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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_4693_Библиотеки_им_академика_М_И_Перельмана
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fMRI functionalmagneticresonanceimaging
FPD filterpaperdisc
FPR formyl-peptidereceptors
GA gestationalage
GBC globosebasalcells
GCRP Gprotein–coupledreceptorprotein
GERD gastroesophagealrefluxdisease
GLN lossopharyngealnerve
GnRH gonadotrophinreleasinghormone
HLA humanlymphocyteantigens
IA isolatedanosmia
ICA independentcomponentanalysis
ICAM intercellularadhesionmolecule
IL-8 interleukin8
IMN intermediatenerveofWrisberg
IR idiopathicrhinitis
LBD Lewybodydisease
LN lingualbranchofthetrigeminalnerve
LOT lateralolfactorytract
MEG magnetoencephalography
MRI magneticresonanceimaging
MRT magneticresonancetomography
MS multiplesclerosis
MSA multiplesystematrophy
MSG monosodiumglutamate
MTST match-to-sampleodoridentificationtest
N1 firstmajornegativepeak(ineventrelatedpotentialtesting)
NMP negativemucosalpotential
NPD persistentnasopalatineduct
NTS solitarytractnucleus
NV/I branchIofthetrigeminalnerve
NV/II branchIIofthetrigeminalnerve
NV/III branchIIIofthetrigeminalnerve
OB olfactorybulb
OE olfactoryepithelium
OERP olfactoryevent-relatedpotential
OFC orbitofrontalcortex
OFO orbitofrontaloperculum
OMP olfactorymarkerprotein
OMP-ir OMP-immunoreactive
ON olfactorynerve
OR olfactoryreceptor
ORN olfactoryreceptorneuron
OS olfactorysulcus
OSN olfactorysensoryneuron
OT olfactorytract
P1 firstpositivepeak(inevent-relatedpotentialtesting)
PEA phenylethylalcohol
PET positronemissiontomography
PGA primarygustatorycortex
pirC piriformcortex
PKD1L3 polycystickidneydiseaseprotein1L3
PKD2L1 polycystickidneydiseaseprotein2L1
PrCO precentraloperculum
PROP 6-n-propylthiouracil
PSP progressivesupranuclearpalsy
PTA post-traumaticanosmia
PTC phenylthiocarbamide
RARS recurrentacuterhinosinusitis
rCBF regionalcerebralbloodflow
RF receptivefield
RSV respiratorysyncytialvirus
RTF rhinosinusitistaskforce
RUDS reactiveupperairwaysdysfunctionsyndrome
SA shortaxon
SCA spinocerebellarataxia
SCC solitarychemoreceptorcells
SCHGT SydneyChildren'sHospitalgustatorytest
SDOIT SanDiegoodoridentificationtest
SGP superficialgreaterpetrosalnerve
SIT specificimmunotherapy
SMT sniffmagnitudetest
SNOD sensorineuralolfactorydisorders
T1R tastereceptortype1
T2R tastereceptortype2
TDI Threshold,discrimination,andidentification
TIRM turboinversionrecoverymagnitude
TLE temporallobeepilepsy
TN trigeminalnerve
TRC tastereceptorcell
TRP transientreceptorpotential
TRPM5 transientreceptorpotentialproteinM5
TSE turbospinecho
UPSIT UniversityofPennsylvaniaSmellIdentificationTest
URTI upperrespiratorytractinfection
UTE ultra-shortechotime
VCD vocalcorddysfunction
VN vagalnerve
VND vomeronasalduct
VNO vomeronasalorgan
VNS vagalnervestimulatorparvocellularpartoftheventromedialposteriornucleus
TableofContents
1LossofSmellandTaste:EpidemiologyandImpactonQualityofLife
Introduction
EpidemiologyofSme llandTaste Loss
Age -relatedLossinSmellandTaste
ImpactofSmellandTasteLossonQualityofLife
ImpactofAmbientOdorantsonBe haviorandHealth
Acknowledgments
References
ISenseofSmell
2FunctionalAnatomyoftheOlfactorySystemI:FromtheNasalCavitytotheOlfactoryBulb
StructuralConsiderations
Neurophys iologicalConsiderations
Acknowledgments
References
3FunctionalAnatomyoftheOlfactorySystemII:CentralRelays,Pathways,andtheirFunction
Introduction
OutlineofOlfactoryPathways
CorticalOlfactoryAreasandtheirFunction
FunctionalCharacte risticsofOlfactoryProce s s ing
