Impaired sense of smell can be a sign of the development of serious illnesses. The odorant kit is a diagnostic test that shows the importance of the perception of olfactory sensations.
Peculiarities
- This test makes it possible to determine the level of smell in a person: anosmia, hyposmia or normosmia. Based on several odors offered to choose from, the subject selects 1 of 4 options. When tested, the patient must give an answer even if he does not feel anything.
- If the testing indicators do not fully or partially correspond to the patient’s symptoms, then another examination must be prescribed.
- The test itself is carried out quickly, the entire study will take about 10 minutes. The patient should be tested on an empty stomach. It is forbidden to eat or drink drinks before the examination, only water fifteen minutes before the start of the procedure.
- The components used in the testing process do not harm humans at all.
- This test has the appropriate certificates and license.
Before start to the study, collect anamnesis, including information about provoking factors, accompanying symptoms, diseases, previous surgeries, medications taken and contacts with harmful substances. Then a nasal endoscopy is performed, examining the nasopharynx and the area of the olfactory fissure.
Olfactory function assessment is based on a standardized, valid sample. The following tests are widely used:
Olfactory stick test. The patient is allowed to smell 16 odors emitted by substances with which the tips of special sticks, arranged like a felt-tip pen, are impregnated, and is asked to name the smell. This test is widely used in Europe. It involves determining the olfactory threshold, identifying and discriminating odors. An identification test can be used for screening.
University of Pennsylvania Olfactory Identification Test (UPSIT). This test uses 40 odorants in microcapsules applied to a sheet of paper. When rubbed, the microcapsules emit an odor. The patient must identify given odors, each of which is offered with four alternatives. The Cross-Country Olfactory Identification Test (CCSIT) is a simplified version of the University of Pennsylvania test.
Connecticut Chemosensory Center Test clinical trials (CCCRC). This test is designed to determine the olfactory threshold for butanol inhalation and identify 10 different odors. Odorous substances are placed in polypropylene bottles that open when pressed on them. The disadvantage of this test is its low validity.
Olfactory evoked potential studies allows you to objectively assess the impairment of olfactory function. This is the only objective research method that can reliably confirm a loss. The study is carried out by applying a chemosensory stimulus through a tube inserted into the middle nasal meatus at intervals of 20-40 s. Stimulation lasts 250 ms. Phenylethyl alcohol or hydrogen sulfide is used as an odorant.
Ability recognize various odorous substances are important for carrying out differential diagnosis for neurological disorders.
By using research evoked olfactory potentials can be determined by 2 parameters:
1. The threshold at which the patient begins to perceive an odorous substance.
2. The threshold at which the patient recognizes an odorous substance.
Odor threshold below the recognition threshold. All of the tests mentioned above, except olfactory evoked potentials, require a high degree of cooperation from the patient, so the test results are largely subjective. Objective results are obtained only by studying olfactory evoked potentials.
Simulation test includes olfactory evoked potential testing and the cinnamon test. The olfactory nerve is involved in the perception of the taste of cinnamon. If the ability to smell is impaired, it is impossible to taste the taste of cinnamon.
Under anosmia understand the complete loss of the ability to smell; hyposmia means a decrease in this ability; Parosmia is a condition in which the subjective impression of the odor of a substance does not correspond to the nature of that substance. Cacosmia often indicates damage to the central nervous system.
P.S. Ideally before anyone surgical intervention A full olfactory examination should be performed in the nasal cavity or paranasal sinuses.
The olfactometry kit is a highly effective diagnostic tool for the human olfactory system. Few people think that smells largely determine our taste preferences, giving pleasure or causing disgust from food and drinks. Deviations in the functioning of the olfactory system entail a decrease protective functions body. A person ceases to identify spoiled foods, bad water, poisoned air, thereby increasing the risk of poisoning with toxic substances.
A set of odorants for olfactometry can be either disposable or reusable. The latter variety assumes the presence of a predominant amount of aromatic agents. Disposable rapid tests are designed for quick diagnostics (from 5 minutes), including self-diagnosis. They are easy to use and do not require special knowledge or conditions to obtain reliable results. Such products are in less demand in professional neurology than their reusable counterparts.
Features of the method
Any set of odorous substances for olfactometry, the express test is no exception, includes at least 10 different odors. The diagnostic method is based on the choice of one or another option, which, in the patient’s opinion, corresponds to the aromatic substance. In other words, a person, after sniffing the sample, must determine its smell. The result of such testing is to determine the degree of performance of the sense of smell, namely, the identification of deviations and their degree. Taking the test can give three diagnoses:
- normosmia. The level of the olfactory system is normal;
- hyposmia. Deviations of mild severity were identified;
- anosmia. Critical or complete lack of ability to perceive aromatic substances.
