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{{SignSymptom infobox |
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{{Infobox symptom
Name = Anosmia |
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| Name = Anosmia
ICD10 = R43.0 |
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| ICD10 = {{ICD10|R|43|0|r|40}}
ICD9 = {{ICD9|781.1}} |
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| ICD9 = {{ICD9|781.1}}
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| MeshID = D000857
 
}}
 
}}
'''Anosmia''' is a [[sense organ disorder]], it is the lack of [[olfaction]], or a loss of the sense of smell. It can be either temporary or permanent. A related term, '''[[hyposmia]]''' refers to a decrease in the ability to smell. Some people may be anosmic for one particular odor. This is called "specific anosmia" and may be genetically based. Anosmia can be diagnosed by doctors by using scratch-n-sniff odor tests or by using commonly available odors such as coffee, lemon, and cinnamon.
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'''Anosmia''' (pronounced {{IPAc-en|æ|n|ˈ|ɒ|z|m|i|ə|}}) is [[an [[olfaction disorder]] and is the inability to perceive [[odor]], or in other words a lack of functioning [[olfaction]]. Anosmia may be temporary but traumatic anosmia can be permanent. Anosmia is due to an inflammation of the [[nasal mucosa]]; blockage of nasal passages or a destruction of one [[temporal lobe]]. Specifically, according to ''The Lancet'' journal, inflammation is due to chronic mucosa changes in the paranasal sinus lining and the middle and superior turbinates. Since anosmia causes inflammatory changes in the nasal passage ways, it is treated by simply reducing the presence of inflammation.<ref>Knight, Allan, [http://journals1.scholarsportal.info.myaccess.library.utoronto.ca/tmp/16298504906951908277.pdf "Anosmia"], ''The Lancet'', August 27, 1988</ref> It can be caused by chronic [[meningitis]] and [[neurosyphilis]] that would increase intracranial pressure over a long period of time,<ref>{{cite news|last=The Lancet|date=January 1943|title=ANOSMIA}}</ref> and in some cases by [[ciliopathy]]<ref>[http://www.ciliopathyalliance.org/cilia/impact-of-defective-cilia.html Impact of Defective Cilia<!-- Bot generated title -->]</ref> including ciliopathy due to [[primary ciliary dyskinesia]] (Kartagener syndrome, Afzelius’ syndrome or Siewert’s syndrome).<ref>{{Cite pmid | 21475513 }}</ref> Many patients may experience unilateral anosmia, often as a result of minor head trauma. This type of anosmia is normally only detected if both of the nostrils are tested separately. Using this method of testing each nostril separately will often show a reduced or even completely absent sense of smell in either one nostril or both, something which is often not revealed if both nostrils are simultaneously tested.<ref>[http://simplelink.library.utoronto.ca/url.cfm/263805 Harvey, Peter. "Anosmia". ''Practical Neurology'', 206, p. 65]</ref>
   
It should be emphasized that there are no more than 5 distinctive tastes: salty, sour, sweet, bitter, and [[umami]]. The 10,000 different scents which humans usually recognize as 'tastes' are often lost or severely diminished with the loss of olfaction.
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A related term, [[hyposmia]], refers to a decreased ability to smell, while [[hyperosmia]] refers to an increased ability to smell. Some people may be anosmic for one particular odor. This is known as "specific anosmia". The absence of the sense of smell from birth is called Congenital Anosmia.
   
While termed as a disability, anosmia is often viewed in the medical field as a trivial problem. This is not always the case - [http://www.emedicine.com/med/topic748.htm esthesioneuroblastoma] is a cancerous tumor originating in or near the [[olfactory nerve]]. This is a serious condition - if you suspect that you have lost your sense of smell, see an Otolaryngologist (Ear, Nose and Throat doctor) '''immediately'''.
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==Diagnosis==
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Anosmia can be diagnosed by doctors by using [[acetylcysteine]] tests. Doctors will begin with a detailed elicitation of history. Then the doctor will ask for any related injuries in relation to anosmia which could include upper respiratory infections or head injury. Psychophysical Assessment of order and taste identification can be used to identity anosmia. A nervous system examination is performed to see if the cranial nerves are damaged.<ref>{{cite web|title=Anosmia / Loss Of Smell|url=http://www.medindia.net/patients/patientinfo/anosmia_diagnosis.htm}}</ref> The diagnosis as well as the degree of impairment can now be tested much more efficiently and effectively than ever before thanks to "smell testing kits" that have been made available as well as screening tests which use materials that most clinics would readily have.<ref>{{cite journal |pages=54–60 |doi=10.1097/00020840-200302000-00012 |title=Anosmia: Diagnosis and management |year=2003 |last1=Holbrook |first1=Eric H. |last2=Leopold |first2=Donald A. |journal=Current Opinion in Otolaryngology & Head and Neck Surgery |volume=11}}</ref> Occasionally, after accidents, there is a change in a patient's sense of smell. Particular smells that were present before are no longer present. On occasion, after head traumas, there are patients who have unilateral anosmia. The sense of smell should be tested individually in each nostril.<ref>Harvey, Peter. "Anosmia". Practical Neurology, 206, p.65.</ref>
   