References
4TheHumanVomeronasalSystem
TheVomeronasalOrganisFunctionalinManyNonhumanVertebrates andhasDe finedComponents
AnatomyoftheVomeronasalSysteminHumans
EvidenceForandAgainstaFunctioningHumanVomeronasalOrgan
OutlookandPracticalAdviceforPhysicians
References
5SmellandTasteDisorders—DiagnosticandClinicalWork-Up
Introduction
ExaminationofthePatient
QuantificationofSme llDisorder
AdditionalWork-up
References
6AssessmentofOlfactionandGustation
WhyAss e s stheChemicalSenses?
TestsofOlfaction
AssessmentofTaste Function
InvestigationoftheIntranasalTrige minalSyste m
SummaryandOutlook
References
7SinonasalOlfactoryDisorders
IntroductionandEpide miolgy
AcuteViralRhinitis—AcuteBacterialRhinos inusitis
AllergicRhinitis
AtrophicRhinitis
ChronicRhinosinusitis
Case Study
References
8PostinfectiousandPost-traumaticOlfactoryDisorders
Etiology,Prevalence ,andPathophysiology
TypicalClinicalFindings
Treatment,PrognosisandCase Reports
Conclusion
References
9MiscellaneousCausesofOlfactoryDysfunction
Introduction
ToxicantsandIndus trialAgents
TherapeuticAgents
IdiopathicOlfactoryDisorder
EndocrineDisorders
Conge nitalOlfactoryDisorder
TumoralCaus e sofOlfactoryDisorder
ComplicationsofSurge ryandOlfactoryDysfunction
TheOlfactoryCleftSyndrome
Conclusions
References
10ChemosensoryFunctioninInfantsandChildren
Deve lopmentofChemos e nsoryFunctionality
Importance ofChemorece ptioninInfancyandChildhood
EvaluationofChemosensoryFunctionsinNewbornsandInfants
Me asurementofChemosensoryFunctionsinSchool-age Childre n
References
11NeurologicalDiseasesandOlfactoryDisorders
OlfactoryLossinNeurodegenerative Disorders
Non-neurodegenerativeDis orders
References
12ClinicalDisordersoftheTrigeminalSystem
Introduction
FunctionalNeuroanatomyoftheTrigeminalSyste m
Responsive ne s s toPhysicalandChemicalStimuli
ClinicalDisordersoftheTrigeminalSystem
Conclusion
Acknowledgments
References
IISenseofTaste
13FunctionalAnatomyoftheGustatorySystem:FromtheTastePapillatotheGustatoryCortex
GeneralAspe ctsofTaste Se nsation
Taste Rece ption
Periphe ralTasteNe rves
CentralPathways:Tas te RelayNucleusandRelatedStructure s
GustatoryCorticesinSubhumanPrimate s
GustatoryCorticesinHumans
References
14TasteTesting
GeneralRemarks onGustatoryTe s ting
PatientHis tory
Psychophys icalTasteTes ting
Objective Measurements
Case Re ports
References
15TasteDisorders
Introduction
TypicalClinicalFindings
Class ificationofTas te Disorders
Pathophysiology
EtiologyofTasteDisorders
Diagnosis
TherapyofTaste Disorders
Acknowledgments
References
16BurningMouthSyndromeandQualitativeTasteandSmellDisorders
BurningMouthSyndrome
QualitativeTas te Disorder:Dysgeusia
QualitativeSmellDis order:ParosmiaandPhantosmia
References
17StructuralImaginginChemosensoryDysfunction
ImagingTe chnique
OlfactoryImaging
TrigeminalImaging
GustatoryImaging
Conclusion
Acknowledgments
References
18ProvidingExpertOpiniononOlfactoryandGustatoryDisorders
Introduction
ProvidingExpertOpinion
ExpertOpinioninOlfactoryDisorders
ExpertOpinioninGustatoryDisorders
Case Studies
References
19Flavor:InteractionBetweentheChemicalSenses
Introduction
FlavorPerce ption
Conclusions
References
1LossofSmellandTaste:EpidemiologyandImpactonQualityof
Life
StevenNordin,HelyTuorila
Introduction
Fromanevolutionaryperspective,thechemicalsensesaretheoldestofoursenses,andthereforediffer
considerablywithregardstoroleandfunctionfromtheyoungersenses,suchasvisionandhearing.The
life-preserving role of the chemical senses requires smell and taste loss to be taken seriously by the
clinician.
