Nose, Sinus, and Taste Disorders

Introduction

The upper part of the nose consists mostly of bone. The lower part of the nose gains its support from cartilage. Inside the nose is a hollow cavity (nasal cavity), which is divided into two passages by a thin sheet of cartilage and bone called the nasal septum. The bones of the face contain the paranasal sinuses, which are hollow cavities that open into the nasal cavity.

 

Because of its prominent position, the nose is especially vulnerable to injury, including fractures. Infections, nosebleeds, and polyps also can affect the nose. The mucous membrane of the nose may become inflamed (rhinitis). This inflammation may spread to the lining of the sinuses (rhinosinusitis).

Usually, the nasal septum is straight, lying about in the middle of the two nostrils. Occasionally, it may be bent (deviated) because of a birth defect or injury and positioned so that one nostril is much smaller than the other. Most people have some minor deviation of the septum so that one nostril is tighter than the other. A minor deviation usually causes no symptoms and requires no treatment. However, if severe, a deviation may block one side of the nose, making a person prone to inflammation of the sinuses (sinusitis), particularly if the deviated septum blocks drainage from a sinus into the nasal cavity. Also, a deviated septum may make a person prone to nosebleeds because of the drying effect of airflow over the deviation. Other symptoms may include facial pain, headaches, and noisy night breathing. A deviated septum that causes breathing problems can be surgically repaired.

  • Typically, a broken nose bleeds, hurts, and swells.
  • To diagnose a broken nose, a doctor looks at and feels the bridge of the nose.
  • Doctors sometimes need to push the broken pieces of bone back into place.

The bones of the nose are broken (fractured) more often than any other facial bone. When nasal bones break, the mucous membrane lining the nose usually tears, resulting in a nosebleed. Most commonly, the bridge of the nose is pushed to one side. Sometimes, the cartilage of the nasal septum can break. If blood collects under the mucous membrane that lines the cartilage of the nasal septum (septal hematoma), the cartilage may die. The dead cartilage may disintegrate, resulting in a saddle nose deformity, in which the bridge of the nose sags in the middle.

Diagnosis

 

A person whose nose bleeds, hurts, and is swollen and tender after a blunt injury may have a broken nose. Applying ice packs every 2 hours for 15 minutes at a time, taking pain relievers (such as acetaminophen or ibuprofen), and sleeping with the head elevated help limit pain and swelling; however, medical attention is needed.

 

The mucous membrane and other soft tissues swell quickly, making the break difficult for a doctor to find, so the evaluation needs to be done either very quickly (within the first few hours) or later after the swelling has started to subside but before the bones become fixed in their new position. Ordinarily, a doctor diagnoses a broken nose by gently feeling the bridge of the nose for irregularities in shape and alignment, unusual movement of bones, the rough sensation of broken bones moving against one another, and tenderness. X-rays of the nose may not be as accurate as the doctor's eyes and fingers for determining proper bone alignment.

 

Treatment

Doctors usually wait 3 to 5 days after an injury for the swelling to go down before they push the broken pieces of bone back into place (called reduction). Waiting makes it easier for doctors to see and feel when the pieces are perfectly aligned. Many nasal fractures are in a good position and do not have to be reduced.

 

First, doctors give adults a local anesthetic, which numbs the area. Children are given a general anesthetic, which causes temporary unconsciousness. Before reducing the fracture, any blood that has collected in the septum is drained through a small incision in the mucous membrane of the septum to prevent the destruction of the cartilage. By pressing with their fingers, doctors manipulate the bones into their normal position. The nose is then stabilized with an external splint. Internal packing (stenting) may also be used. Antibiotics are given while the packing is in place to decrease the risk of infection. Nasal bone fractures heal in about 6 weeks. Fractures of the septum are difficult to set and often require surgery later.

Nasal polyps are fleshy outgrowths of the mucous membrane of the nose.

  • Nasal polyps are more likely to develop in people who have allergies or asthma.
  • Some of the symptoms caused by polyps are nasal obstruction and congestion.
  • Doctors usually diagnose nasal polyps based on their characteristic appearance.
  • Corticosteroids can shrink or eliminate polyps, but sometimes polyps must be removed surgically.

