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Chronic inability to smell sexual dysfunction

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Smell and taste disorders can be challenging to diagnose because of the large number of potential etiologies. Patients are often unable to provide a clear history of symptoms, because they frequently cannot distinguish between difficulties with smell and taste. Standardized questionnaires may be helpful in diagnosis. Smell and taste dysfunction have been implicated in loss of appetite, unintended weight loss, malnutrition, and reduced quality of life.

Taste dysfunction may be complete or partial, and affect one or more aspects of taste sweetness, bitterness, sourness, saltiness, and umami [savory]. The most common causes of olfactory dysfunction include allergic rhinitis, chronic rhinosinusitis with or without sinonasal polypsand upper respiratory infection.

Other potential causes include head Introvert dating style, neurodegenerative diseases including Parkinson disease and cognitive impairmentsand medications. Examination of the nose, mouth, and oropharynx as well as neurologic examination focusing on "Chronic inability to smell sexual dysfunction" nerves I, VII, IX, and X is essential.

Kallmann syndrome (KS) is a...

Additional assessment such as cognitive testing, nasal endoscopy, computed tomography of the sinuses or nose, or brain magnetic resonance imaging may be indicated. Up to one-half of patients with olfactory dysfunction improve over time.

Improvement in olfactory function is inversely correlated with severity and duration of loss, age, smoking, and male sex. Smell and taste disorders have been implicated as Chronic inability to smell sexual dysfunction of loss of appetite, unintended weight loss, malnutrition, and reduced quality of life.

Taste is influenced by odor, flavor, texture, and temperature. Traditionally, taste has been categorized into sweetness, bitterness, sourness, saltiness, and umami also described as savory. Taste disorders such as ageusia, hypogeusia, and dysgeusia may involve one or more of these five basic tastes Table 1. Given the large number of etiologies, physicians should initially evaluate for the most common causes of smell loss: Chronic sinonasal disease may be treated with nasal steroids, surgery, or both to improve ability to smell.

For information about the SORT evidence rating system, go to https: Odorants entering the nose dissolve in nasal mucus that is produced, humidified, and warmed by the nasal turbinates and nasal mucosa.

Once absorbed through the nasal mucosa, dissolved odorants stimulate olfactory receptors in the neuroepithelium located over the cribriform plate. Smell is transmitted via the olfactory bulb and nerve to various regions of the olfactory cerebral cortex.

Precise smelling centers and related pathways continue to be elucidated. Smell disorders can occur at any stage in this process. Olfactory receptors in the nose regenerate throughout a person's life.

Additional features of smell include temperature, irritation, and sharpness, which are mediated by ophthalmic and maxillary divisions of the trigeminal nerve. In the mouth, taste odorants dissolve in saliva before encountering the taste buds on the tongue, soft palate, pharynx, larynx, Chronic inability to smell sexual dysfunction, and first one-third of the esophagus.

Gustatory receptors sense the five basic tastes. Taste on the anterior two-thirds of the tongue is innervated by the chorda tympani of the facial nerve. The glossopharyngeal nerve mediates taste from the posterior one-third of the tongue. The greater superficial petrosal nerve serves the palate, and the vagus nerve innervates taste from the pharynx and larynx.

The mediation of taste by multiple nerves may explain why gustatory loss is less common than olfactory loss. The trigeminal nerve mediates the temperature, stinging sensation, and degree of sharpness that refine Chronic inability to smell sexual dysfunction five basic tastes. Gustatory receptors also regenerate throughout a person's life, approximately every 10 days.

The deficits seem to relate...

Advancing age contributes to olfactory and gustatory loss. Women generally have better smell and taste than men of the same age. Smoking appears to have a small detrimental impact on smell. Patients are often unable to distinguish between disorders "Chronic inability to smell sexual dysfunction" smell and taste. Most patients who report taste loss are found to have a loss of smell instead.

Standardized questionnaires can help assess patients with concerns about taste loss or distortion. A study of a four-item questionnaire Table 2 reported effectiveness in detecting parosmia, with the first and fourth questions demonstrating the highest sensitivity and specificity.

The biggest problem is not that I do not or only weakly perceive odors, but that they smell different than they should. Evaluating the clinical usefulness of structured questions in parosmia assessment. When the response is negative for gustatory loss easilythe NPV is high and gustatory loss can be ruled out with a high degree of confidence. When the response to the question is positive, the result is less clear low positive predictive value: Information from reference 2.

For olfactory disorders and for most taste problemsthe history should include severity and persistence of symptoms. Patients should be asked Chronic inability to smell sexual dysfunction medical history of allergic rhinitis or chronic rhinosinusitis with or without nasal polypsas well as symptoms of nasal congestion, obstruction, or rhinorrhea.