The MEDMART company offers a set for olfactometry to buy at an affordable price. The catalog contains different types products that meet the requirements of the modern medical materials market. We have disposable tests, kits for providing professional services, as well as products for self-diagnosis.
It is worth noting that each of them is suitable for studying different patients. The outcome table includes factors such as patient gender and age. The latter indicator suggests a natural deterioration in the sensitivity of the olfactory system, which is the norm. An olfactometry kit can be purchased as an integral part of the comprehensive equipment of a neurologist’s office. In this case, the MEDMART online store is ready to provide preferential conditions for cooperation, as well as free assistance in selecting equipment.
The Odor Set is a laboratory test consisting of 12 specific odors that clearly demonstrates the importance of concepts in the perception of olfactory sensations.
This rapid test is based on the individual's choice (5 minutes is enough for testing). It incorporates psychometric principles and contains smells that people are familiar with. Moreover, the presence of norms in the test makes it possible to standardize the determination of the level of olfactory function in a person. This test is especially useful for studies with limited time.
Scope of delivery
- a catalog with special stickers containing polymer capsules of 12 aromatic substances, the activation of which occurs under the influence of the included pencil.
- pencil
- a transparent table attached to the patient’s answers for quick calculation of test results
- table for determining the functions of smell for women and men based on test results
- instruction manual
Test Description
The senses of taste and smell control the body's absorption of all nutrients, as well as chemicals, essential for life and transmitted by air. The olfactory system, in particular, warns against the entry of various harmful substances into the body, for example, toxic gas, spoiled foods and others. hazardous substances from environment. The sense of smell, more than any other receptors, determines the taste qualities of food and drinks and provides a wide range of aesthetic pleasure from them.
The assessment of olfactory functions is a common problem in otolaryngology, neurology and other medical fields. For example, some patients report problems with deterioration of their sense of smell, although their odor perception is adequate. acceptable standards. Others are not even aware of the actual smell dysfunction (for example, 90% of people with Parkinson's disease have an obvious deficit in the ability to smell, but only 28% of them are aware of their problem before taking the test). Therefore, it is very important that the tester has valid and objective criteria for assessing patients' olfactory dysfunction before concluding that it does not exist.
The test criteria allow the person conducting the test to establish the degree of smell dysfunction in relation to the norm. Therefore, this test provides accurate information about the olfactory results of the tested people, necessary for comparison with people of the same gender, age, and with a level of olfactory function corresponding to the norm.
Olfactory test kit is certified and suitable for licensing
MINISTRY OF HEALTH OF THE USSR LVIV STATE MEDICAL INSTITUTE
DIAGNOSIS AND TREATMENT OF OLMMOR DISORDERS
LVIV - 1976
A N N O T A T I O N
IN presented methodological recommendations methods for studying the sense of smell that are available to a wide range of doctors are described, and the symptoms and diagnosis of olfactory disorders are outlined. Particular attention is paid to the issues of differential diagnosis of olfactory disorders, which are most often encountered in the practical work of an otorhinolaryngologist. Recommendations for treatment are given various forms disorders of the olfactory function.
(Lviv State Medical Institute)
Responsible for the preparation and publication of methodological recommendations is the Vice-Rector for scientific work Lviv Medical Institute prof. V. M. OMELCHENKO.
APPROVED BY THE BUREAU OF THE PRESIDIUM OF THE ACADEMIC COUNCIL
prot. No. 10
Problems of smell have remained out of sight for a long time, and only in recent decades has interest in them increased. This is due, first of all, to the intensive development of “big chemistry”, gasification, as well as an increase in the frequency of lesions of the olfactory analyzer due to infectious diseases (primarily influenza), allergic rhinosinusopathies, the use of ototoxic and, at the same time, as it turned out, olfactotoxic antibiotics .
EXAMINATION OF PATIENTS WITH OLfactory Impairment
Patients suffering from smell disorders may present various complaints. In some cases, qualitative changes in the sense of smell come to the fore: cacosmia (constant or periodic perception of unpleasant odors), parosmia (distorted perception of odors). Cacosmia can be subjective (the patient perceives odors that do not exist in the external environment) or objective (both the patient and those around him perceive bad smell, the source of which is in or near the respiratory tract).