Polyps are common teardrop-shaped growths that form around the openings to the sinus cavities. A mature polyp resembles a peeled, seedless grape. Unlike polyps in the colon or bladder, polyps in the nose are not tumors and do not suggest an increased risk of cancer. They are merely a reflection of inflammation, although there may be a family history of the problem. The doctor may perform a biopsy of the polyp to ensure that it is not a cancer.

 

Polyps may develop during infections and may disappear after the infection subsides, or they may begin slowly and persist. Many people are not aware that they have nasal polyps, although they may have sneezing, nasal congestion, obstruction, drainage of fluid down the throat (postnasal drip), facial pain, excessive discharge from the nose, loss of smell (anosmia), reduced ability to smell (hyposmia), itching around the eyes, and chronic infections.

 

People with nasal polyps may be seriously allergic to aspirin and other nonsteroidal anti-inflammatory drugs. People with nasal polyps can develop sinus infections if the polyps block drainage from the sinuses. Many develop asthma as well. Nasal polyps also can form if a foreign body is in the nose.

 

Corticosteroids in the form of nasal sprays or oral tablets may shrink or eliminate polyps. Endoscopic surgery or oral corticosteroids are needed if polyps block the airways or cause frequent sinus infections. Polyps tend to grow back unless the underlying irritation, allergy, or infection is controlled. Using an aerosol corticosteroid spray may slow or prevent recurrences. However, a doctor may need to examine the person periodically with nasal endoscopy (looking in the nose with a small rigid or flexible viewing tube) to evaluate and treat persistent or recurring problems.

Nasal vestibulitis is infection of the area just inside the opening of each nostril (the nasal vestibule).

 

Minor infections at the opening of the nose may result in pimples at the base of nasal hairs (folliculitis) and sometimes crusts around the nostrils. The cause is usually the bacteria Staphylococcus. The infection may result from nose picking or excessive nose blowing and causes annoying crusts and bleeding when the crusts slough off. Bacitracin ointment or mupirocin ointment usually cures these infections.

 

More serious infections result in boils (furuncles) in the nasal vestibule. Boils may develop into a spreading infection under the skin (cellulitis) at the tip of the nose. A doctor becomes concerned about infections in this part of the face because veins lead from there to the brain. A life-threatening condition called cavernous sinus thrombosis can develop if the bacteria spread to the brain through these veins.

 

A person with nasal vestibulitis usually takes an antibiotic by mouth and applies moist hot cloths 3 times a day for about 15 to 20 minutes at a time. A doctor may need to surgically drain large boils or those that do not respond to antibiotic therapy.

  • Nose picking and injuries are the most common causes of nosebleeds.
  • People typically bleed from the front part of the nose.
  • Avoiding nose picking, humidifying the air during the winter, and, for some people, moistening the front of the nasal septum with petroleum jelly are ways to prevent nosebleeds.
  • If pinching the sides of the nose together does not stop the bleeding, people should seek medical attention.

Nosebleeds (epistaxis) have a variety of causes, the most common of which are nose picking and injury. The cold, dry air of winter also makes nosebleeds more likely. People who take aspirin or other drugs that interfere with the blood's ability to clot (anticoagulants) commonly develop nosebleeds. Some people get them rather often, and others rarely get them.

 

Bleeding usually comes from the front part of the nasal septum, which contains many blood vessels. There may be just a trickle of blood or a strong stream. Most nosebleeds are more frightening than serious. However, bleeding from the back part of the nose (posterior nosebleed, an uncommon occurrence) is more dangerous and difficult to treat.

 

Prevention and Treatment

Important steps to prevent nosebleeds include avoiding picking the nose, humidifying the air during the winter, and, for some people, moistening the front of the nasal septum with saline gel or petroleum jelly.