This history correlates with ongoing symptomatic allergic rhinitis or chronic rhinosinusitis with or without nasal polyps as the cause of diminishing olfactory function; this may improve after treatment of these conditions.

Difficulties with memory or neurologic abnormalities may indicate mild cognitive impairment, Alzheimer disease, Parkinson disease, or parkinsonism.

A medication history can identify use of agents implicated in smell and taste disorders Table 4.

Upper respiratory infection especially viralallergic rhinitis, chronic rhinosinusitis, nasal polyps. Damage to cribriform plate, shearing forces, and intracranial damage; facial trauma. Parkinson disease, parkinsonism, Alzheimer disease, mild cognitive impairment, multiple sclerosis. Chemotherapy, angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, dihydropyridine calcium channel blockers, diuretics, intranasal zinc, antimicrobials macrolides, terbinafine [Lamisil], fluoroquinolones, protease inhibitors, griseofulvin, penicillins, tetracyclines, nitroimidazoles [metronidazole Flagyl ]antiarrhythmics, antithyroid agents, antidepressants, anticonvulsants, lipid-lowering agents.

Ammonia, hairdressing chemicals, gasoline, formaldehyde, paint solvents, welding agents, benzene, sulfuric acids, cadmium, acrylates, iron, lead, chromium. Renal or hepatic failure, complicated type 2 diabetes mellitus, cancer, human immunodeficiency virus.

Ischemic stroke, subarachnoid or intracranial hemorrhage, brain or sinonasal tumor. Malnutrition, pernicious anemia or vitamin B 12 deficiency, deficiencies in vitamins B 6 or A, niacin, zinc, or copper. Nasal surgery septal or sinustotal laryngectomy, pharyngectomy, tonsillectomy.

Anorexia nervosa not bulimiamajor depressive disorder, bipolar disorder, schizophrenia. Information from references 2 through 68 through 10and 12 through Given the high prevalence of sinonasal disease in olfactory disorders, anterior rhinoscopy should be done to evaluate for nasal polyposis, chronic sinusitis, allergic rhinitis, and other conditions.

Significant rhinitis, nasal polyps, or findings indicative of inflammation or infection correlate fairly well with sinonasal pathology affecting smell. Conversely, isolated moderate turbinate hypertrophy and septal deviation are of limited predictive value in determining a cause of smell loss. Examination of the oral cavity and oropharynx for salivary deficiency and for evidence Chronic inability to smell sexual dysfunction infection, inflammation, or other pathology of the oral mucosa, tongue, teeth, gums, and palate is also important.

Neurologic examination should include cranial nerve I olfactory by testing smell perception independently in each nostril. Because of their role in taste conduction, cranial nerves VII facialIX glossopharyngealand X vagus should also be tested in gustatory disorders. Cognitive assessment including memory testing and motor examination including observation for gait disorders, tremor, or bradykinesia are important in identifying the common neurodegenerative disorders that can cause or contribute to olfactory loss.

Any abnormal neurologic finding is significant. Nasal endoscopy and computed tomography CT of the sinuses and nose are highly diagnostic for sinonasal pathology. The remaining etiologies are usually evident on CT. Several abbreviated tests are available for taste and smell disorders, but all have limitations Table 5. For any olfactory problem: Information from references 5 and Decreased olfactory bulb size is found in patients who have chronic rhinosinusitis with nasal polyps, a finding associated with olfactory loss.

Smell improves and olfactory bulb size increases in the three months after endoscopic sinus surgery in patients who have nasal polyposis. Oral steroids may be helpful in diagnosis or for short-term symptom relief. Head trauma is a well-recognized cause of olfactory loss.

Trauma can cause loss of olfactory detection, such as damage to the olfactory nerve from cribriform plate fractures or closed head injury from nerve disruption or shearing forcesor difficulties in olfactory discrimination caused by closed head injury and cortical trauma. Although some patients have detectable cerebral damage on magnetic resonance imaging or CT in the olfactory bulb, cribriform plate, or olfactory areas of cerebral cortex, damage in other patients may only Chronic inability to smell sexual dysfunction evident as abnormal perfusion on single-photon emission CT.

Twelve weeks of olfactory training has been shown to increase olfactory sensitivity in one-third of patients who had olfactory loss secondary to posttraumatic, postinfectious, or idiopathic causes. This at-home technique involves twice-daily exposure to four odors phenylethyl alcohol, eucalyptus, citronellal, and eugenol.

Patients with mild cognitive impairment and Alzheimer disease may subjectively recognize smell and taste deficits as early symptoms. In these conditions, gustatory and olfactory testing indicates greater dysfunction than reported subjectively by patients. The loss of smell and taste in patients with mild cognitive impairment and Alzheimer Chronic inability to smell sexual dysfunction differs from that of age-matched controls, but not between the two conditions.

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