The mostimportantrole ofthe humansense ofsmell is toguide ourattentiontowardhazards(e.g.,
poisonous fumesandspoiledfood)and toward itemsthatinageneralsensehavepositiveconnotations
(e.g., nutritious food). This guidance is primarily driven by the hedonic value (i.e., pleasantness or
unpleasantnessofanodorousitem[e.g.,food]),which,toalargeextent,isdeterminedbytheindividual's
personal history with that item. The relatively strong positive or negative emotions often evoked by
smellsarealsoshapedbypriorexperience,andbelievedtoenhancetheappropriatebehavioralresponse.
Apartfrombeinganimportantchemicalwarningsystemforsafetyissuesandforregulatingfoodintake,
the sense of smell is involved in social communication.
1
An infinite number of volatile chemical
compoundscanevokeasmellsensation,andasmellis,inmanycases,anintegratedsensationcausedby
acombinationofsuchcompounds.
The sense of taste functions as a gatekeeper of the internal milieu, acting to guide ingestive and
avoidancebehaviors.
2
Aswithsmell,hedonicvalueisanimportantperceptualdimensionoftaste,with
close ties to motivational behavior. Taste qualities provide information about the presence of useful
substances or dangers: carbohydrateenergysources insweetness,sodiuminsaltiness, and proteins in
umami (“meaty,” “brothy”) perception; and possible danger from acids and toxins in sour and bitter
perceptions,respectively.
The most common cause of a loss in smell or taste is aging, a natural condition applying to an
increasing number of people in the developed world. Typically, age-associated loss in the chemical
senses appears progressively after the age of60 years, andshows large individual variation,greatly
afflictingsomeandleavingothersintact.Pathologicallossesinsmell andtastearecausedbydisease,
trauma,working conditions, andlifestyle,andcanappear eitherabruptlyorprogressively. Congenital
lossesinsmellandtastearerare.
Acompletesmellortastelossiscalledanosmiaorageusia,respectively,whereasdiminishedsmell
andtastesensitivityiscalledhyposmiaandhypogeusia,respectively.Thetermsfunctionalanosmiaand
functionalageusiaarecommonlyusedinclinicalwork,referringtosomesensationsbeingevoked,butnot
sufficientlyforsmellandtastetobeusefulindailylife(seealsoChapter5DiagnosticandClinicalWork-
Up). Thesmell loss canbe temporary(e.g.,duringviral disease), causing some discomfortor loss of
appetite, but with no major disturbance. In contrast, long-term or permanent smell or taste loss is a
clinicallychallengingcondition.
Persons may also seek medical attention for hypersensitivity to ambient odorants, with a symptom
profilethatcanvaryconsiderablybetweenindividuals.Thosewhoconsiderthemselvestobesensitiveto
odors report higher annoyance from odors than those who perceive themselves to be less sensitive.