Anosmia can have a number of detrimental effects [http://www.anosmiafoundation.org]. Patients with anosmia may find food less appetizing. Loss of smell can also be dangerous because it hinders the detection of gas leaks, fire, body odor, and spoiled food. The common view of anosmia as trivial can make it more difficult for a patient to receive the same types of medical aid as someone who is blind, deaf, or mute.
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Many cases of congenital anosmia remain unreported and undiagnosed. Since the disorder is present from birth the individual may have little or no understanding of the sense of smell, hence are unaware of the deficit.<ref>Vowels, R.H., Bleach, N. R., Rowe-Jones, J. M. (1997). Congenital anosmia. 41: 207-214.</ref> It may also lead to reduction of appetite <ref>Summer, D. W. Appetite and Anosia. The Lancet (1971), 297 (7706), pg. 970-970.</ref>
   
Losing an established and sentimental [[smell memory]] (e.g. the smell of grass, of a grandparent's attic, of a particular book, of loved ones, or of oneself) has been known to cause feelings of [[clinical depression|depression]].
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According to a research article, there have been many cases where MRI scans have resulted in anxiety and panic in patients, due to various reasons but mainly claustrophobia. However, these experiences were of random nature.<ref>Knight, Allan, [http://journals1.scholarsportal.info.myaccess.library.utoronto.ca/tmp/2867018600203700334.pdf "Anosmia"], ''The Lancet'', August 27, 1988.</ref>
   
Loss of olfaction may lead to the loss of [[libido]], even to the point of [[impotency]], which often preoccupies younger anosmic men.{{cn}}
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==Presentation==
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Anosmia can have a number of harmful effects. Patients with sudden onset anosmia may find food less appetizing, though [[congenital]] anosmics rarely complain about this, and none report a loss in weight.<ref>[http://journals2.scholarsportal.info.myaccess.library.utoronto.ca/tmp/13668629570508521477.pdf my.access — University of Toronto Libraries Portal<!-- Bot generated title -->]</ref> Loss of smell can also be dangerous because it hinders the detection of [[gas leak]]s, fire, and spoiled food. The common view of anosmia as trivial can make it more difficult for a patient to receive the same types of medical aid as someone who has lost other senses, such as hearing or sight.
   
Scientists involved in anosmia research include [[Richard Doty]].
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Losing an established and sentimental [[olfactory memory|smell memory]] (e.g. the smell of grass, of the grandparents' attic, of a particular book, of loved ones, or of oneself) has been known to cause feelings of [[clinical depression|depression]].<ref name="bbc1">{{cite news| url=http://news.bbc.co.uk/2/hi/uk_news/magazine/6199605.stm | work=BBC News | title=Sense and scent ability | date=December 27, 2006 | accessdate=April 25, 2010}}</ref>
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Loss of olfaction may lead to the loss of [[libido]], though this usually does not apply to congenital anosmics.<ref name="bbc1"/>
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Often people who have congenital anosmia report that they pretended to be able to smell as children because they thought that smelling was something that older/mature people could do, or did not understand the concept of smelling but did not want to appear different from others. When children get older, they often realize and report to their parents that they do not actually possess a sense of smell, often to the surprise of their parents.<ref name="bbc1"/>
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A study done on patients suffering from anosmia found that when testing both nostrils, there was no anosmia revealed, however when testing each nostril individually, tests showed that the sense of smell was usually affected in only one of the nostrils as opposed to both. This demonstrated that unilateral anosmia is not uncommon in anosmia patients.
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<ref>Harvey,P. (2006). Anosmia. Practical Neurology. 6:64-65. Retrieved from: http://pn.bmj.com.myaccess.library.utoronto.ca/content/6/1/65.full.pdf+html</ref>
   
 
==Causes==
 
==Causes==
A temporary loss of smell can be caused by a stuffy [[nose]] or infection. In contrast, a permanent loss of smell may be caused by death of [[olfactory receptor neuron]]s in the nose, or by [[brain injury]] in which there is damage to the [[olfactory nerve]] or damage to brain areas that process smell (see [[olfactory system]]). The lack of the sense of smell at birth, usually due to genetic factors, is referred as ''congenital anosmia.'' Anosmia may be an early sign of degenerative brain diseases such as [[Parkinson's disease]] and [[Alzheimer's disease]]. Another specific cause of permanent loss could be from damage to olfactory receptor neurons due to use of [[nasal spray]]s. To avoid loss of smell from nasal spays, use them for only a short amout of time. Nasal sprays that are used to treat allergy related congestion are the only nasal sprays that are safe to use for extended periods of time. [http://www.coldcure.com/anosmia/anosmia.html]. [http://www.emedicine.com/med/topic748.htm Esthesioneuroblastoma]is an exeedingly rare cancerous tumor that originates in or near the olfactory nerve.
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A temporary loss of smell can be caused by a blocked [[human nose|nose]] or infection. In contrast, a permanent loss of smell may be caused by death of [[olfactory receptor neuron]]s in the nose or by [[Acquired brain injury|brain injury]] in which there is damage to the [[olfactory nerve]] or damage to brain areas that process smell (see [[olfactory system]]). The lack of the sense of smell at birth, usually due to genetic factors, is referred to as ''congenital anosmia.'' Family members of the patient suffering from congenital anosmia are often found with similar histories; this suggests that the anosmia may follow an autosomal dominant pattern.<ref>Waguespack, R. (1992). Congenital Anosmia. Arch Otolargyngol Head Neck Surg. 118(1): 10.</ref> Anosmia may very occasionally be an early sign of a degenerative brain disease such as [[Parkinson's disease]] and [[Alzheimer's disease]]. Another specific cause of permanent loss could be from damage to olfactory receptor neurons because of use of certain types of [[nasal spray]]; i.e., those that cause vasoconstriction of the nasal microcirculation. To avoid such damage and the subsequent risk of loss of smell, vasoconstricting nasal sprays should be used only when absolutely necessary and then for only a short amount of time. Non-vasoconstricting sprays, such as those used to treat allergy-related congestion, are safe to use for prescribed periods of time.<ref>[http://web.archive.org/web/20060101000005/http://www.coldcure.com/anosmia/anosmia.html Preventing Anosmia from Intranasal Zinc Administration<!-- Bot generated title -->]</ref> Anosmia can also be caused by nasal polyps. These polyps are found in people with allergies, histories of sinusitis & family history. Individuals with [[cystic fibrosis]] often develop nasal polyps.
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[[Amiodarone]] is a drug used in the treatment of arrhythmias of the heart. A clinical study performed demonstrated that the use of this drug induced anosmia in some patients. Although rare, there was a case in which a 66-year-old male was treated with Amiodarone for ventricular tachycardia. After the use of the drug he began experiencing olfactory disturbance, however after decreasing the dosage of Amiodarone, the severity of the anosmia decreased accordingly hence correlating the use of Amiodarone to the development of anosmia.<ref>Maruyama T. Yasuda S. Odashiro K. Kaji Y. Harada M. (2007). Anosmia Induced by Amiodarone. The American Journal of Medicine. 120 (11). Retrieved from: http://journals1.scholarsportal.info.myaccess.library.utoronto.ca/tmp/8327703549542877532.pdf</ref>
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  +
Causes of anosmia include:
   