 

Bleeding usually can be controlled at home by pinching the sides of the nose together for 10 minutes. It is important to hold the nose with a firm pinch and not let go even once during the 10 minutes. Other home techniques, such as ice packs to the nose, wads of tissue paper in the nostrils, and placing the head in various positions, are not effective.

 

If the pinch technique does not stop the bleeding, the person should see a doctor. The doctor packs the bleeding nostril with a piece of cotton saturated with a drug that causes blood vessels in the nose to narrow (constrict), such as phenylephrine. A local anesthetic, such as lidocaine, numbs the nose so the doctor can look in the nose and find the bleeding site. For minor bleeds, often nothing more is done. For more severe or recurring bleeding, sometimes the doctor seals (cauterizes) the bleeding source with a chemical (silver nitrate) or electrocautery (cauterization using an electrical current to produce heat). Another treatment is to place a long absorbent sponge in the nostril. The sponge swells in contact with moisture and compresses the bleeding site. The sponge is removed after 2 to 4 days. Rarely, the doctor may need to pack the entire nasal cavity on one side with a long strip of gauze. Nasal packing is usually removed after 3 days.

 

In some people, particularly those who are older and have narrowing of the arteries (arteriosclerosis), the bleeding source is sometimes further back in the nose (posterior nosebleed). Bleeding in this area is very difficult to stop and can be life threatening. For a posterior nosebleed, the pinch technique does not stop the bleeding, which then runs down the throat instead of out the nose. For a posterior nosebleed, doctors may place a specially shaped balloon in the nose and inflate it to compress the bleeding site. However, this and other types of nasal packing are very uncomfortable and interfere with the person's breathing. Doctors usually give people sedatives by vein before placing this kind of balloon and packing. Also, people who have had this type of packing are admitted to the hospital and given oxygen and antibiotics to prevent an infection of the sinuses. Because of the discomfort and breathing risks associated with nasal packing, doctors sometimes cauterize or clip the bleeding vessel while looking in the nose through a small visualizing device (endoscope). Occasionally, doctors, guided by x-ray techniques, can pass a small catheter through the person's blood vessels to the bleeding site and inject material to block the bleeding vessel.

Ulcers and holes (perforations) in the nasal septum may occur as a result of nasal surgery; repeated injury such as that resulting from picking the nose; cosmetic piercing; exposure to toxins (such as acids, chromium, phosphorus, and copper vapor); chronic nasal spray use (including corticosteroids and over-the-counter phenylephrine or oxymetazoline; oxygen inhaled through the nose; or diseases such as tuberculosis, leprosy, Wegener's granulomatosis, and syphilis. Frequent use of cocaine snorted through the nose causes ulcerations and perforations because it decreases blood flow.

 

Symptoms may include crusting around the nostrils and repeated nosebleeds. People who have small perforations in the septum may make a whistling sound when they breathe.

 

Bacitracin ointment or mupirocin ointment reduces the crusting, as may saline nasal spray. Doctors can sometimes surgically repair perforations using a person's own tissue from another part of the nose or with an artificial membrane made of a soft, pliable plastic. Most perforations do not need to be repaired unless bleeding or crusting is a major problem.

Rhinitis is inflammation and swelling of the mucous membrane of the nose, characterized by a runny nose and stuffiness and usually caused by the common cold or an allergy.

  • Colds and allergies are the most common causes of rhinitis.
  • Symptoms of rhinitis include a runny nose, sneezing, and stuffiness.
  • Typically, the diagnosis is based on the symptoms.
  • The various forms of rhinitis are treated in various ways, such as with antibiotics, antihistamines, surgery, allergy shots, and avoidance of irritants.

The nose is the most commonly infected part of the upper airways. Rhinitis may be acute (short-lived) or chronic (long-standing). Acute rhinitis commonly results from viral infections but may also be a result of allergies or other causes. Chronic rhinitis usually occurs with chronic sinusitis (chronic rhinosinusitis).

