Toxin-induced chemosensory dysfunction: a case series and review.
BACKGROUND
Toxic chemical exposures are estimated to account for 1-5% of all olfactory disorders. Both olfactory neurons and taste buds are in direct contact with environmental agents because of their relatively unprotected anatomic locations, thereby making them susceptible to damage from acute and chronic toxic exposures. The aim of this study was to illustrate different aspects of the diagnostic and therapeutic approach to this disorder using a series of case reports and review of the literature.


METHODS
Cases were selected for inclusion based on a retrospective chart review of patients who presented to a university-based nasal dysfunction clinic with toxin-induced olfactory or gustatory dysfunction between January 1985 and December 2008. Workup included complete history, otolaryngologic examination, psychophysical testing, and imaging.


RESULTS
Patient ages ranged from 31 to 67 years (mean, 49.3 years). Etiology of chemosensory impairment included exposure to ammonia, isodecanes, hairdressing chemicals, chemotherapy, gasoline, and intranasal zinc. Five of the seven patients (71%) presented with olfactory dysfunction alone, one patient (14%) presented with dysgeusia alone, and one patient (14%) presented with both smell and taste loss. Only one patient (14%) reported parosmias. Tests of olfaction revealed normosmia in one patient (14%), mild-to-moderate hyposmia in one patient (14%), and severe hyposmia to anosmia in five patients (72%). Both patients who reported taste disorders had hypogeusia on testing.


CONCLUSIONS
This case series illustrates the wide spectrum of this disorder and provides a framework for the workup and treatment of these patients.
Smith
Wendy M
WM
Department of Surgery, Division of Otolaryngology-Head and Neck Surgery and Continuing Medical Education, University of California, San Diego School of Medicine, San Diego, California 92103, USA. wmsmith@ucsd.edu
Davidson
Terence M
TM
Murphy
Claire
C
D000328:Adult; D000368:Aged; D000818:Animals; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D005260:Female; D015386:Hazardous Substances / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008223:Lymphoma / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D000857:Olfaction Disorders / Q000139:chemically induced / Q000175:diagnosis* / Q000628:therapy; D010353:Patient Education as Topic; D013256:Steroids / Q000627:therapeutic use; D013651:Taste Disorders / Q000139:chemically induced / Q000175:diagnosis* / Q000628:therapy; D007507:Therapeutic Irrigation
D000970:Antineoplastic Agents; D015386:Hazardous Substances; D013256:Steroids