*Upper respiratory tract infection (e.g., [[sinusitis]] or the [[common cold]])<ref name="Doty2001">{{cite journal
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*Upper respiratory tract infection (e.g., [[sinusitis]] or the [[common cold]])<ref name="Doty2001">{{cite journal |pages=409–23 |doi=10.1097/00005537-200103000-00008 |title=Olfaction and Its Alteration by Nasal Obstruction, Rhinitis, and Rhinosinusitis |year=2001 |last1=Doty |first1=Richard L. |last2=Mishra |first2=Anupam |journal=The Laryngoscope |volume=111 |issue=3 |pmid=11224769}}</ref>
| author=Doty RL, Mishra A
 
| title=Influences of nasal obstruction, rhinitis, and rhinosinusitis on the ability to smell
 
| journal=Laryngoscope
 
| volume=111
 
| pages=409&ndash;23
 
| year=2001 }}</ref>
 
 
*[[Nasal polyps]]
 
*[[Nasal polyps]]
*[[Smoking]]
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*Idiopathic [[hypogonadotropic hypogonadism]]
*Head trauma<ref name="Doty1997">{{cite journal
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* [[Hypothyroidism]]
| author=Doty RL, Yousem DM, Pham LT, Kreshak AA, Lee WW
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*Head trauma, damage to the [[ethmoid bone]]<ref name="Doty1997">{{cite journal |pages=1131–40 |doi=10.1001/archneur.1997.00550210061014 |title=Olfactory Dysfunction in Patients with Head Trauma |year=1997 |last1=Doty |first1=R. L. |last2=Yousem |first2=D. M. |last3=Pham |first3=L. T. |last4=Kreshak |first4=A. A. |last5=Geckle |first5=R. |last6=Lee |first6=W. W. |journal=Archives of Neurology |volume=54 |issue=9 |pmid=9311357}}</ref>
| title=Olfactory dysfunction in patients with head trauma
 
| journal=Arch Neurol
 
| volume=54
 
| pages=1131&ndash;1140
 
| year=1997 }}</ref>
 
 
*[[Dementia with Lewy bodies]]
 
*[[Dementia with Lewy bodies]]
*[[Parkinson's Disease]]<!--
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*[[Tumors]] of the [[frontal lobe]]
--><ref name="Doty1988">{{cite journal
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*[[Parkinson's disease]]<ref name="Doty1988">{{cite journal |pmid=3399075 |year=1988 |last1=Doty |first1=RL |last2=Deems |first2=DA |last3=Stellar |first3=S |title=Olfactory dysfunction in parkinsonism: A general deficit unrelated to neurologic signs, disease stage, or disease duration |volume=38 |issue=8 |pages=1237–44 |journal=Neurology |doi=10.1212/WNL.38.8.1237}}</ref>
| author=Doty RL, Deems D, Stellar S
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*[[Alzheimer's disease]]<ref name="Murphy1988">{{cite journal |pages=177–82 |doi=10.1016/S0031-9384(98)00262-5 |title=Loss of Olfactory Function in Dementing Disease |year=1999 |last1=Murphy |first1=Claire |journal=Physiology & Behavior |volume=66 |issue=2}}</ref>
| title=Olfactory dysfunction in Parkinson's disease: A general deficit unrelated to neurologic signs, disease stage, or disease duration
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*Toxins (especially [[acrylate]]s, [[methacrylate]]s<ref name="Schwartz">{{cite journal |pages=613–8 |doi=10.2105/AJPH.79.5.613 |title=Olfactory function in chemical workers exposed to acrylate and methacrylate vapors |year=1989 |last1=Schwartz |first1=B S |last2=Doty |first2=R L |last3=Monroe |first3=C |last4=Frye |first4=R |last5=Barker |first5=S |journal=American Journal of Public Health |volume=79 |issue=5 |pmid=2784947 |pmc=1349504}}</ref> and [[cadmium]]<ref name="Rose1992">{{cite journal |pmid=1619490 |year=1992 |last1=Rose |first1=CS |last2=Heywood |first2=PG |last3=Costanzo |first3=RM |title=Olfactory impairment after chronic occupational cadmium exposure |volume=34 |issue=6 |pages=600–5 |journal=Journal of occupational medicine}}</ref><ref name="Rydzewski1998">{{cite journal |pmid=9844306 |year=1998 |last1=Rydzewski |first1=B |last2=Sułkowski |first2=W |last3=Miarzyńska |first3=M |title=Olfactory disorders induced by cadmium exposure: A clinical study |volume=11 |issue=3 |pages=235–45 |journal=International journal of occupational medicine and environmental health}}</ref>)
| journal=Neurology
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*Old age<ref name="">{{cite journal |pages=1441–3 |doi=10.1126/science.6505700 |title=Smell identification ability: Changes with age |year=1984 |last1=Doty |first1=R. |last2=Shaman |first2=P |last3=Applebaum |first3=S. |last4=Giberson |first4=R |last5=Siksorski |first5=L |last6=Rosenberg |first6=L |journal=Science |volume=226 |issue=4681 |pmid=6505700}}</ref>
| volume=38
 
