Resume Propos Des troubles de l'odorat ont ete decrits dans de nombreuses pathologies generales. Cependant, il est exceptionnel de decouvrir ces pathologies a l'occasion du bilan etiologique d'une hyposmie. Neanmoins, il n'est pas rare, chez de tels patients, d'etre confronte a une analyse difficile de l'etiologie reelle du trouble de l'odorat devant la presence de nombreux facteurs associes interferant avec le systeme olfactif. L'objectif des auteurs est de realiser une revue de la litterature sur les troubles olfactifs observes dans les pathologies generales. Actualites et points forts Les affections hepatiques aigues ou chroniques s'accompagnent souvent d'une hyposmie amelioree par la prise de vitamine A. L'insuffisance renale semble susceptible de provoquer une hyposmie correlee au degre d'atteinte renale. Les troubles olfactifs semblent regresser apres transplantation et non apres dialyse. Le sida s'accompagne frequemment de troubles du gout et de l'odorat, surtout dans les formes neurologiques. Des troubles de l'odorat sont aussi observes dans l'hypothyroidie ou la pseudohypoparathyroidie. Des troubles du gout et de l'odorat ont ete decrits aussi bien chez des patients ayant une insuffisance surrenale que chez les patients ayant une maladie de Cushing. L'insuffisance surrenalienne provoque une hypersensibilite olfactive regressive apres traitement par glucocorticoide. Les pertes olfactives observees chez le diabetique pourraient etre associes aux manifestations macrovasculaires diabetiques et expliquees par des troubles ischemiques sur le neuroepithelium olfactif. Enfin, des troubles de l'odorat ont ete decrits dans de nombreuses maladies de systeme telles que la maladie de Horton et le syndrome de Gougerot-Sjogren. Perspectives et projets Penser plus souvent a depister un trouble olfactif chez un malade presentant une des pathologies precitees.

Troubles olfactifs et pathologie générale. Analyse et revue de la littérature

Olfactory loss is frequent. However, in public not many people complain of that, or they are even not (fully) aware of it. This indicates that it is possible to live a life without a sense of smell, albeit it is more dangerous, less pleasant, and food tastes much less interesting. Most common causes for smell loss are sinunasal disease (chronic rhinosinusitis with and without nasal polyps), acute infections of the upper airways, head trauma, and neurodegenerative disorders. In many people smell loss seems to be due to the aging process. Before treatment olfactory disorders are diagnosed according to cause with the medical history being a big portion of the diagnostic process. Olfactory disorders are in principle reversible, with a relatively high degree of spontaneous improvement in olfactory loss following infections of the upper respiratory tract. Medical treatment is according to cause. It also involves surgical approaches as well as conservative treatments including the use of corticosteroids, antibiotics, or smell training. Because today olfactory dysfunction seems to receive more attention than in previous years it can be expected that tomorrow we will have more specific and effective treatment options available.

/pdf/disrupted-odor-perception-2ja2jhsw9q.pdf

Disrupted Odor Perception

Olfactory dysfunction is a common clinical phenomenon observed in various liver diseases. Previous studies have shown a correlation between smell disorders and bilirubin levels in patients with hepatic diseases. Bilirubin is a well-known neurotoxin; however, its effect on neurons in the main olfactory bulb (MOB), the first relay in the olfactory system, has not been examined. We investigated the effect of bilirubin (>3 μM) on mitral cells (MCs), the principal output neurons of the MOB. Bilirubin increased the frequency of spontaneous firing and the frequency but not the amplitude of spontaneous excitatory postsynaptic currents (sEPSCs). TTX completely blocked sEPSCs in almost all of the cells tested. Bilirubin activity was partially blocked by N-methyl-D-aspartate (NMDA) and α-amino-3-hydroxy-5-methyl-4-isoxazolepro pionic acid (AMPA) receptor antagonists. Furthermore, we found that bilirubin increased the frequency of intrinsic firing independent of synaptic transmission in MCs. Our findings suggest that bilirubin enhances glutamatergic transmission and strengthens intrinsic firing independent of synaptic transmission, all of which cause hyperexcitability in MCs. Our findings provide the basis for further investigation into the mechanisms underlying olfactory dysfunction that are often observed in patients with severe liver disease.

The effect of bilirubin on the excitability of mitral cells in the olfactory bulb of the rat.

Disturbances of olfaction are a common occurrence in many neurological and neurosurgical patients and their correct diagnosis might be helpful in management and enhancement of quality of life. However, olfaction is seldom checked in most neurosurgical units and the “smell bottles” are often either absent or out of date. This chapter reviews systematically recent advances in our understanding of the anatomy, physiology (olfactory coding) and measurement of olfactory function in the human. The causes and symptoms of smell disorders, risk of damage to the olfactory system by various surgical procedures and, finally, the natural history of recovery and treatment of smell disorders, for example after trauma, are discussed.

/pdf/basic-and-clinical-aspects-of-olfaction-34qikbkf4h.pdf

Basic and Clinical Aspects of Olfaction

In olfacto-odorimetrical examinations of 32 patients with chronic liver diseases (18 female and 14 male patients at the age of 23 to 77 years) 13 patients with a disturbed olfactory function were found. With one exclusion these patients suffered from liver cirrhosis. On the basis of the anamnesis in 10 of these patients a causal connection between disturbance of smelling and liver disease could be assumed. Out of this group with chronic active hepatitis of 10 patients only 1 patient had a disturbed olfactory function. In 8 patients with disturbed olfactory function suffering from liver cirrhosis a comparison of the olfactometrical findings with activity of GOT and GPT in the serum and the serum bilirubin content showed a correlation between possibilitiy of smelling and serum bilirubin level. Possible causes of appearing olfactory disturbances are demonstrated in short.

Functional study on the sense of smell in patients with chronic liver disease

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Functional study on the sense of smell in patients with chronic liver disease