Hyposmia

Hyposmia (from the Greek "hypo" - decrease, "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 olfactory impairment is observed among smokers, workers in paint and varnish factories and the chemical industry.

Hyposmia can act as an independent disease, or be the initial stage of anosmia – a virtually complete lack of sense of smell.

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Causes hyposmia

The development of hyposmia occurs as a result of pathology of the central or peripheral nervous system.

Hyposmia can be essential and receptor.

There are two mechanisms for the development of essential hyposmia:

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

Receptor hyposmia occurs due to a malfunction of the olfactory receptors located in the superior nasal concha. These receptors are located on the surface, so they react quickly when in contact with odors from the external environment. In the case of damage to the mucous membrane of the nasal concha, air cannot fully contact the receptors.

Hyposmia can manifest itself as:

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

Hyposmia can be unilateral (damage to one side) or bilateral (decreased sensitivity on both sides).

In rare cases, hyposmia is congenital. Most often, various types of hyposmia occur after prolonged exposure to a certain factor.

1. Brain injuries, especially in the temporal region.
2. A consequence of surgical intervention on the facial part of the skull, for example, surgery due to maxillary sinusotomy.
3. Exposure to tobacco smoke and chemicals.
4. Inflammation and swelling of the nasal mucosa of viral and bacterial etiology (rhinitis, sinusitis, complications of acute respiratory viral infections and influenza).
5. Edema of the mucous membrane due to long-term use of nasal drops (reserpine, naphthyzine).
6. Olfactory neuritis.
7. Polyposis of the maxillary sinuses and nasal turbinates.
8. Deviated nasal septum.

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Risk factors

People who abuse smoking and passive smokers are at risk. Workers in paint and varnish factories, perfume factories and household chemical factories may eventually experience a receptor reduction in the sense of smell – essential hyposmia.

People who often suffer from respiratory diseases and allergies experience a temporary decrease in their sense of smell, which is restored after recovery.

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Pathogenesis

The mucous membrane of smokers is dried out by tobacco smoke, the cells of the olfactory epithelium are damaged and they lose the ability to detect odors and register air temperature.

Viral and bacterial infections cause inflammation when in contact with the nasal mucosa. The mucous membrane swells, increases in size, and compresses the receptors. That is why we cannot fully sense the full range of odors in the environment during a cold or runny nose. A similar mechanism for the development of hyposmia is also observed in allergic rhinitis, only the trigger is not an infection, but an allergen.

With polyposis, pathological changes occur in the olfactory epithelium, which leads to insensitivity of the olfactory receptors. The inability to sense odors in the absence of obvious causes can be one of the symptoms of the presence of polyps.

Head injuries and severe concussions can sometimes cause temporary or permanent hyposmia. This occurs when the area of the brain responsible for smell is unable to receive and process the impulse coming from the receptors.

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Symptoms hyposmia

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

A loss of smell occurs due to other symptoms and diseases, such as lack or weakening of nasal breathing, runny nose, inflammation of the nasal sinuses and headaches in the frontal bone area.

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

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

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

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Complications and consequences

If left untreated, it can lead to a complete lack of smell – anosmia. Anosmia is much more difficult to treat and cannot be cured completely.

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

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Diagnostics hyposmia

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

The doctor makes a diagnosis of hyposmia based on the patient’s complaints, medical history and special olfactory tests.

During the anamnesis process, the underlying cause of the disease can be determined. They are sure to ask about working and living conditions, the presence of injuries and damage, previous surgeries, and the presence of other pathologies of the brain and blood vessels.

The next stage of diagnostics allows to determine the level of smell at the moment. For this purpose, an olfactometric test is carried out using forty different smells and flavored microcapsules. The smells are selected in such a way that they are familiar to the person, for example, the smell of chocolate or onion. The maximum number of points for the test is 40 units. Patients with anosmia receive an average of 7-15 points, since some aromas are detected by the trigeminal nerve. Patients with hyposmia score from 20 to 30 points, the indicator depends on the degree of olfactory damage.

Biochemical and laboratory tests are not informative in case of gopismia, but they provide information about the general condition of the body.

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Differential diagnosis

To establish a correct diagnosis, differential diagnostics are performed to exclude the presence of other similar pathologies. The doctor carefully examines the condition of the auditory canal and respiratory tract. To exclude a tumor in the anterior cranial fossa, hidden cracks and fractures in this area, inflammation and oncology of the nasal and paranasal sinuses, instrumental diagnostics are performed. Most often, computed tomography with contrast enhancement is prescribed.