| pages=1237&ndash;44
 
| year=1988 }}</ref>
 
*[[Alzheimer's Disease]]<!--
 
--><ref name="Murphy1988">{{cite journal
 
| author=Murphy C
 
| title=Loss of olfactory function in dementing disease
 
| journal=Physiology &amp; Behavior
 
| volume=66
 
| pages=177&ndash;182
 
| year=1999 }}</ref>
 
*Toxins (especially [[acrylate]]s, [[methacrylate]]s<ref name="Schwartz">{{cite journal
 
| author=Schwartz B, Doty RL, Frye RE, Monroe C, Barker S
 
| title=Olfactory function in chemical workers exposed to acrylate and methacrylate vapors
 
| journal=Am J Pub Health
 
| volume=79
 
| pages=613&ndash;618
 
| year=1989 }}</ref> and [[cadmium]]<ref name="Rose1992">{{cite journal
 
| author=Rose CS, Heywood PG, Costanzo RM
 
| title=Olfactory impairment after chronic occupational cadmium exposure
 
| journal=Journal of Occupational Medicine
 
| volume=34
 
| pages=600&ndash;605
 
| year=1992 }}</ref><ref name="Rydzewski1998">{{cite journal
 
| author=Rydzewski B, Sulkowski W, Miarzynaska M
 
| year=1998
 
| title=Olfactory disorders induced by cadmium exposure: A clinical study
 
| journal=Int J Occ Med Env Health
 
| volume=11
 
| pages=235&ndash;245 }}</ref>)
 
*Old age<ref name="">{{cite journal
 
| author=Doty RL, Shaman P, Applebaum SL, Giberson R, Sikorsky L, Rosenberg L
 
| title=Smell identification ability: Changes with age
 
| journal=Science
 
| volume=226
 
| pages=1441&ndash;1443
 
| year=1984 }}</ref>
 
 
*[[Kallmann syndrome]]
 
