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Anosmia: Verification and Etiologies

Physicians seldom ask their patients about their ability to smell and they rarely test this special sense. The relative infrequency of olfactory impairment is due to the fact that bilateral loss of function (anosmia) must occur before the patient is aware of the problem, which is in sharp contrast to dysfunction in the paired organs of vision and hearing. The patient views his loss of ability to smell as an annoyance and most generally complains that his food tastes flat, which emphasizes the fact that the savor and flavor of food is not only a gustatory but very much an olfactory experience. The patient is generally unaware that the anosmic state may be hazardous in that he lacks protection against potential dangers such as fire where the smoke is not detected, leaking gas from an appliance which is not appreciated, and spoiled or tainted food whose odor cannot be perceived. Furthermore, he is unaware that the cause of the anosmia may be life-threatening, such as a space-occupying lesion in the anterior fossa or parasellar area. Therefore, the anosmia should be confined and an attempt made to establish the etiology since the defect may be correctable and a prognosis established.