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Assessing the sense of smell.

British Journal of Hospital Medicine, March 2015, Vol 76, No 3 © 2 01 5 M A H ea lth ca re L td Assessment of the sense of smell is a frequently overlooked part of the clinical examination. The assessment is sometimes more complex than the examination of a ‘single’ cranial nerve and therefore not infrequently requires more than the simple question: ‘Do you have any problems with your sense of smell?’. There is almost always a degree of uncertainty among exam candidates about how to proceed when the patient replies ‘Yes’ to this question, both in terms of immediate examination and further investigations. This short article outlines a basic schema for examining the sense of smell and answering questions about further investigations which may be required. Owing to the subjective nature of smell perception the assessment involves a combination of both targeted history and clinical examination.