*[[Kallmann syndrome]]
*[http://www.emedicine.com/med/topic748.htm Esthesioneuroblastoma]is an exeedingly rare cancerous tumor that originates in or near the olfactory nerve. Symptoms are anosmia (loss of sense of smell) often accompanied by chronic sinusitus.
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*[[Primary ciliary dyskinesia]]
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*[[Post-perfusion syndrome]]
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*[[Laryngectomy]] with permanent [[tracheostomy]]
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*Esthesioneuroblastoma is an exceedingly rare cancerous tumor that originates in or near the [[olfactory nerve]]. Symptoms are anosmia (loss of sense of smell) often accompanied by chronic [[sinusitis]].<ref>{{cite web |first1=Michael |last1=Somenek |editor1-first=Jules E |editor1-last=Harris |title=Esthesioneuroblastoma |url=http://emedicine.medscape.com/article/278047-overview |date=October 30, 2009 |work=[[eMedicine]]}}</ref>
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*[[Insufflation (medicine)|Intranasal]] [[Recreational drug use|drug use]]
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*[[Samter's triad]]
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*[[Foster Kennedy syndrome]]
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*[[Cadmium poisoning]]
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*[[Tobacco smoking|Smoking]]
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*[[Neurotropic virus]]<ref>{{cite journal |doi=10.1001/archoto.2009.141 |laysummary=http://www.sciencedaily.com/releases/2009/10/091019172331.htm |laysource=ScienceDaily |laydate=October 19, 2009 |title=Treatment of Postviral Olfactory Loss with Glucocorticoids, Ginkgo biloba, and Mometasone Nasal Spray |year=2009 |last1=Seo |first1=B. S. |last2=Lee |first2=H. J. |last3=Mo |first3=J.-H. |last4=Lee |first4=C. H. |last5=Rhee |first5=C.-S. |last6=Kim |first6=J.-W. |journal=Archives of Otolaryngology - Head and Neck Surgery |volume=135 |issue=10 |pages=1000–4 |pmid=19841338}}</ref>
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*[[Schizophrenia]]<ref>{{cite journal |pages=149–61 |doi=10.1016/j.schres.2004.07.010 |title=Olfactory functions and volumetric measures of orbitofrontal and limbic regions in schizophrenia |year=2005 |last1=Rupp |first1=Claudia I. |last2=Fleischhacker |first2=W. Wolfgang |last3=Kemmler |first3=Georg |last4=Kremser |first4=Christian |last5=Bilder |first5=Robert M. |last6=Mechtcheriakov |first6=Sergei |last7=Szeszko |first7=Philip R. |last8=Walch |first8=Thomas |last9=Scholtz |first9=Arne W. |journal=Schizophrenia Research |volume=74 |issue=2–3 |pmid=15721995}}</ref>
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*[[Pernicious anemia]]
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*[[Zinc deficiency]]
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*[[Bell's Palsy]] or nerve paralysis and damage
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*[[Idiopathic intracranial hypertension]]
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*[[Sella turcica|Suprasellar]] [[meningioma]]
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*[[Refsum's disease]]
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*[[Adrenergic agonist]]s or withdrawal from [[alpha blocker]]s (vasoconstriction)
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*[[Sarcoidosis]]<ref>{{cite journal |pages=S183–6 |doi=10.1016/S0194-5998(97)70097-4 |title=Isolated neurosarcoidosis presenting as anosmia and visual changes |year=1997 |last1=Kieff |first1=D |last2=Boey |first2=H |last3=Schaefer |first3=P |last4=Goodman |first4=M |last5=Joseph |first5=M |journal=Otolaryngology - Head and Neck Surgery |volume=117 |issue=6 |pmid=9419143}}</ref>
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*[[Zinc#Precautions|Zinc-based intranasal cold products]]
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*[[Chronic atrophic rhinitis]]
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*[[Paget's disease of bone]]<ref>{{cite journal |pmid=7490390 |year=1995 |last1=Wheeler |first1=TT |last2=Alberts |first2=MA |last3=Dolan |first3=TA |last4=McGorray |first4=SP |title=Dental, visual, auditory and olfactory complications in Paget's disease of bone |volume=43 |issue=12 |pages=1384–91 |journal=Journal of the American Geriatrics Society}}</ref>
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*[[Cerebral aneurysm]]<ref>[http://www.ncbi.nlm.nih.gov/pubmed/2338570 Anosmia following operation for cerebral aneurys... [J Neurosurg. 1990&#93; - PubMed - NCBI<!-- Bot generated title -->]</ref>
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*[[Wegener's Granulomatosis]]
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*[[Primary amoebic meningoencephalitis]]
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*[[Myasthenia gravis]]<ref>{{Cite journal | author = Leon-Sarmiento FE, Bayona EA, Bayona-Prieto J, Osman A, Doty RL | year = 2012 | month = October | title = Profound Olfactory Dysfunction in Myasthenia Gravis | journal = [[PLoS ONE]] | volume = | issue = | pages = | id = | url = http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0045544 }}</ref>
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{{Expand list|date=August 2008}}
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*[[Tobacco]]
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==Treatment==
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Though anosmia caused by brain damage cannot be treated, anosmia caused by inflammatory changes in the mucosa may be treated with [[glucocorticoids]]. Reduction of inflammation through the use of oral glucocorticoids such as prednisone, followed by long term topical glucocorticoid nasal spray, would easily and safely treat the anosmia. A prednisone regimen is adjusted based on the degree of the thickness of mucosa, the discharge of oedema and the presence or absence of nasal polyps.<ref>Knight, A. (1998). Anosmia. ''The Lancet, 332(8609),''512. doi: 10.1016/S0140-6736(88)90160-2</ref> However, the treatment is not permanent and may have to be repeated after a short while.<ref>{{cite journal | author = Knight A | year = 1988 | title = Anosmia | url = | journal = The Lancet | volume = 332 | issue = 8609| page = 512 | doi = 10.1016/S0140-6736(88)90160-2 | pmid = 2900434 }}</ref> Together with medication, pressure of the upper area of the nose must be mitigated through aeration and drainage.<ref>{{cite journal | author = Turnley W. M. H. | year = 1963 | title = Anosmia | url = | journal = The Laryngoscope | volume = 73 | issue = 4| pages = 468–473 | doi = 10.1288/00005537-196304000-00012 }}</ref>
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There have also been cases where the use of acupuncture have successfully treated anosmia.<ref>{{cite journal | author = Michael W | year = 2003 | title = Anosmia treated with acupuncture | url = | journal = Acupuncture in Medicine | volume = 21 | issue = 4| page = 153 | doi = 10.1136/aim.21.4.153 }}</ref>
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Although very early in development, [[gene therapy]] has restored a sense of smell in mice with congenital anosmia when caused by [[ciliopathy]]. In this case a genetic condition had affected cilia in their bodies which normally enabled them to detect air-borne chemicals, and an [[adenovirus]] was used to implant a working version of the [[IFT88]] gene into defective cells in the nose, which restored the cilia and allowed a sense of smell.<ref>[http://www.nature.com/nm/journal/vaop/ncurrent/full/nm.2860.html Gene therapy rescues cilia defects and restores olfactory function in a mammalian ciliopathy model]</ref><ref>[http://www.bbc.co.uk/news/health-19409154 BBC News]</ref>
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==Zicam controversy==
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On June 16, 2009, the U.S. [[Food and Drug Administration]] sent a warning letter to Matrixx Initiatives, manufacturer of an over-the-counter nasal spray for the [[common cold]], [[Zicam]]. The FDA cited complaints that the product caused anosmia. The manufacturer strongly denies these allegations, but has recalled the product and has stopped selling it.<ref>{{cite news| url=http://www.cnn.com/2009/HEALTH/06/16/zicam.fda.warning/index.html | work=CNN | title=FDA warns against using 3 popular Zicam cold meds - CNN.com | accessdate=April 25, 2010 | date=June 16, 2009| archiveurl= http://web.archive.org/web/20100409102000/http://www.cnn.com/2009/HEALTH/06/16/zicam.fda.warning/index.html| archivedate= 9 April 2010 <!--DASHBot-->| deadurl= no}}</ref>
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In fact, Matrixx has received more than 800 reports of Zicam users who were losing their sense of smell but did not provide those reports to the F.D.A due to this product produced.<ref>[http://www.nytimes.com/2009/06/17/health/policy/17nasal.html?_r=0 title=F.D.A. Warns Against Use of Popular Cold Remedy]</ref>
   