Treatment hyposmia

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

For smokers, the only solution to the problem is to quit smoking. Within six months after quitting smoking, there will be a significant improvement in the sense of smell. However, the sense of smell after smoking is not fully restored.

Hyposmia of allergic etiology is successfully treated by eliminating the source of the allergy (or isolating the patient) with the administration of antihistamines.

Loss of smell due to traumatic brain injury can be treated with cerebral circulation correctors, general tonics, or surgical intervention.

Hyposmia due to viral and bacterial infections is eliminated with the help of antiviral and antibacterial drugs. In parallel, symptomatic therapy is carried out, aimed at eliminating nasal congestion and facilitating nasal breathing. The use of vasoconstrictor nasal drops can be effective during the first five days. Long-term use of vasoconstrictor drops causes mucosal edema and can increase hyposmia.

The main drugs used for receptor hyposmia are:

1. Pinosol is a natural remedy based on fir and pine oils. The drug is available in the form of nasal drops. Unlike other products, it is not addictive and does not dry out 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 side effects.
2. Milgamma. Improvement of olfactory nerve conductivity is observed after treatment with B vitamins. The drug includes vitamins B1, B6 and B12. Vitamin B1 improves neuromuscular transmission and impulse conduction from the receptor to the brain. Vitamin B6 is involved in the formation of special mediator substances that regulate the functioning of the brain and promote the restoration of damaged structures. Vitamin B12 improves intracellular metabolism, affects the digestibility and synthesis of protein. The above components in combination normalize the trophism of the nervous tissue and the conductivity of nerve impulses. The drug is available in the form of tablets and a solution for intramuscular injections. Intramuscularly administer 1 ampoule (2 ml) 1 time per day in the evening or take 1-2 tablets 1 time per day during meals. Contraindications to taking the drug are individual intolerance to the components, acute heart failure, stomach ulcer and the presence of oncology.
3. Dr. Theiss nasal spray with eucalyptus oil stimulates the olfactory cells of the nasal mucosa, increases the sensitivity of receptors, relieves inflammation and kills germs in the nasal cavity and nasopharynx. Adults and children over 6 years old are prescribed 1-2 presses in each nasal passage 3-5 times a day. The drug is well tolerated by patients. Possible side effects include allergies to the components of the drug, increased blood pressure, and a burning sensation in the nose.
4. Evkazolin is a vasoconstrictor. It is recommended to use only as a symptomatic therapy, and not for treatment. Evkazolin reduces the blood supply to the vessels of the nasal mucosa, thereby reducing its swelling and facilitating breathing. Eucalyptus oil has a bactericidal effect and moisturizes the mucosa. The drug is available as a nasal spray. Adults and children over 12 years of age are prescribed 1 press in each nasal passage as needed. Contraindications for use are age under 12 years, glaucoma and hyperthyroidism. Side effects may occur in the form of increased rhinitis symptoms, burning and tingling.

Physiotherapy treatment is an important complement to drug therapy.

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

• Nasal lavage.

Nasal lavage is performed in a hospital or at home. Most often, a weak saline solution is used for rinsing. To prepare the solution, you can use either regular or sea salt. Pour a quarter teaspoon of salt into a 200 ml glass of warm water and stir until completely dissolved. Then draw the solution into a medical bulb syringe or a 20 ml syringe. Tilt your head over the sink, open your mouth and carefully pour the solution first into one nasal concha, then into the other. This procedure cleans the nasal cavity well and improves air flow. Salt has a detrimental effect on pathogens.

The procedure is performed 3-4 times a day.

• Tube-quartz.

This procedure is performed using ultraviolet radiation. Ultraviolet has a bactericidal, wound-healing and anti-inflammatory effect. During treatment, the symptoms and manifestations of allergic rhinitis disappear, blood circulation in the nasal vessels improves, and the sensitivity of nerve endings and the olfactory epithelium is restored. The Tubus-quartz device uses short UV rays, which are the most effective. The optimal length is 255-257 nm, which helps activate the body's defenses. The duration and frequency of sessions is determined by the attending physician.

