Hyposmia

Hyposmia (with the Greek "hypo" - lowering, "Osme" - sense of smell) is a pathological condition that manifests itself in a decrease in the sense of smell. Statistics show that the greatest number of cases of smelling is observed among smokers, paint workers and the chemical industry.

Hyposmia can act in the role of an independent disease, or be the initial stage of anosmia - almost complete absence of smell.

[1], [2], [3], [4],

Causes of the hyposmia

The development of hyposmia occurs due to the pathology of the central or peripheral nervous system.

Hyposmia is both essential and receptor.

There are two mechanisms for the development of essential hyposmia:

1. damage to brain structures that are responsible for the sense of smell. These structures are located mainly in the temporal lobe of the brain.
2. damage to sensitive branches of the olfactory nerve.

Receptor hyposmia occurs due to disruption of the olfactory receptors located in the superior nasal concha. These receptors are on the surface, so they react quickly when exposed to odors from the environment. In case of damage to the mucous membrane of the nasal conchae, air can not fully contact the receptors.

Hyposmia can manifest itself as:

1. General hyposmia - a decrease in the perception of absolutely all smells.
2. Partial hyposmia is a decrease in sensitivity to only certain odors.
3. Parasymia - a lower perception of some smells and a distorted perception of others.

Hyposmia can be one-sided (defeat on one side) and bilateral (decreased sensitivity on both sides).

In rare cases, hyposmia is congenital. Most often, different types of hyposmia occur after a prolonged action of a certain factor.

1. Injuries of the brain, especially the temporal region.
2. The consequence of a surgical procedure on the facial part of the skull, for example surgery due to gaymorotomy.
3. Effects of tobacco smoke and chemicals.
4. Inflammation and swelling of the nasal mucosa of viral and bacterial etiology (rhinitis, sinusitis, complications of SARS and influenza).
5. Swelling of the mucous membrane against a background of prolonged use of nasal drops (reserpine, naphthyzine).
6. Neuritis of the olfactory nerve.
7. Polyposis of the maxillary sinuses and nasal concha.
8. Curvature of the nasal septum.

[5], [6], [7], [8], [9]

Risk factors

In the risk zone are people who abuse smoking, as well as passive smokers. Employees of paint and varnish factories, perfumeries and factories for the manufacture of household chemicals can eventually detect a receptor decrease in the sense of smell - essential hyposmia.

People who often suffer from respiratory diseases and allergies, observe the unstable decrease in the sense of smell, which is restored after recovery.

[10], [11], [12],

Pathogenesis

The mucous membrane of smokers undergoes drying under the influence of tobacco smoke, the cells of the olfactory epithelium are damaged and lose the ability to catch odors and record the temperature of the air.

Viral and bacterial infections on contact with the nasal mucosa cause an inflammatory process. The mucous membrane swells, increases in size, squeezes the receptors. That is why during the common cold and cold, we can not fully experience the whole range of environmental odors. A similar mechanism of occurrence of hyposmia is also observed in allergic rhinitis, only the trigger is not an infection, but an allergen.

In polyposis, pathological changes occur in the olfactory epithelium, which leads to insensitivity of the olfactory receptors. The inability to smell when there are no obvious causes can be one of the symptoms of the presence of polyps.

Trauma to the skull and severe concussion in some cases cause temporary or permanent hypersemia. The reason for such a violation is that the brain region responsible for the sense of smell can not accept and process the impulse coming from the receptors.

[13], [14], [15], [16], [17]

Symptoms of the hyposmia

Symptoms of hyposmia are often secondary, that is, more serious violations come to the fore.

The weakening of the sense of smell arises on the basis of other symptoms and diseases, such as the absence and relaxation of nasal breathing, runny nose, sinus inflammation and headaches in the region of the frontal bone.

Symptoms at the beginning of the disease do not have a vivid clinical picture, the first signs develop gradually. At first the patient does not feel faint smells and aromas, then the condition worsens. Usually, after the elimination of the underlying disease, the patient gradually regains his normal sense of smell.