 
==Associated conditions==
 
==Associated conditions==
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* [[Dysosmia]]
 
* [[Kallmann syndrome]]
 
* [[Kallmann syndrome]]
* [[Zinc#Zinc Deficiency|zinc deficiency]]
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* [[Zinc#Deficiency|Zinc deficiency]]
* [[Parkinson's disease]]
 
* [[Alzheimer's disease]]
 
 
* [[Cadmium Poisoning]]
 
* [[Cadmium Poisoning]]
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* [[Holoprosencephaly]]
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* [[Primary amoebic meningoencephalitis]] caused by [[Naegleria fowleri]]
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* [[Refsum disease]]
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* [[CHARGE syndrome]]
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* [[Ageusia]]
   
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{{Expand list|date=August 2008}}
   
 
==See also==
 
==See also==
  +
* [[Dysosmia]]
  +
* [[Phantosmia]]
  +
* [[Hyperosmia]]
  +
* [[Hyposmia]]
  +
* [[Parosmia]]
  +
* [[Olfactory bulbectomy]]
 
* [[Olfactory perception]]
 
* [[Olfactory perception]]
 
* [[Parosmia]]
 
* [[Parosmia]]
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==References==
 
==References==
<references/>
+
{{reflist|2}}
  +
  +
== Further reading ==
  +
* {{cite book |title=Remembering Smell: A Memoir of Losing - and Discovering - the Primal Sense |last=Blodgett |first=Bonnie |year=2010 |publisher=Houghton Mifflin Harcourt |isbn=978-0-618-86188-0}}
  +
* {{cite book |title=Nunca sabrás a qué huele Bagdad (You will never know the smell of Bagdad)|last=Tafalla |first=Marta |year=2010 |publisher=Autonomous University of Barcelona |language=Spanish |isbn=978-84-490-2611-9}} - Novel dealing with congenital anosmia.
  +
  +
  +
{{Cognition, perception, emotional state and behaviour symptoms and signs}}
  +
  +
   
 
==External links==
 
==External links==
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*[http://www.anosmia.net/ The Congenital Anosmia Forums]
 
*[http://www.anosmia.net/ The Congenital Anosmia Forums]
 
*[http://www.scienceofsmell.com/scienceofsmell/index.cfm?action=promo&pc=sathome3 The Smell and Taste Treatment & Research Foundation]
 
*[http://www.scienceofsmell.com/scienceofsmell/index.cfm?action=promo&pc=sathome3 The Smell and Taste Treatment & Research Foundation]
  +
*[http://www.cardiff.ac.uk/biosi/staffinfo/jacob/Anosmia/anosmia.html Cardiff University Anosmia resource site][[Category:Disorders of olfactory perception]]
   
[[Category:Disorders of olfactory perception]]
+
[[Category:Olfactory system]]
 
[[Category:Neurological disorders]]
 
[[Category:Neurological disorders]]
 
[[Category:Sense organ disorders]]
 
[[Category:Sense organ disorders]]
 
 
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[[de:Anosmie]]
 
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Anosmia
ICD-10 R430
ICD-9 781.1
MeSH D000857

Anosmia (pronounced /ænˈɒzmiə/) is [[an olfaction disorder and is the inability to perceive odor, or in other words a lack of functioning olfaction. Anosmia may be temporary but traumatic anosmia can be permanent. Anosmia is due to an inflammation of the nasal mucosa; blockage of nasal passages or a destruction of one temporal lobe. Specifically, according to The Lancet journal, inflammation is due to chronic mucosa changes in the paranasal sinus lining and the middle and superior turbinates. Since anosmia causes inflammatory changes in the nasal passage ways, it is treated by simply reducing the presence of inflammation.[1] It can be caused by chronic meningitis and neurosyphilis that would increase intracranial pressure over a long period of time,[2] and in some cases by ciliopathy[3] including ciliopathy due to primary ciliary dyskinesia (Kartagener syndrome, Afzelius’ syndrome or Siewert’s syndrome).[4] Many patients may experience unilateral anosmia, often as a result of minor head trauma. This type of anosmia is normally only detected if both of the nostrils are tested separately. Using this method of testing each nostril separately will often show a reduced or even completely absent sense of smell in either one nostril or both, something which is often not revealed if both nostrils are simultaneously tested.[5]

A related term, hyposmia, refers to a decreased ability to smell, while hyperosmia refers to an increased ability to smell. Some people may be anosmic for one particular odor. This is known as "specific anosmia". The absence of the sense of smell from birth is called Congenital Anosmia.