Contraindications to the use of the procedure are the presence of oncology, hypersensitivity to UV rays and tuberculosis.

• Laser therapy.

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

Folk remedies

• Treatment with honeycombs

Honeycombs contain a large number of vitamins and biologically active substances. Honeycombs should be chewed for 15-20 minutes 6 times a day an hour after eating. This method helps improve nasal breathing, reduces inflammation of the nasal and paranasal sinuses. The substances contained in honeycombs help strengthen the immune system.

• Treatment with aloe

Mix a tablespoon of honey with 1 tablespoon of melted butter. Add 1 teaspoon of eucalyptus oil and 3 tablespoons of aloe juice to this mixture. Mix all ingredients thoroughly until a homogeneous mass is formed. Cotton swabs soaked in this mixture are placed in each nostril for 15-20 minutes 3 times a day. The mixture can be stored in the refrigerator.

• Treatment with mumiyo (a special type of rock, sold in pharmacies)

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

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Herbal treatment

To treat hyposmia associated with rhinitis or sinusitis, use a decoction of calendula, St. John's wort, chamomile and sage.

1. Calendula decoction is prepared in a water bath. To prepare, 2-3 tablespoons (without a slide) of calendula are poured into an enamel container and filled with a glass of water. The herb is placed in a water bath, boiled for 15 minutes under a closed lid, then the container is removed from the water bath and infused until completely cooled. Squeeze and strain the calendula, drink 3-4 times a day 30-40 minutes before meals for a month.
2. Sage decoction is also prepared in a water bath, but it needs to be infused for 5-7 minutes. Take 5 tablespoons 4 times a day an hour after meals. The course of treatment is 1 month.
3. To prepare St. John's wort infusion, take a half-liter thermos. Pour 2 tablespoons of St. John's wort into the thermos and add hot water (90-95 degrees). Infuse for about 8 hours. Then strain the liquid and pour it into a separate container. Take half a glass 3-4 times a day for 2 weeks.
4. Pour 1 tablespoon of chamomile into a small enamel container and pour in 200-300 ml of boiling water. Leave for 1 hour. Dilute a quarter of a glass of infusion with warm water, add 1 teaspoon of honey and drink like tea.

Homeopathy

To improve nasal breathing, the following homeopathic remedies are used:

1. Apis or "honey bee" is a homeopathic medicine made from bees. It is prescribed for mucosal edema, difficulty in nasal breathing, inflammation, runny nose and lacrimation. Granules with small doses of the active substance are made. Contraindication for use is an allergy to bee products.
2. Arum Triphyllum or Aronia trifoliate.

Three-leaf fern is used during severe swelling of the nasal mucosa, when the patient can only breathe with an open mouth. Also, indications for use are pain in the sinuses, lacrimation, sneezing and loss of strength. Granules are used with doses from 3 to 30, depending on the patient's condition. The drug is well tolerated by patients. Side effects appear with individual intolerance.

1. Ammonium carbonicum is a preparation based on ammonium carbonate and ammonia. The preparation is prescribed for rhinitis, sinusitis. It has proven itself well for the treatment and prevention of adenoids. For effective therapy, 5-6 dilutions are used. The preparation is well tolerated by patients.
2. Kalium bichromicum is used for rhinitis, when the patient is bothered by pain and a burning sensation in the nose, profuse nasal discharge, redness and peeling of the skin around the nose. It is produced in the form of granules and liquids for rubbing. For the preparation of granules, 6 dilution is used. The drug does not cause side effects.

The dosage of the drugs is selected by the attending physician. If symptoms of allergy or overdose occur, you must stop taking the drug and inform your attending physician.

Surgical treatment

Surgical intervention for hyposmia is indicated in cases where the normal anatomical structure of the structures responsible for the sense of smell is disrupted.

A decrease in the sense of smell due to a deviated septum may completely disappear after surgery on the nasal septum. Surgeries for maxillary sinusotomy for chronic sinusitis will also help to return the sense of smell to normal.
Surgery to remove or cauterize polyps in the nasal cavity, nasal and paranasal sinuses will significantly improve the sense of smell, but will not restore it completely due to trauma to the olfactory epithelium.

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

Prevention

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

Don't forget about following a daily routine, giving up smoking completely, and wearing warm clothes in the cold season. It is important to avoid drafts and hypothermia.

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Forecast

The prognosis for the disease is favorable.

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