In other patients, smell disturbances are quantitative in nature. They complain of a complete loss of smell - anosmia, or its decrease, dullness - hyposmia. Both anosmia and hyposmia can be total or complete in some cases, and partial or partial in others (related to some odors). In the latter case, you should find out which odors are perceived worse or are not perceived at all: “floral, pleasant, aromatic” - affecting mainly the sensitive endings of the olfactory nerve, or “sharp, pungent, kitchen” - for odors of mixed action, in perception which involve the trigeminal and glossopharyngeal nerves.
When examining the ENT organs, you should pay special attention to the condition of the olfactory fissure, in particular the entrance to it -
space between the middle turbinate and the nasal septum. If necessary, anemization of the nasal mucosa is performed. If you have the Friedel pediatric bronchoscopic set, examination of the olfactory area of the nose can be successfully carried out using the optical bronchoscopes included in the set. Optical rhinoscopy is preceded by thorough local anesthesia with a 2% dicaine solution with the addition of a 1: 1000 solution of adrenaline.
Qualitative research into olfaction carried out using a set of odorous substances of different receptor orientation. The approximate composition of the set is as follows:
1. Olfactory substances with olfactory action (acting mainly on the olfactory receptor):
2. Odoriferous substances of mixed action (also affecting auxiliary receptors):
a) odorous substances of olfactive-trigeminal action:
b) odorous substances with olfactive-glossopharyngeal action:
c) odorous substance with olfactory-trigeminal-glossopharyngeal action:
acetic acid, concentration over 20%.
Odorous substances should be placed in identical bottles with ground stoppers and labeled. 5 ml pycnometers are best suited for this purpose. 3 ml of an odorous substance is placed into each pycnometer, after which the vessels are placed in a tripod or box with partitions.
The research technique is as follows: covering the bottle with the palm of your hand (to exclude visual recognition and warm the vessel to body temperature), open the cap and bring the neck to the nostril of the subject. The opposite nostril is closed by pressing the wing of the nose against the septum. The patient is asked to answer whether he feels the smell, and if he does, then name
or describe it. The other half of the nose is examined in the same way. Odorous substances are offered at intervals of 20-30 seconds to avoid adaptation phenomena. The study begins with odorous substances of olfactory action, then moving on to odorous substances of mixed action.
Qualitative research aims to find out:
- Is there a disturbance in the perception of smells?
- which group of odorous substances is perceived worse or not perceived.
- whether there is a violation of odor recognition,
Which group of odorous substances is recognized worse or is not recognized.
Quantitative research of smell: can be performed using pulse olfactometers Elsberg-Levi Medvedovsky, Melnikova-Dainyak, Shevrygin, OKI-68 OKI-70 (our design), etc. However, since these olfactometers are still limitedly available to a wide range of practitioners, A modified method of “olfactometry without an olfactometer” is proposed for widespread use.
For this purpose, you should prepare a set of odorous substances of various dilutions (the concentration of the original substance is taken as one): simple tincture of valerian - 0.8; 0.4; 0.2 0.1; 0.05; 0.025; 0.0125; 0.0062 and acetic acid- 0.8; 0.4 0.2; 0.1; 0.05; 0.025; 0.0125; 0.0062; 0.0031; 0.0015; 0.0007. The starting material is initially diluted at the rate of 8 volumetric parts to 2 parts by volume distilled water. Subsequently, the resulting solution is diluted with distilled water by half, etc. As in the manufacture of a kit for qualitative research of smell, the resulting solutions can be conveniently poured into standard 5 ml pycnometers. Each pycnometer is supplied with a label, after which all vessels are installed on a tripod.
The technique does not differ from that of a qualitative study of smell. Odoriferous substances are offered in order of increasing concentration. The subject is asked to answer whether he feels the smell, and if he does, then name or characterize it. The dilution of an odorous substance at which the patient perceived the odor characterizes the odor perception threshold, and the dilution that allows the odor to be recognized or characterized is the odor recognition threshold. The study is carried out first with solutions of valerian tincture (an odorous substance with a predominantly olfactory effect), and then with solutions of acetic acid (an odorous substance with mixed effects).
The average thresholds of smell in healthy individuals are: for a simple tincture of valerian - the odor perception threshold is 0.0125, the odor recognition threshold is 0.025;
for acetic acid - odor threshold 0.025; odor recognition threshold 0.05.
Considering that the substances used for olfactometry, especially the valerian tincture of different releases, may differ somewhat in their odorous properties, it is advisable, by preparing solutions, to clarify the thresholds of perception and recognition of odors in a group of healthy individuals.