In some cases, even after the elimination of aggressive factors, if they cause irreversible damage to the mucosa, a persistent decrease in smell persists.

The defeat of the olfactory nerve by a viral and bacterial infection leads to neuritis of the nasal nerve and inflammation of the nasal sinuses. The patient may feel symptoms of general malaise, pain in the face and severe headache.

[18], [19], [20], [21]

Complications and consequences

Absence of treatment leads to the development of a complete lack of smell - anosmia. Anosmia is much more difficult to treat and does not cure completely.

Hyposmia itself does not give any complications. Complications are caused by primary pathological conditions, such as rhinitis, sinusitis, sinusitis, which turn into chronic diseases and cause anosmia.

[22], [23]

Diagnostics of the hyposmia

Diagnosis and treatment of hyposmia is performed by an ENT doctor.

The doctor puts the diagnosis of "hyposmia" on the basis of patient complaints, anamnesis and special olfactory tests.

In the process of collecting anamnesis, you can establish the root cause of the disease. Be sure to ask about working and living conditions, the presence of injuries and injuries, previously transferred operations and the presence of other pathologies of the brain and blood vessels.

The next stage of the diagnosis allows you to determine the level of smell at the moment. To do this, an olfactometric test is performed using forty different odors and flavored microcapsules. Smells are selected in such a way that they are familiar to a person, for example, the smell of chocolate or onions. The maximum number of points per test is 40 units. Patients with anosmia receive an average of 7-15 points, as some flavors help to trap the trigeminal nerve. Patients with hypoxia gain from 20 to 30 points, the indicator depends on the degree of defeat of the sense of smell.

Biochemical and laboratory analyzes are not informative in goponmia, but provide information on the general state of the body.

[24], [25], [26], [27], [28]

Differential diagnosis

To establish the correct diagnosis, differential diagnosis is performed, which makes it possible to exclude the presence of other similar pathologies. The doctor carefully examines the condition of the ear canal and the airways. To exclude tumors in the anterior cranial fossa, latent cracks and fractures in this area, inflammation and oncology of nasal and paranasal sinuses conduct instrumental diagnostics. Most often, computer tomography is prescribed with increased contrast.

Treatment of the hyposmia

To cure hypomyia, it is necessary to eliminate the underlying cause of the disease.

For smokers, the only solution is to quit smoking. Within six months after cessation of smoking, there will be a significant improvement in smell. However, the feeling of smells after smoking is not subject to complete recovery.

Hyposmia of allergic etiology is successfully treated by removing the source of allergy (or isolation of the patient) with the appointment of antihistamines.

The loss of smell on the background of craniocerebral trauma can be treated with the help of correctors of cerebral circulation, restorative means or surgical intervention.

Hyposmia against the background of viral and bacterial infection is eliminated with the help of antiviral and antibacterial drugs. In parallel, symptomatic therapy aimed at eliminating nasal congestion and alleviating nasal breathing is performed. The use of vasoconstrictive drops for the nose can be effective for the first five days. Long-term use of vasoconstrictive drops causes mucosal edema and may enhance hyposemia.

The main drugs used for receptor hyposmia:

1. Pinosol is a natural remedy based on fir and pine oils. The drug is released in the form of nasal drops. Unlike other means, it does not become addictive and does not overdry the nasal mucosa. The drug has a bactericidal, anti-inflammatory and wound-healing effect. Adults and children are prescribed 1-2 drops in each nostril 4 times a day. Pinosol is well tolerated by patients and does not cause adverse reactions.
2. Milgamma. Improvement of the conductivity of the olfactory nerve is observed after treatment with vitamins of group B. The preparation includes vitamins B1, B6 and B12. Vitamin B1 improves neuromuscular transmission and impulse conduction from the receptor to the brain. Vitamin B6 takes part in the formation of special mediator substances, which regulate the work of the brain and contribute to the restoration of damaged structures. Vitamin B12 improves intracellular metabolism, affects digestibility and protein synthesis. The above components in the complex normalize the trophism of the nervous tissue and the conductivity of nerve impulses. The drug is released in the form of tablets and a solution for intramuscular injection. Intramuscularly inject 1 ampoule (2ml) 1 time per day in the evening or take 1-2 tablets once a day with meals. Contraindication to taking the drug is the individual intolerance of the components, acute heart failure, stomach ulcer and the presence of oncology.
3. Nasal Spray Dr. The tais with eucalyptus oil stimulates the olfactory cells of the nasal mucosa, enhances the sensitivity of the receptors, removes the inflammatory process and kills germs in the nasal cavity and nasopharynx. Adults and children over 6 years of age are prescribed 1-2 pressure in each nasal passage 3-5 times a day. The drug is well tolerated by patients. Possible side effects include allergy to the components of the drug, increased blood pressure, burning sensation in the nose.
4. Eucazoline is a vasoconstrictor. It is recommended to be used only as symptomatic therapy, and not for treatment. Eucazoline reduces the blood supply to the vessels of the nasal mucosa, thereby reducing its edema and facilitating breathing. Eucalyptus oil has a bactericidal effect and moisturizes the mucous membrane. The drug is released as a nasal spray. Adults and children over 12 years of age are prescribed 1 push in each nasal passage as needed. Contraindication to use is the age younger than 12 years, glaucoma and hyperthyroidism of the thyroid gland. Possible occurrence of adverse reactions in the form of increased symptoms of rhinitis, burning sensation and tingling.

Physiotherapeutic treatment is an important addition to drug therapy.

In ENT-practice, 3 main types of physiotherapy are widely used:

• Rinsing of the nose.

Nasal washing is performed in a hospital and at home. Most often, a weak saline solution is used for washing. For the preparation of the solution, both conventional and sea salt can be used. A quarter of a teaspoon of salt is poured into a 200 ml glass with warm water and stirred until completely dissolved. The solution is then taken into a medical pear or a 20 ml syringe. Head tilt over the sink, open your mouth and gently pour the solution first into one nasal concha, then into the other. This procedure cleans the nasal cavity well, improves the passage of air. Salt has a detrimental effect on pathogens.

The procedure is carried out 3-4 times a day.

• Tubus-quartz.

This procedure is carried out using ultraviolet radiation. Ultraviolet has bactericidal, wound healing and anti-inflammatory action. During treatment, symptoms and manifestations of allergic rhinitis disappear, the blood circulation of the vessels of the nose improves, and the sensitivity of nerve endings and olfactory epithelium is restored. In the Tubus-quartz apparatus, short UV rays are involved, which are the most effective. The optimal length is 255-257 nm, which contributes to the activation of the body's defenses. The duration and frequency of sessions is determined by the attending physician.

Contraindication to the procedure is the presence of oncology, hypersensitivity to UV rays and tuberculosis.

• Laser therapy.

Helium-neon laser radiation (wavelength 0.63 μm) is used. The laser beam is directed into the nasal cavity into the region of the olfactory zone. The procedure is carried out daily for 10 days. After a month, the course of treatment should be repeated. The procedure eliminates the mucosal edema and improves the functioning of the olfactory receptors.

Alternative treatment

• Treatment with honeycombs

Honey combs contain a large number of vitamins and biologically active substances. Honeycomb should be chewed 15-20 minutes 6 times a day an hour after eating. This method helps to improve nasal breathing, reduces inflammation of the nasal and paranasal sinuses. Substances contained in honeycombs, contribute to strengthening immunity.

• Treatment with aloe

A tablespoon of honey mixed with 1 tablespoon of melted butter. In this mixture add 1 teaspoon of eucalyptus oil and 3 tablespoons of aloe juice. All the ingredients are thoroughly mixed until a uniform mass is formed. Cotton swabs soaked in this mixture are poured into each nostril for 15-20 minutes 3 times a day. The mixture can be stored in the refrigerator.

• Treatment with the help of mummies (a special type of rock, sold at the pharmacy)

For treatment use 10% solution mummy. To prepare the solution, take 2 g of mummy and 1 tablespoon of peach oil. Drip 4 drops into each nostril 4-5 times a day.

