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PRACTICE: E Ofo, B O'Reilly, and A O'Doherty Olfactory loss BMJ 2007; 334: 423 [Full text]

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Can you test my smell doctor?!

Usama F Kamel, LL57 2PW   (24 February 2007)

Drugs and Deficiencies Damage, too

Kathi J Kemper   (16 March 2007)

Can you test my smell doctor?! 24 February 2007
Usama F Kamel, Staff Otolaryngologist Ysbyty Gwynedd Hospital, LL57 2PW Send response to journal: Re: Can you test my smell doctor?!	Smell identification tests (Scratch and sniff) have become widely available, cheap and easy to perform. Patients can purchase them directly from the internet. Patients can then test themselves at home. These tests examine the patient ability to recognise different smells (which may be lost in some degenerative diseases e.g. Alzheimer’s disease). They are usually starter tests, reassure patients or alert them to seek advice. Smell threshold tests are more specialised and deal with the fine tuning of the olfactory sensation. Smell threshold testing (e.g. University of Pennsylvania Smell Threshold Test) require a specialist to perform and interpret. Competing interests: None declared
Drugs and Deficiencies Damage, too 16 March 2007
Kathi J Kemper, Caryl Guth Chair for Holistic and Integrative Medicine Wake Forest University School of Medicine; Winston-Salem, NC USA 27157 Send response to journal: Re: Drugs and Deficiencies Damage, too	Thank you for your nice review of contributors to anosmia. A growing problem in the US is anosmia due to use of topical zinc (in the nose) as a treatment for upper respiratory infections. There have been several case reports (Laryngoscope, 2006; Am J Rhinol, 2004) in humans, replicated in rats. Perhaps this is not a problem elsewhere if patients are not using these non-prescription products. On the other hand, an early symptom of systemic zinc deficiency is hyposmia. So, patients could have decreased sense of smell either from too much zinc topically or insufficient zinc systemically. Despite the overabundance of calories in modern diets in developed countries, zinc deficiency is not uncommon, particularly in elderly populations. The sense of smell also declines with age, and may be exacerbated by poor diet. Several systemic drugs/medicines can also adversely affect the sense of small (Drug Saf, 1994; Pharmacotherapy, 1997). It is always worthwhile to take a history (as well as doing a physical examination) and to consider diet and iatrogenesis in the differential diagnosis, even in a 10 minute consultation. Competing interests: None declared