 

Acute Viral Rhinitis: Acute viral rhinitis (the common cold) can be caused by a variety of viruses. Symptoms consist of runny nose, sneezing, congestion, postnasal drip, cough, and a low-grade fever. Stuffiness can be relieved by taking decongestants such as phenylephrine as a nasal spray or pseudoephedrine by mouth. These drugs, available over the counter, cause the blood vessels of the nasal mucous membrane to narrow (constrict). Nasal sprays should be used for only 3 or 4 days because after that period of time, when the effects of the drugs wear off, the mucous membrane often swells even more than before. This phenomenon is called rebound congestion. Antihistamines help control runny nose but cause drowsiness and other problems, especially in older people. Antibiotics are not effective for acute viral rhinitis.

 

Allergic Rhinitis: Allergic rhinitis is caused by a reaction of the body's immune system to an environmental trigger. The most common environmental triggers include dust, molds, pollens, grasses, trees, and animals. Symptoms include itching, sneezing, runny nose, stuffiness, and itchy, watery eyes. A doctor may diagnose allergic rhinitis based on a person's history of symptoms. Often, the person has a family history of allergies. More detailed information may be obtained from blood tests or skin testing.

 

Avoiding the substance that triggers the allergy prevents symptoms but is often not possible. Nasal corticosteroid sprays decrease nasal inflammation caused by many sources and are relatively safe for long-term use. Antihistamines help prevent the allergic reaction and thus symptoms. Antihistamines dry the mucous membrane of the nose but many of them also cause sleepiness and other problems, especially in older people. Newer ones require a prescription but do not have these side effects. Allergy shots (desensitization) help to build long-term tolerance to specific environmental triggers, but they may take months or years to become fully effective. Antibiotics do not relieve the symptoms of allergic rhinitis.

 

Chronic Rhinitis: Chronic rhinitis is usually an extension of rhinitis caused by inflammation or an infection. However, it also may occur with diseases such as syphilis, tuberculosis, rhinoscleroma (a skin disease characterized by very hard, flattened tissues that first appear on the nose), rhinosporidiosis (an infection in the nose characterized by bleeding polyps), leishmaniasis, blastomycosis, histoplasmosis, and leprosy—all of which are characterized by the formation of inflamed lesions (granulomas) and the destruction of soft tissue, cartilage, and bone. Chronic rhinitis causes nasal obstruction, pus-filled discharge from the nose, and frequent bleeding.

 

Both low humidity and airborne irritants can result in chronic rhinitis. Decongestants may relieve symptoms. Any underlying bacterial infection requires a culture (examination of microorganisms grown from a sample to identify infection with bacteria or fungi) or biopsy (removal of a tissue sample for identification under a microscope) and appropriate treatment.

 

Atrophic Rhinitis: Atrophic rhinitis is a form of chronic rhinitis in which the mucous membrane thins (atrophies) and hardens, causing the nasal passages to widen (dilate) and dry out. This atrophy often occurs in older people. The cells normally found in the mucous membrane of the nose—cells that secrete mucus and have hairlike projections to move dirt particles out—are replaced by cells like those normally found in the skin. The disorder can develop in someone who had sinus surgery in which a significant amount of intranasal structures and mucous membranes were removed. A prolonged bacterial infection of the lining of the nose is also a factor.

 

Crusts form inside the nose, and an offensive odor develops. People may have recurring severe nosebleeds and can lose their sense of smell (anosmia).

 

Treatment is aimed at reducing the crusting, eliminating the odor, and reducing infections. Topical antibiotics, such as bacitracin applied inside the nose, kill bacteria. Estrogens and vitamins A and D sprayed into the nose or taken by mouth may reduce crusting by promoting mucosal secretions. Other antibiotics, given by mouth or by vein, may also be helpful. Surgery to narrow the nasal passages may reduce crusting because the decreased airflow prevents drying of the thinned mucous membrane.