The conducted studies make it possible to judge the mechanism of occurrence of olfactory disorders, and, therefore, to choose the correct treatment tactics.
Below is developed by the Lviv Medical Institute clinical classification smell disorders (Table 1).
Table 1
CLASSIFICATION OF OLFFOR DISORDERS A. CONGENITAL OLMMOR DISORDERS
We divide all smell disorders into two main groups: congenital and acquired. While the former are very rare, the latter represent a large and diverse group.
Acquired smell disorders in turn, are divided into two large subgroups:
1. Impaired sense of smell caused by a violation of the conduction of odorous substances to the olfactory receptors - conductive disorders of the sense of smell.
2. Olfactory disorders associated with limited perception of odor stimuli - perceptual (neurosensory) disorders s t v a o b o n i n i i.
Conductive disorders of the sense of smell are most often the result of processes leading to restriction of air flow into the olfactory zone of the nose: deformations of the nose of the skeletal system and, above all, the nasal septum, atresia of the entrance to the nose and choanae, synechiae of the olfactory region of the nasal cavity, hypertrophic rhinitis, some forms of allergic rhinosinusopathy, foreign bodies of the nose, adenoids.
Much less often, the reason for limiting the contact of an odorous substance with the receptor cells of the neuroepithelium is the insufficiency of the secretion of the Bowman glands in hypotrophic rhinitis, ozena, and the dystrophic form of scleroma. However, in most cases of these diseases, both the olfactory neuroepithelium and other receptors of the nasal cavity and pharynx are early involved in the dystrophic process, so pure forms of olfactory disorders of this type occur only in some cases.
Based on this, conductive disorders of the sense of smell are
Olfactory disorders due to damage to the receptor apparatus - olfactory neuritis - observed in patients who have had influenza, with acute and chronic sinusitis, with intoxication with streptomycin and other antibiotics. Damage to the peripheral part of the olfactory analyzer can also occur with scleroma, nasal tumors, and tumors of the nasopharynx.
IN initial stage Olfactory neuritis, the disturbance of the sense of smell is rather qualitative in nature. It most often manifests itself as subjective cacosmia - symptoms of irritation of the olfactory nerve. Along with this, disturbances in the peripheral analysis of odors occur - partial hyposmia or even anosmia occur. These symptoms focal lesion neuroepithelium - focal neuroepithelitis - can often be detected only with a qualitative study using a large set of odorous substances. Hyposmia, determined in a quantitative study, is usually characterized by a uniform moderate increase in both the perception thresholds and the thresholds for recognizing odorous substances with a predominantly olfactory effect.
Much less often, for example, during acute intoxication, the disease can immediately begin with anosmia. We observed this onset of olfactory neuritis in patients with acute intoxication streptomycin, as well as in acute ethmoiditis, sphenoiditis, pansinuit.
Treatment of olfactory neuritis, begun at this stage, usually gives a good effect.
At further development olfactory neuritis, qualitative changes in the sense of smell gradually give way to quantitative ones. Cacosomies disappear. Olfactometry determines an increase in the thresholds for perception and recognition of olfactory odors, up to anosmia. Qualitative research allows us to identify a violation of recognition, and then the perception of everything more odorous substances, mainly with olfactory action, parosmia is observed.
Treatment started at this stage is less effective.
Smell disorders due to disruption of the conduction pathways. It is extremely rare to observe isolated lesions of the olfactory analyzer at this level, mainly in cases of traumatic brain injury. If the olfactory bulbs are completely torn off or bone fragments cross the olfactory tracts, anosmia should be expected, primarily in relation to odorous substances with an olfactory effect. Odorous substances of mixed action in high concentrations can be perceived and even recognized due to the trigeminal and glossopharyngeal components. When some nerve fibers are destroyed, partial anosmia may occur.
Olfactory disorders due to disruption of the central part of the olfactory analyzer. Central disorders of smell are manifested, first of all, by impaired recognition and verbal designation of odors. Some patients with central olfactory disorders indicate that they “do not understand” odors. This situation can be characterized as amnestic anosmia.
When studying a large set of odorous substances, it turns out that the violation of identification concerns equally odorous substances of different receptor orientation. In a quantitative study of the sense of smell, a significant gap is noted between the thresholds of perception and the thresholds for recognizing odorous substances of both olfactory and mixed action.
Defeat central departments olfactory analyzer can occur after traumatic brain injury, with neoplasms of the nose and nasopharynx growing into the cranial cavity, and also, quite often, with scleroma. They are most likely associated with dysfunction of the central parts of the nervous system in patients with scleroma.
