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When your nose goes ... your senses of smell and taste wane with age, but more rapid declines may signal an underlying, often treatable, condition.

You probably learned about the relationship between smell and taste at an early age, when you held your nose as your mother gave you medicine.

Many people don't have to hold their nose to blunt these senses. Your olfactory abilities decline with age, and men already are less accurate than women at identifying smells. But loss of these senses also may be hastened by an array of medical conditions, many of them treatable, and even medications can affect smell and taste.


"If you have lost your sense of smell and it goes on for more than a week, especially without other nasal symptoms, it should be evaluated," says Catherine Henry, MD, with Cleveland Clinic's Head & Neck Institute. "It's hard to know until you get it looked at whether it's something that you can do anything about."


Scent molecules entering your nose are collected by receptor hair cells in the olfactory mucosa (located high in the nose). These cells then transmit electrical signals to the olfactory bulb, where mitral cells forward the signals to the brain for processing.

Your sense of smell is most accurate between ages 30 and 60 but then wanes. By age 95, you have less than a quarter of the mitral cells that you had when you were 25.

Most of what you perceive as taste is actually due to smell. Problems with smell and taste affect not only your enjoyment of food--and thus your quality of life--but also your ability to detect dangers such as fire, noxious fumes or spoiled food or milk. In severe cases, these problems significantly diminish your appetite and can lead to poor nutrition.

Dr. Henry says taste impairment often originates in the nose, and the most common treatable causes of olfactory problems are due to nasal obstruction resulting from sinusitis, colds or nasal polyps. "If you relieve that obstruction--treat sinus disease, reduce polyps--and get that airway to open up a little, you'll improve your sense of smell," she says.


Loss of smell and taste also may be the product of head trauma, dry mouth, exposure to tobacco smoke, pesticides and other irritants, or use of certain medications, including some antibiotics, zinc nasal sprays and a class of blood pressure medications known as ACE inhibitors.

Many patients are concerned about neurological causes: Alzheimer's or Parkinson's diseases. "It's common for people with Alzheimer's disease to have a poor sense of smell, but most people who have a poor sense of smell are not going to get Alzheimer's," Dr. Henry says.


Your doctor will examine your nasal passages with an endoscope, and may order a computed tomography (CT) scan of your sinuses. A magnetic resonance imaging scan (MRI) may be necessary, especially if your physician suspects a neurological cause of your problems. A "scratch and sniff" test is available to assess the degree of olfactory impairment, but it doesn't help diagnose the cause of the problem, Dr. Henry says.

Treating the underlying cause (if one is present) may help restore your smell and taste. Your doctor may prescribe medications such as antihistamines, antibiotics or nasal steroid sprays for these conditions. In some instances, minimally invasive procedures to treat polyps, sinusitis or a deviated septum may be necessary.

There is no treatment for age-related decline in smell and taste. Loss of smell due to head trauma, toxic exposures or viral infections that damage the olfactory mucosa may return over time, but if there is no improvement in six to 12 months, the condition is generally permanent.


* If you smoke, discuss smoking-cessation methods. Tobacco smoke affects your ability to identify smells and diminishes your sense of taste.

* Avoid prolonged use of over-the-counter nasal sprays and decongestant medicines, which can inhibit your sense of smell.

* Review your medications with your doctor to see if any of them could affect your smell and taste.

* Prevent dry mouth. Sip water or sugarless drinks, avoid caffeinated beverages, suck on sugar-free candies, or chew sugar-free gum to stimulate saliva flow.

* If your senses of smell and taste have declined, add variation to the texture, color and appearance of your foods to make your meals more appetizing. Avoid adding extra salt to your food, especially if you have high blood pressure.
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Title Annotation:Otolaryngology
Publication:Men's Health Advisor
Geographic Code:1USA
Date:Jul 1, 2009
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