Clinical assessment of patients with smell and taste disorders

Abstract

Clinical assessment of the patient who has smell and taste disorders requires understanding of the etiology of the olfactory and gustatory disorders. Available clinical tests of olfactory and gustatory systems allow detecting and measuring the degree of the sensory loss, but are unable to determine the cause and give neither prognostic information nor therapeutic guidance. With physical examination, however, clinical history can help to establish the diagnosis and guide the treatment if available. A clinician evaluating a patient who has smell and taste loss must understand that "taste" complaints usually are symptoms of an olfactory dysfunction. The distinction between true gustatory loss (bitter, sweet, salty, sour, or umami) and olfactory loss, the inability to perceive complex flavors of food, will help clarify the patient's diagnosis. Easy-to-administer tests are available for olfactory (eg, UPSIT) and gustatory testing (eg, spatial tests, taste sticks, tasting tablets). In rare circumstances, imaging studies (eg, MRI, CT) are indicated.

Fig. 1

Algorithm of evaluation of the patient who has olfactory loss. From Leopold DA. Physiology of olfaction. In: Cummings CW, Fredrikson JM, Harker LA, et al, editors. Otolaryngology Head and Neck Surgery, Third edition, Philadelphia: Elsevier/Mosby-Year Book; 1998; Vol. 2, Chapter 41, p. 70; with permission.

Fig. 2

(A,B) University of Pennsylvania Identification Test.

Fig. 2

(A,B) University of Pennsylvania Identification Test.

Fig. 3

(A,B) Spatial gustatory testing.

Fig. 3

(A,B) Spatial gustatory testing.