria of olfactory cleft disease were included in this retrospective study. All patients had bilateral olfactory cleft abnormalities. A complete ENT examination with endoscopic evaluation and a computed tomography scan were performed in all cases. An olfactory threshold test was available in 12 cases before and after medical therapy, which included oral and topically administered steroid therapy. RESULTS: Olfactory disability was the major symptom of olfactory cleft disease. Other symptoms of chronic rhinosinus dysfunction was present in 75% of cases. Three pathologic processes were identified in patients with olfactory cleft disease: malformative, inflammatory, and inflammatory associated with anatomical deformities of olfactory cleft boundaries. Medical therapy was effective in lowering olfactory thresholds in 25% of the cases. CONCLUSIONS AND SIGNIFICANCE: Olfactory cleft disease involves various pathophysiologic processes. Computed tomography scanning provides the most information for diagnosis. Indications of functional endoscopic surgery remain to be defined after failure of medical therapy.