 

Vasomotor Rhinitis: Vasomotor rhinitis is a form of chronic rhinitis. Nasal stuffiness, sneezing, and a runny nose—common allergic symptoms—occur when allergies do not seem to be present. In some people, the nose reacts strongly to irritants (such as dust and pollen), perfumes, and pollution. The disorder comes and goes but is worsened by dry air. The swollen mucous membrane varies from bright red to purple. Sometimes, people also have slight inflammation of the sinuses. When persistent, endoscopy of the nose or computed tomography of the sinuses may be needed. If inflammation of the sinus is not severe, treatment is aimed at relieving symptoms. Avoiding smoke and irritants and using a humidified central heating system or vaporizer to increase humidity may be beneficial.

Sinusitis is inflammation of the sinuses, most commonly caused by a viral or bacterial infection or by an allergy.

  • Some of the most common symptoms of sinusitis are pain, tenderness, nasal congestion, and headache.
  • The diagnosis is based on symptoms, but sometimes x-rays or other imaging tests are needed.
  • Antibiotics can eliminate the underlying infection.

Sinusitis is one of the most common medical conditions. About 10 to 15 million people each year develop symptoms of sinusitis. Sinusitis may occur in any of the four groups of sinuses: maxillary, ethmoid, frontal, or sphenoid. Sinusitis nearly always occurs in conjunction with inflammation of the nasal passages (rhinitis), and some doctors refer to the disorder as rhinosinusitis. It may be acute (short-lived) or chronic (long-standing).

 

Acute Sinusitis: Sinusitis is defined as acute if it is totally resolved in less than 30 days. Acute sinusitis may be caused by a variety of bacteria and often develops after something blocks the openings to the sinuses. Such blockage commonly results from a viral infection of the upper airways, such as the common cold. During a cold, the swollen mucous membranes of the nasal cavity tend to block the openings of the sinuses. Air in the sinuses is absorbed into the bloodstream, and the pressure inside the sinuses decreases, causing pain and drawing fluid into the sinuses. This fluid is a breeding ground for bacteria. White blood cells and more fluid enter the sinuses to fight the bacteria. This influx increases the pressure and causes more pain.

 

Allergies also cause mucous membrane swelling, which blocks the openings to the sinuses. Additionally, people with a deviated septum are more prone to obstructed sinuses.

Chronic Sinusitis: Sinusitis is defined as chronic if it has been ongoing for more than 8 to 12 weeks. Doctors do not understand exactly what causes chronic sinusitis, but it may follow a viral infection, a severe allergy, or exposure to an environmental pollutant. Often the person has a family history, and a genetic predisposition seems to be a factor. If the person has a bacterial or fungal infection, the inflammation is much worse. Occasionally, chronic sinusitis of the maxillary sinus results when an upper tooth abscess spreads into the sinus above.

 

Symptoms

Acute sinusitis usually results in pain, tenderness, congestion and obstruction in the nose, reduced ability to smell (hyposmia), bad breath (halitosis), a productive cough (especially at night), and swelling over the affected sinus. Maxillary sinusitis causes pain over the cheeks just below the eyes, toothache, and headache. Frontal sinusitis causes headache over the forehead. Ethmoid sinusitis causes pain behind and between the eyes, a bacterial infection of the skin around the eye socket (periorbital cellulitis), tearing, and headache (often described as splitting) over the forehead. Sphenoid sinusitis causes pain that does not occur in well-defined areas and may be felt in the front or back of the head.

 

In acute sinusitis, yellow or green pus may be discharged from the nose. Fever and chills also can occur, but their presence may suggest that the infection has spread beyond the sinuses. Any change in vision or swelling around the eye is a very serious condition that can quickly—within minutes to hours—result in blindness. Such a change should be evaluated by a doctor as soon as possible. Often, pain is more severe in acute sinusitis.

 

The symptoms of chronic sinusitis are similar to those caused by acute sinusitis. The most common symptoms of chronic sinusitis are nasal obstruction, nasal congestion, and postnasal drip. People with sinusitis may have colored discharge and a decreased sense of smell. A person also may feel generally ill (malaise).

