Clinical Evaluation and Symptoms of Chemosensory Impairment: One Thousand Consecutive Cases from the Nasal Dysfunction Clinic in San Diego

Abstract

Background The aim of this study was to measure olfactory impairment in patients with various etiologies using symptom ratings and psychophysical measures of olfactory function. Methods We performed a cross-sectional, population-based study at the Nasal Dysfunction Clinic of the University of California, San Diego (UCSD), Medical Center. One thousand consecutive patients presented to the UCSD Nasal Dysfunction Clinic for evaluation of chemosensory dysfunction. Olfactory impairment was assessed by odor threshold and odor identification and symptom scores were assessed by self-report. Results The degree of olfactory impairment was driven by diagnostic category, age, and gender. Postviral disturbance was more prevalent in women and among elderly people. Elderly people and patients under 20 years of age showed the highest incidence of head trauma. Overall, older patients had poorer thresholds. Men showed higher prevalence of olfactory loss secondary to inflammation and toxin exposure. Patients with inflammation scored better than patients with other diagnoses (i.e., congenital, head trauma, postviral, toxin exposure, and miscellaneous causes). Patients with congenital etiologies and head trauma had the poorest scores. Symptom ratings were significantly different depending on diagnostic category, age, and gender. Patients with inflammation rated the majority of symptoms as most bothersome. Patients with postviral diagnoses were most likely to report parosmias. Patients with head trauma rated taste and smell loss as significantly more severe than other patients. Conclusion Evaluation of 1000 patients at the UCSD Nasal Dysfunction Clinic in San Diego revealed differential olfactory impairment and differential symptom complaints based on diagnostic category, age, and gender.