[29], [30], [31], [32], [33], [34]

Herbal Treatment

For the treatment of hyposmia against rhinitis or sinusitis, decoction of marigold, St. John's wort, chamomile and sage is used.

1. A decoction of marigold is prepared in a water bath. To prepare 2-3 tablespoons (without a slide), marigolds are covered in an enameled container and filled with a glass of water. The grass is put on a water bath, boiled for 15 minutes under a closed lid, then the container is removed from the water bath and insisted until it cools completely. Calendula squeeze and drain, drink 3-4 times a day for 30-40 minutes before eating for a month.
2. Decoction of sage is also prepared in a water bath, only insist 5-7 minutes. Take 5 tablespoons 4 times a day an hour after eating. The course of treatment is 1 month.
3. For the preparation of a true St. John's wort, it is necessary to take a half-liter thermos. 2 tablespoons of St. John's wort to pour into a thermos and pour hot water (90-95 degrees). Insist about 8 hours. Next, the liquid must be filtered and drained into a separate container. Take half a cup 3-4 times a day for 2 weeks.
4. 1 tablespoon chamomile to fall asleep in a small enamel container and pour 200-300 ml of boiling water. Infuse 1 hour. A quarter of the glass should be diluted with warm water, add 1 teaspoon of honey and drink as tea.

Homeopathy

To improve nasal breathing, such homeopathic remedies are used:

1. Apis or "honeybee" is a homeopathic preparation made from bees. Assign for swelling of the mucous membrane, obstruction of nasal breathing, inflammation, runny nose and lachrymation. The granules are prepared with small dosages of the active substance. Contraindication to use is an allergy to bee products.
2. Arum Trifillyum or Aronic three-leaved.

Three-leaved fern is used during a strong swelling of the nasal mucosa, when the patient can breathe only with his mouth open. Also an indication for use is pain in the sinuses of the nose, tearing, sneezing and loss of strength. Apply granules with doses from 3 to 30, depending on the patient's condition. The drug is well tolerated by patients. Side effects occur with individual intolerance.

1. Ammonium carbonium is a preparation based on ammonium carbonate and ammonia. The drug is prescribed for rhinitis, sinusitis. Well proven for treatment and prevention of adenoids. For effective therapy, 5-6 dilutions are used. The drug is well tolerated by patients.
2. Kalium bichromicum is used in the common cold, when the patient is troubled by pain and burning sensation in the nose, abundant discharge from the nose, redness and flaking of the skin around the nose. Issue in the form of granules and rubbing liquids. For the preparation of granules 6 dilutions are used. The drug does not cause adverse reactions.

The dosage of drugs is selected by the attending physician. If symptoms of an allergy or overdose occur, stop taking the medication and tell your doctor.

Surgery

Operative intervention with hyposmia is indicated in those cases when the normal anatomical structure of the structures responsible for the sense of smell is violated.

Decreased sense of smell on the soil of curvature of the nasal septum can completely disappear after surgery on the nasal septum. Operations on the genyanthomia in chronic sinusitis will also help restore the sense of smell.
Surgery for the removal or cauterization of polyps in the nasal cavity, nasal and paranasal sinuses will significantly improve the sense of smell, but will not restore it completely due to traumatization of the olfactory epithelium.

Traumatic anosmia and hyposmia require surgical intervention when the integrity of the bones of the brain or facial skull is violated.

Prevention

Prevention of loss of smell consists in observance of all recommendations of the doctor. It is necessary to undergo a full course of treatment to exclude the possibility of recurrence or chronicization of the primary disease. After a complete cure, once every six months, it is necessary to undergo a course of physiotherapy (for example, tube-quartz). This will help strengthen the defenses of the body and minimize the likelihood of a relapse.

Do not forget about adherence to the regime of the day, a complete refusal to smoke and warm clothes in the cold season. It is important to avoid drafts and hypothermia.

[35], [36], [37], [38]

Forecast

The prognosis of the disease is favorable.

[39], [40], [41], [42]