Often there are perceptual disorders of smell, in which all parts of the olfactory analyzer are affected: from the receptors to the cortical centers. Their symptoms consist of symptoms of dysfunction of all parts of the olfactory analyzer,
Moreover, the predominance of certain signs depends on the predominant dysfunction of one or another part of the analyzer. In these cases the term should be used
“perceptual (neurosensory) hypo- or anosmia” without a more precise determination of the level of damage.
Olfaction disorders due to damage to auxiliary analyzers. Olfactory disorders can also occur when the receptors or nerves are damaged, and in some cases, the more central parts of the analyzers, which play an auxiliary role in the act of smell. (Predominantly impaired perception and recognitionolfactive-trigeminal-odors can be observed with tumors of the gasserian node, hypotrophic rhinitis, ozena, and the dystorific form of scleroma.
Olfactory disorders associated with damage to the V and IX pairs of cranial nerves can be established, for example, in patients after laryngectomy, in whom the mucous membrane, lining of the pharynx and root of the tongue were widely reserved, and the presence of a pharyngostomy required prolonged wearing of a nasoesophageal probe, which injured the mucous membrane along the Loss of the nose and pharynx.
The basic principles of differential diagnosis of acquired olfactory disorders are presented in Table. 2.
TREATMENT OF SMELL DISORDERS
Therapeutic measures for aerodynamic disorders of the sense of smell aim to restore the aerodynamics of the nasal cavity and, above all, its upper sections. At the same time, they should be gentle on the soft and supporting tissues of the nose. The need to leave the upper parts of the nasal septum intact makes the generally accepted Killian operation unsuitable for the treatment of deviated anterior-superior parts of the septum, which most often cause aerodynamic disorders of the sense of smell. The specified requirements are met: resection-reimplantation of the nasal septum, submucosal interventions on the nasal turbinates
etc. The operation of resection-reimplantation of the nasal septum has been used by us since 1961. Comparative analysis The results of operations on the nasal septum showed that after the mentioned operation such complications as dystrophic changes mucous membrane, nasal septum flotation
And its perforations, persistent violations smell and other meeting
occur 2-3 times less frequently than after Killian’s septum operation.
At the first stage, the operation of resection-reimplantation of the nasal septum is carried out as resection of the nasal septum along
The cartilage is excised and preserved in sterile saline until reimplantation. After complete elimination of deviations, spines and ridges, smooth plane-parallel plates are cut out from the removed sections of the cartilage, which are placed in a previously washed and dried mucoperiosteal pocket so that individual reimplants do not overlap each other. In cases where during surgery it is necessary to remove the upper anterior sections of the nasal septum, it is necessary to provide support for the back of the nose and its cartilaginous part. For this purpose, the reimplant is given an L-shape. When placing such a reimplantant in a mucoperiosteal pocket, you should strive to ensure that its short arm rests against alveolar ridge upper jaw, and the long one was fixed in the area of the back of the nose. Finally, a bilateral moderately tight nasal tamponade is performed.
In more complex cases, when the deformation involves the bone and cartilaginous elements of the external nose, a rhinoseptoortoplasty operation is performed, which consists of wide exposure and mobilization of all elements of the nasal skeleton with their subsequent fixation in correct position. In this case, access to the deviated nasal septum is carried out from the front, between the cartilages of the external nose. Reduced fragments of the nasal skeleton are fixed externally plaster cast, and from the side of the nasal cavity - bilateral anterior tamponade.
It should be emphasized that such serious and labor-intensive plastic interventions can be avoided if, immediately after the injury, complete reduction of fractures of the nasal skeleton is ensured. To avoid unnecessary haste, repositioning is best performed under short-term anesthesia with sembrevin (propanidide). When repositioning fragments of the nasal skeleton, you should pay special attention to restoring the normal lumen of the anterior-superior sections of the nasal cavity; to hold the fragments in the correct position, narrow strips of gauze moistened with sterile solution should be inserted into these sections. Vaseline oil. A plaster nasal splint fulfills its role only if it fits tightly to the prism of the external nose. Therefore, we suggest that after applying 10-12 layers of plaster gauze moistened with water, place two metal spatulas on the side edges of the bandage and squeeze them tightly with your hand until the plaster hardens. The bandage applied in this way tightly fixes the external nose for 3-4 days, preventing the displacement of fragments and the formation of hematomas.
If the cause of the violation of the aerodynamics of the nasal cavity is an increase in the volume of the soft tissues of the nasal turbinates, interventions aimed at reducing their volume are indicated.