 

Diagnosis

A doctor makes the diagnosis based on the typical symptoms and, sometimes, on x-ray studies. X-rays may show fluid in the sinuses, but a computed tomography (CT) scan is better able to determine the extent and severity of sinusitis. If a person has maxillary sinusitis, the teeth may be x-rayed to check for tooth abscesses. Sometimes a doctor passes a thin viewing scope (endoscope) into the nose to inspect the sinus openings and to obtain samples of fluid for culture. This procedure, which requires a local anesthetic (to numb the area), can be done in the doctor's office.

 

Sinusitis in children is suspected when a pus-filled discharge from the nose persists for more than 10 days along with extreme tiredness (fatigue) and cough. Pain or discomfort in the face may be present. Fever is uncommon. When examining the nose, a doctor sees pus-filled drainage. A CT scan can confirm the diagnosis.

 

Treatment

Treatment of acute sinusitis is aimed at improving sinus drainage and curing the infection. Steam inhalation; hot, wet towels over the affected sinuses; and hot beverages may help relieve the tightened or constricted blood vessels and promote drainage. Nasal sprays, such as phenylephrine, which cause blood vessels to narrow (constrict), can be used for a limited time. Similar drugs, such as pseudoephedrine, taken by mouth are not as effective. For acute sinusitis, antibiotics such as amoxicillin or trimethoprim/sulfamethoxazole are given.

 

People who have chronic sinusitis take antibiotics, such as amoxicillin/clavulanate or cefuroxime, for a longer period of time. When antibiotics are not effective, surgery may be performed either to wash out the sinus and obtain material for culture or to improve sinus drainage, which allows the inflammation to resolve.

  • Smell may be lost temporarily when a person smokes or has a cold or seasonal allergy.
  • Smell may be lost permanently after a head injury.
  • People may lose their sense of taste if they have a condition that causes a very dry mouth.
  • Doctors can test smell by using common fragrant substances.
  • Taste is tested by using sweet, salty, sour, and bitter substances.
  • Infections are treated with antibiotics, and blockages are removed, but sometimes the ability to smell is not restored.

Because disorders of smell and taste are rarely life threatening, they may not receive close medical attention. Yet, these disorders can be frustrating because they can affect the ability to enjoy food and drink and to appreciate pleasant aromas. They can also interfere with the ability to notice potentially harmful chemicals and gases and thus may have serious consequences. Occasionally, impairment of smell and taste is due to a serious disorder, such as a tumor.

Smell and taste are closely linked. The taste buds of the tongue identify taste, and the nerves in the nose identify smell. Both sensations are communicated to the brain, which integrates the information so that flavors can be recognized and appreciated. Some tastes—such as salty, bitter, sweet, and sour—can be recognized without the sense of smell. However, more complex flavors (such as raspberry) require both taste and smell sensations to be recognized

A reduced ability to smell (hyposmia) and loss of smell (anosmia) are the most common disorders of smell and taste. Because distinguishing one flavor from another is based largely on smell, people often first notice that their ability to smell is reduced when their food seems tasteless.

 

Causes

Smell: The ability to smell can be affected by changes in the nose, in the nerves leading from the nose to the brain, or in the brain. For example, if nasal passages are stuffed up from a common cold, the ability to smell may be reduced because odors are prevented from reaching the smell receptors (specialized nerve cells in the mucous membrane lining the nose). Because the ability to smell affects taste, food often does not taste right to people with colds. Smell receptors can be temporarily damaged by the influenza (flu) virus. Some people cannot smell or taste for several days or even weeks after a bout of the flu, and rarely, loss of smell or taste becomes permanent. Polyps, tumors, other infections in the nose, seasonal allergies (allergic rhinitis), and smoking (tobacco) may interfere with the ability to smell. Occasionally, serious infections of the nasal sinuses or radiation therapy for cancer causes a loss of smell or taste that lasts for months or even becomes permanent. These conditions can damage or destroy smell receptors.

 

A common cause of permanent loss of smell is a head injury, as may occur in a car accident. Permanent loss of smell results when fibers of the olfactory nerves—the pair of cranial nerves that connect smell receptors to the brain—are damaged or sheared at the roof of the nasal cavity. The roof of the nasal cavity is formed by a bone (cribriform plate) that separates the brain from the nasal cavity. Damage to the olfactory nerves can also result from fractures of the cribriform plate or from infections (such as abscesses) or tumors near this bone.