DiagnosisEdit

Anosmia can be diagnosed by doctors by using acetylcysteine tests. Doctors will begin with a detailed elicitation of history. Then the doctor will ask for any related injuries in relation to anosmia which could include upper respiratory infections or head injury. Psychophysical Assessment of order and taste identification can be used to identity anosmia. A nervous system examination is performed to see if the cranial nerves are damaged.[6] The diagnosis as well as the degree of impairment can now be tested much more efficiently and effectively than ever before thanks to "smell testing kits" that have been made available as well as screening tests which use materials that most clinics would readily have.[7] Occasionally, after accidents, there is a change in a patient's sense of smell. Particular smells that were present before are no longer present. On occasion, after head traumas, there are patients who have unilateral anosmia. The sense of smell should be tested individually in each nostril.[8]

Many cases of congenital anosmia remain unreported and undiagnosed. Since the disorder is present from birth the individual may have little or no understanding of the sense of smell, hence are unaware of the deficit.[9] It may also lead to reduction of appetite [10]

According to a research article, there have been many cases where MRI scans have resulted in anxiety and panic in patients, due to various reasons but mainly claustrophobia. However, these experiences were of random nature.[11]

PresentationEdit

Anosmia can have a number of harmful effects. Patients with sudden onset anosmia may find food less appetizing, though congenital anosmics rarely complain about this, and none report a loss in weight.[12] Loss of smell can also be dangerous because it hinders the detection of gas leaks, fire, and spoiled food. The common view of anosmia as trivial can make it more difficult for a patient to receive the same types of medical aid as someone who has lost other senses, such as hearing or sight.

Losing an established and sentimental smell memory (e.g. the smell of grass, of the grandparents' attic, of a particular book, of loved ones, or of oneself) has been known to cause feelings of depression.[13]

Loss of olfaction may lead to the loss of libido, though this usually does not apply to congenital anosmics.[13]

Often people who have congenital anosmia report that they pretended to be able to smell as children because they thought that smelling was something that older/mature people could do, or did not understand the concept of smelling but did not want to appear different from others. When children get older, they often realize and report to their parents that they do not actually possess a sense of smell, often to the surprise of their parents.[13]

A study done on patients suffering from anosmia found that when testing both nostrils, there was no anosmia revealed, however when testing each nostril individually, tests showed that the sense of smell was usually affected in only one of the nostrils as opposed to both. This demonstrated that unilateral anosmia is not uncommon in anosmia patients. [14]

CausesEdit

A temporary loss of smell can be caused by a blocked nose or infection. In contrast, a permanent loss of smell may be caused by death of olfactory receptor neurons in the nose or by brain injury in which there is damage to the olfactory nerve or damage to brain areas that process smell (see olfactory system). The lack of the sense of smell at birth, usually due to genetic factors, is referred to as congenital anosmia. Family members of the patient suffering from congenital anosmia are often found with similar histories; this suggests that the anosmia may follow an autosomal dominant pattern.[15] Anosmia may very occasionally be an early sign of a degenerative brain disease such as Parkinson's disease and Alzheimer's disease. Another specific cause of permanent loss could be from damage to olfactory receptor neurons because of use of certain types of nasal spray; i.e., those that cause vasoconstriction of the nasal microcirculation. To avoid such damage and the subsequent risk of loss of smell, vasoconstricting nasal sprays should be used only when absolutely necessary and then for only a short amount of time. Non-vasoconstricting sprays, such as those used to treat allergy-related congestion, are safe to use for prescribed periods of time.[16] Anosmia can also be caused by nasal polyps. These polyps are found in people with allergies, histories of sinusitis & family history. Individuals with cystic fibrosis often develop nasal polyps.

Amiodarone is a drug used in the treatment of arrhythmias of the heart. A clinical study performed demonstrated that the use of this drug induced anosmia in some patients. Although rare, there was a case in which a 66-year-old male was treated with Amiodarone for ventricular tachycardia. After the use of the drug he began experiencing olfactory disturbance, however after decreasing the dosage of Amiodarone, the severity of the anosmia decreased accordingly hence correlating the use of Amiodarone to the development of anosmia.[17]

Causes of anosmia include:

TreatmentEdit

Though anosmia caused by brain damage cannot be treated, anosmia caused by inflammatory changes in the mucosa may be treated with glucocorticoids. Reduction of inflammation through the use of oral glucocorticoids such as prednisone, followed by long term topical glucocorticoid nasal spray, would easily and safely treat the anosmia. A prednisone regimen is adjusted based on the degree of the thickness of mucosa, the discharge of oedema and the presence or absence of nasal polyps.[33] However, the treatment is not permanent and may have to be repeated after a short while.[34] Together with medication, pressure of the upper area of the nose must be mitigated through aeration and drainage.[35]

There have also been cases where the use of acupuncture have successfully treated anosmia.[36]

Although very early in development, gene therapy has restored a sense of smell in mice with congenital anosmia when caused by ciliopathy. In this case a genetic condition had affected cilia in their bodies which normally enabled them to detect air-borne chemicals, and an adenovirus was used to implant a working version of the IFT88 gene into defective cells in the nose, which restored the cilia and allowed a sense of smell.[37][38]

Zicam controversyEdit

On June 16, 2009, the U.S. Food and Drug Administration sent a warning letter to Matrixx Initiatives, manufacturer of an over-the-counter nasal spray for the common cold, Zicam. The FDA cited complaints that the product caused anosmia. The manufacturer strongly denies these allegations, but has recalled the product and has stopped selling it.[39]

In fact, Matrixx has received more than 800 reports of Zicam users who were losing their sense of smell but did not provide those reports to the F.D.A due to this product produced.[40]

