Ear Nose & Throat History and Examination:
As with any aspect of a specialty practice, a thorough ear, nose, and throat history and physical examination coupled with a good understanding of the anatomy and physiology of the head and neck organ system are the key factors in reaching an accurate diagnosis of smell and taste disorders.
A detailed medical history will include the assessment of any previous incidents of olfactory loss, taste loss, nasal obstruction, dry mouth conditions, rhinosinusitis, head trauma, and upper respiratory infections. Details regarding the nature and degree of loss will be obtained. The patient will be asked if the onset was sudden or gradual, if the loss is complete or partial, and if is associated with dysgeusia (distorted ability to taste) or dysosmias (distorted identification of smell) such as paraosmias (altered perception of smell in the presence of an odor, usually unpleasant) or olfactory hallucinations. This information will be essential in identifying and localizing the problem to a peripheral or central mechanism.
A history of postnasal drip or clear rhinorrhea may indicate a cerebrospinal fluid leak, typically associated with fractures of the anterior cranial skull base or adjacent ethmoid sinuses. Medical records will be reviewed including any operative and radiological studies. Computer tomography scans and MRI of the head will be carefully reexamined since they may have been initially obtained to evaluate areas of brain injury and not specific olfactory structures.
A physical examination is essential in cases of traumatic anosmia. Nasal endoscopy will include inspection of the inferior, middle and superior meatuses, as well as the nasopharynx. Obstruction of nasal airflow by septal deviation, hypertrophy of the turbinates, neoplasia, and polyposis will be determined. Visualization of the olfactory cleft will be performed.
Additional examinations are also performed as necessary to insure that all aspects of your smell and taste problem is fully understood.
In order to understand the cause of the taste and smell dysfunction, the clinic has developed a comprehensive specialized questionnaire that would need to be completed by the patient. This questionnaire would allow the doctor to understand in detail and in quantitative terms the cause of the patients symptoms and complaints.