 

Alzheimer's disease and some other degenerative brain disorders can also damage the olfactory nerves, commonly causing of loss of smell. A very few people are born without a sense of smell.

Oversensitivity to smell (hyperosmia) is much less common than loss of smell. Pregnant women commonly become oversensitive to smell. Hyperosmia can also be psychosomatic. Psychosomatic hyperosmia is more likely to develop in people who have a histrionic personality (characterized by conspicuous seeking of attention with dramatic behavior.

 

Some disorders can distort the sense of smell, making innocuous odors smell disagreeable (a condition called dysosmia). These disorders include the following:

  • Infections in the sinuses
  • Partial damage to the olfactory nerves
  • Poor dental hygiene
  • Mouth infections
  • Depression
  • Viral hepatitis, which may cause dysosmia that results in nausea triggered by otherwise inoffensive odors

Seizures originating in the part of the brain where memories of smell are stored—the middle part of the temporal lobe—may produce a brief, false sensation of vivid, unpleasant smells (olfactory hallucinations). These smells are part of the intense feeling that seizure is about to begin (called an aura), not a smell disorder. Brain infections due to herpesviruses (herpes encephalitis) may also cause olfactory hallucinations.

 

Taste: A reduction in the ability to taste (hypogeusia) or loss of taste (ageusia) usually results from conditions that affect the tongue, usually by causing a very dry mouth. Such conditions include Sjögren's syndrome, heavy smoking (especially pipe smoking), radiation therapy to the head and neck, dehydration, and use of drugs (including antihistamines and the antidepressant amitriptyline). Nutritional deficiencies, such as decreased zinc, copper, and nickel levels, can alter both taste and smell.

 

In Bell's palsy, the sense of taste is often impaired on the front two thirds of one side of the tongue (the side affected by the palsy). But this loss may not be noticed because taste is normal or increased in the rest of the tongue. Burns to the tongue may temporarily destroy taste buds. Neurologic disorders, including depression and seizures, may impair taste.

 

A distortion of taste (dysgeusia) may be caused by inflammation of the gums (gingivitis) and by many of the same conditions that result in loss of taste or smell, including depression and seizures. Taste may be distorted by some drugs, such as the following:

  • Antibiotics
  • Anticonvulsants
  • Antidepressants
  • Certain chemotherapy drugs
  • Diuretics
  • Drugs used to treat arthritis
  • Thyroid drugs

Diagnosis

To test smell, doctors hold common fragrant substances (such as soap, a vanilla bean, coffee, and cloves) under the person's nose, one nostril at a time. The person is then asked to identify the smell. Smell can also be tested more formally using standardized commercial smell test kits. Taste can be tested using substances that are sweet (sugar), sour (lemon juice), salty (salt), and bitter (aspirin, quinine, or aloes).

 

Doctors and dentists check the mouth and nasal passages for abnormalities, including infection and dryness. If the cause is not apparent, computed tomography (CT) or magnetic resonance imaging (MRI) of the head is needed to look for structural abnormalities (such as a tumor, an abscess, or a fracture) near the cribriform plate.

 

Treatment

Treatment depends on the cause of a smell or taste disorder. For example, sinus infections and irritation may be treated with steam inhalation, nasal sprays, antibiotics, and sometimes surgery. Nutritional deficiencies need to be corrected. Tumors are surgically removed or treated with radiation, but such treatment usually does not restore the sense of smell. Polyps in the nose are removed, sometimes restoring the ability to smell. People who smoke tobacco should stop. Other recommendations may include the following:

  • Changing or stopping a drug
  • Sucking on candy to keep the mouth moist
  • Improving dental hygiene
  • Waiting several weeks to see if the cause of the problem (such as the flu) disappears

Rarely, zinc supplements, which can be purchased without a prescription, are effective, especially for distortion of smell or for reduction or distortion of taste when no cause has been identified.