3
However, this hypersensitivity appears tobe predominantlycognitive inorigin,as persons with these
complaints typicallyhave normal smell detectionsensitivity.It hasbeendocumented that practitioners
requestmoreknowledgeandclinicalguidelinesforthemanagementofthisgroupsofpatients.
4
Theobjectiveofthischapteristoprovideareviewofwhatweknowtodayabouttheepidemiologyof
loss in smell andtaste, and its impact on qualityof life (QoL). As aging accounts for much of these
sensory losses, and as ear, nose, and throat (ENT) and related clinicians also meet patients with
hypersensitivitytoambientodorants,theseissueswillalsobereviewedbriefly.
EpidemiologyofSmellandTasteLoss
SmellLoss
The olfactory epithelium is directly exposed to potentially neurotoxic compounds in surrounding air,
makingthissensorysystemvulnerabletopathology.Furthermore,thesystemdependsononlyonecranial
nervetomediateinformationfromtheepitheliumtothebrain.
Smell loss is a common condition. Large-scale population-based studies withclinical examination
showaprevalenceofsmelllossof19%inSwedishadults(≥20years),
5
22%inGermanadults(25to75
years),
6
and 24%inUSadults(≥ 53years).
7
Theseprevalenceratespersemayleadoneastrayifnot
specifiedbyagefactor.Thetypicalincreaseinprevalencewithaging,andtheslightlyhigherprevalence
in men than in women is illustrated in Fig. 1.1. The prevalence of smell loss in the general adult
population,whenbasedon self-reports,hasbeenreportedtovarybetween9.5and15.3%.
7,8
Although
self-reportsofsmelllossunderestimateprevalenceratesobtainedbysmelltesting,
7,9
itcanbeassumed
thatitispredominantly theindividual's self-evaluation ofhisor hersenseofsmell thatwilldetermine
whetherheorshewillseekmedicalattention.Theunder-reportingofsmelllossislikelytoberelatedto
unawarenessofsmellloss,whichiscommoninoldage.
Regardingclinicalpopulations,areview
10
ofstudiesfocusingonconsecutivecasesatsmellandtaste
clinicsintheUnitedStates,EuropeandJapansuggeststhatthemostcommonetiologiesofsmelllossare
postviral upper respiratory tractinfection (URTI)(18 to45% oftheclinical population) andnasal or
sinusdisease(7to56%),followedbyheadtrauma(8to20%),exposuretotoxinsordrugs(2to6%),and
congenitalloss (0 to4%).Anotherstudyof ENTpatients inGermany, AustriaandSwitzerlandshows
similarresults.
11
Conversely,thepercentageofpatientswiththeseconditionswhohaveclinicallyproven
smelllossisratherhigh:76to95%inpostviralURTI,72to98%innasal/sinusdisease,86to94%in
head trauma, 67% inexposuretotoxins/drugs, and 100% incongenital cases.
10
Loss due to postviral
URTI,headtrauma,andexposuretotoxinsordrugsare,insomecases,spontaneouslyreversible,whereas
manycasesofnasalorsinusdiseasecanbetreatedwithmedicationorwithacombinationofmedicaland
surgicaltreatment.
Certainvolatilecompoundsareperceivedbysomeindividuals,butnotbyothers.Anexampleofsuch
a compound is androstenone, a hormonebased substance to which 20 to 40% of the population are
anosmic.
12
Suchspecificanosmiaemphasizestheindividualityoftheperceptualworld,butthistypeof
lossisnotlikelytohaveamajorconsequenceforQoL.