Associated conditionsEdit

See alsoEdit

ReferencesEdit

  1. Knight, Allan, "Anosmia", The Lancet, August 27, 1988
  2. includeonly>The Lancet. "ANOSMIA", January 1943.
  3. Impact of Defective Cilia
  4. PMID 21475513 (PMID 21475513 &query_hl=14&itool=pubmed_docsum 21475513 )
    Citation will be completed automatically in a few minutes. Jump the queue or expand by hand
  5. Harvey, Peter. "Anosmia". Practical Neurology, 206, p. 65
  6. Anosmia / Loss Of Smell.
  7. (2003). Anosmia: Diagnosis and management. Current Opinion in Otolaryngology & Head and Neck Surgery 11: 54–60.
  8. Harvey, Peter. "Anosmia". Practical Neurology, 206, p.65.
  9. Vowels, R.H., Bleach, N. R., Rowe-Jones, J. M. (1997). Congenital anosmia. 41: 207-214.
  10. Summer, D. W. Appetite and Anosia. The Lancet (1971), 297 (7706), pg. 970-970.
  11. Knight, Allan, "Anosmia", The Lancet, August 27, 1988.
  12. my.access — University of Toronto Libraries Portal
  13. 13.0 13.1 13.2 includeonly>"Sense and scent ability", BBC News, December 27, 2006. Retrieved on April 25, 2010.
  14. Harvey,P. (2006). Anosmia. Practical Neurology. 6:64-65. Retrieved from: http://pn.bmj.com.myaccess.library.utoronto.ca/content/6/1/65.full.pdf+html
  15. Waguespack, R. (1992). Congenital Anosmia. Arch Otolargyngol Head Neck Surg. 118(1): 10.
  16. Preventing Anosmia from Intranasal Zinc Administration
  17. Maruyama T. Yasuda S. Odashiro K. Kaji Y. Harada M. (2007). Anosmia Induced by Amiodarone. The American Journal of Medicine. 120 (11). Retrieved from: http://journals1.scholarsportal.info.myaccess.library.utoronto.ca/tmp/8327703549542877532.pdf
  18. (2001). Olfaction and Its Alteration by Nasal Obstruction, Rhinitis, and Rhinosinusitis. The Laryngoscope 111 (3): 409–23.
  19. (1997). Olfactory Dysfunction in Patients with Head Trauma. Archives of Neurology 54 (9): 1131–40.
  20. (1988). Olfactory dysfunction in parkinsonism: A general deficit unrelated to neurologic signs, disease stage, or disease duration. Neurology 38 (8): 1237–44.
  21. (1999). Loss of Olfactory Function in Dementing Disease. Physiology & Behavior 66 (2): 177–82.
  22. (1989). Olfactory function in chemical workers exposed to acrylate and methacrylate vapors. American Journal of Public Health 79 (5): 613–8.
  23. (1992). Olfactory impairment after chronic occupational cadmium exposure. Journal of occupational medicine 34 (6): 600–5.
  24. (1998). Olfactory disorders induced by cadmium exposure: A clinical study. International journal of occupational medicine and environmental health 11 (3): 235–45.
  25. (1984). Smell identification ability: Changes with age. Science 226 (4681): 1441–3.
  26. Esthesioneuroblastoma. eMedicine.
  27. (2009). Treatment of Postviral Olfactory Loss with Glucocorticoids, Ginkgo biloba, and Mometasone Nasal Spray. Archives of Otolaryngology - Head and Neck Surgery 135 (10): 1000–4.
  28. (2005). Olfactory functions and volumetric measures of orbitofrontal and limbic regions in schizophrenia. Schizophrenia Research 74 (2–3): 149–61.
  29. (1997). Isolated neurosarcoidosis presenting as anosmia and visual changes. Otolaryngology - Head and Neck Surgery 117 (6): S183–6.
  30. (1995). Dental, visual, auditory and olfactory complications in Paget's disease of bone. Journal of the American Geriatrics Society 43 (12): 1384–91.
  31. Anosmia following operation for cerebral aneurys... [J Neurosurg. 1990] - PubMed - NCBI
  32. Leon-Sarmiento FE, Bayona EA, Bayona-Prieto J, Osman A, Doty RL (October 2012). Profound Olfactory Dysfunction in Myasthenia Gravis. PLoS ONE.
  33. Knight, A. (1998). Anosmia. The Lancet, 332(8609),512. doi: 10.1016/S0140-6736(88)90160-2
  34. Knight A (1988). Anosmia. The Lancet 332 (8609).
  35. Turnley W. M. H. (1963). Anosmia. The Laryngoscope 73 (4): 468–473.
  36. Michael W (2003). Anosmia treated with acupuncture. Acupuncture in Medicine 21 (4).
  37. Gene therapy rescues cilia defects and restores olfactory function in a mammalian ciliopathy model
  38. BBC News
  39. includeonly>"FDA warns against using 3 popular Zicam cold meds - CNN.com", CNN, June 16, 2009. Retrieved on April 25, 2010.
  40. title=F.D.A. Warns Against Use of Popular Cold Remedy

Further reading Edit

  • Blodgett, Bonnie (2010). Remembering Smell: A Memoir of Losing - and Discovering - the Primal Sense, Houghton Mifflin Harcourt.
  • Tafalla, Marta (2010). Nunca sabrás a qué huele Bagdad (You will never know the smell of Bagdad) (in Spanish), Autonomous University of Barcelona. - Novel dealing with congenital anosmia.



External linksEdit

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