TasteLoss
Tastesensitivityisforseveralreasonsrobustcomparedwithsmellsensitivity.Notonlyaretherethree
types ofpapilla andthreecranialnervesoneachsideinvolvedinmediatingtaste,butthereisalsoso-
called taste constancy that contributes to the robustness. This constancy is believed to be based on
inhibitoryfeedbackloopsamongthecranialnerves,sothatdamagetoonetastenervereleasesinhibition
on others, resulting in intensification of sensations from other regions of the oral cavity. Despite this
robustness, tasteloss canresultfrom damageto any locationoftheneural gustatorypathway, from the
taste buds via the peripheral (facial, glossopharyngeal, and vagal nerve) and central nervous system
(brainstemandthalamus)tothecerebralcortex.
13
The inabilitytotastethebittercompoundsphenylthiocarbamideandn-propylthiouracilisgenetically
determinedandextensivelystudied,
14
but,ingeneral,thereisalackofpopulation-basedstudiesontaste
losswithclinicalexamination.However,inaGermanpopulationaged25to75years,20%recognized
threeorfewerofthefourtastants(sucrose,sodiumchloride,citricacid,andquininehydrochloride)when
presentedatsuprathresholdconcentrations.
6
Incontrast,only0.14%oftheUSadultpopulationindicated
alossintastefunction.
15
Thelargediscrepancyinprevalencebetweenthesetwostudies(20vs.0.14%)
may be attributable to a rather loose criterion for taste loss in the former study, and perhaps to
unawareness of loss inthe latter. A recent, largestudyexaminingover 700 individualsinSwitzerland
using psychophysical testing with two types of stimulus administration (taste spray and taste strips)
revealed a 5% prevalence of taste disorder. However, none of the participants showed complete
ageusia.
16
Naming a taste, even in a cued task (multiple choice options provided), easily leads to
confusion either between sour and bitter in both adults and children
17,18
or between sour, bitter, and
salty,
16
becausepersonsseldom receive trainingin chemosensorytasks.In any case,itis apparent that
furtherepidemiologicalstudiesoftastelossanditsconsequencesinthegeneralpopulationareneeded.
Tasteandchemestheticperception, together with retronasalodorperception,constitutewhatwecall
theflavoroffood.Owingtothisintegratedperceptionwherebyretronasalodorsarelocalizedintheoral
cavity,aconsiderableproportionofpatientsatENTclinicswhoseekmedicalattentionfortastelossdo
insteadshowsmellloss.ThisisillustratedbydatafromtheUniversityofPennsylvaniaSmellandTaste
Center,showingthat66%ofthepatientscomplainedoftasteloss,butonly5%ofthesehadameasured
taste loss. The most common etiology was head trauma (30%), followed by postviral URTI, toxic
exposure, medication induced,andidiopathic(13% foreachetiology).
19
Theliteraturesuggests a very
large variability in the proportion of patients with measured taste loss (between 1 and 30%),
19–22
probably because of thelack of consensus on appropriate clinical measures. Sparse documentation of
recoveryfromtastelossindicatescompleteorincompleterecoveryin5outof10cases.
22
Summary
Smell loss is common in the general adult population (19 to 24%), but with a rather low self-
awareness.Importantly,bothprevalenceandawarenessareassociatedwithincreasingage.Common
etiologiesofsmelllossamongpatientsatsmellandtasteclinicsincludepostviralURTI,nasal/sinus
disease,andheadtrauma.Acombinationoftoofewpopulation-basedstudiesandlargedifferences
in the criteria used to diagnose taste loss makes it difficult to provide a good estimate of the
prevalence of taste loss in the general population, althoughit has been reported at 5% in a non
population–basedstudy.
16
Commonetiologiesoftastelossamongpatientsatsmellandtasteclinics
areheadtrauma,postviralURTI,toxicexposure,anduseofmedication.
Age-relatedLossinSmellandTaste
SmellLoss
Apartfrom gross anatomical changesin the nasal cavity, aging is typically accompanied by structural
neurologicalabnormalitiesintheolfactoryepithelium,olfactorybulb,andcentralolfactorycortices.
23
As
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