"Doctor, my child has always had a stuffy nose and pus during this time, and the day before yesterday suddenly said that he couldn't smell it, he was only 8 years old, what should I do if I can't smell it in the future?" Seeing that you had a nasal clinic on Saturday morning, I quickly brought him to see him. Recently, Ming Ming's mother brought him to the Department of Otorhinolaryngology, Head and Neck Surgery, Jiangxi Hospital, Children's Hospital Affiliated to Chongqing Medical University, and said anxiously.
After the doctor's detailed medical history, careful examination, and improved the nasal endoscopy, it was clear that the nasal mucosa was swollen and there was a large amount of pus nasal discharge, considering that it was an olfactory disorder caused by sinusitis, the doctor did nasal negative pressure replacement for Mingming, cleaned up the secretions of the nasal cavity, and then cooperated with drug treatment.
A week later, Ming Ming came to the hospital for follow-up, the nasal discharge was much less, and the sense of smell gradually recovered, and it was clear that the parents were finally relieved.
What is smell?
The sense of smell is one of the basic senses of the human body, which is the perception of smell. Smell is an indispensable part of our daily activities, it can recognize smells, warn of danger, cause appetite, participate in memory, regulate emotions and immunity, and can also detect some diseases early, just like vision, hearing, taste, is crucial.
Theoretically, humans can smell 1 trillion smells. There are not so many smells of human beings in daily life, and it is generally believed that humans can identify 4000~10000 different odors. Olfactory cells are renewed every 30-60 days, and the olfactory nerve is the only regenerative cranial nerve. The sense of smell has a memory, even for life.
Olfactory disturbance is the loss or loss of the ability to perceive odors.
According to the etiology, it can be divided into three categories: conductive olfactory disorders (mainly caused by nasal diseases), sensorineural olfactory disorders (such as olfactory epithelium and olfactory nerve degeneration caused by viral infections or drugs), and central olfactory disorders (neurological diseases caused by head trauma, neurodegenerative diseases, congenital developmental abnormalities, etc.).
The self-reported prevalence of olfactory disorders was 1.4%~40.0%, while the prevalence of olfactory disorders obtained by olfactory psychophysical test was 4.7%~27.0%.
How do we smell it?
The olfactory system consists of the olfactory epithelium (olfactory receptors), olfactory bulbs, and olfactory cortex. The olfactory epithelium is located on the parietal wall of the nasal cavity, and the olfactory bulb and olfactory cortex are located in the skull.
Olfactory system
The odor molecules in the air enter the top of the nasal cavity with breathing, bind to the receptors distributed in the olfactory epithelium, stimulate the excitation of olfactory neurons, pass through the olfactory nerve through the sieve plate into the first level processing station of the central system - olfactory bulb, carry out information conversion in the olfactory bulb, and finally pass into the brain high-level center to form olfaction.
The principle of olfactory formation
Why can't I smell it?
Olfactory disorder refers to abnormal odor perception caused by organic or functional lesions in each link during the process of odor perception, conduction and information analysis and integration. That is, problems in any part of the olfactory pathway will lead to olfactory dysfunction. Colds, sinusitis, nasal polyps, allergic rhinitis, nasal tumors, trauma, craniocerebral diseases, etc. can all cause olfactory disorders.
Studies at home and abroad have reported that retrosensory, inflammatory and traumatic are common causes of clinical olfactory disorders, accounting for 29.3%/36.0%, 26.4%/30.0%, 14.3%/18.0% (domestic/foreign), respectively. No smell anymore, it's an alarm to health.
Acute and chronic rhinitis, sinusitis, allergic rhinitis, nasal polyps, etc. are common causes of olfactory disorders in otolaryngology. These nasal diseases cause swelling of the nasal mucosa, increased secretions, blocking nasal passages, and preventing odor molecules from binding to olfactory receptors through the olfactory area, resulting in conductive olfactory disorders; In addition, viruses and bacteria may directly invade olfactory nerve tissue, or long-term chronic inflammation will also damage the olfactory nerve epithelium and affect the sense of smell.
What are the tests related to smell?
First, first improve the specialized examination of otolaryngology, head and neck surgery. Examination of the anatomy of the nasal cavity (whether there are deformities, anatomic abnormalities, etc.) through nasal endoscopy, focusing on the patency of the middle nasal passage and olfactory fissure area and the mucosal state (whether there is hyperemia, edema, discharge, dry crust, new organisms, etc.).
Nasal endoscopy
There are subjective and objective tests to assess the sense of smell.
The subjective test is mainly an olfactory psychophysical test, which is a quantitative basic test of olfactory sensory function, requiring the subject to verbally or consciously respond to stimuli. At present, the more used olfactory psychophysical test methods include T&T olfactory meter test, olfactory stick test, University of Pennsylvania olfactory recognition test, and simple test method. These methods can assess the olfactory perception threshold and discrimination ability, and according to the test results, it can be divided into normal sense of smell, decreased sense of smell, and loss of smell (anosmia).
Methods of psychophysical testing of smell
Objective tests mainly include event-related potential, olfactory pathway nuclear magnetic resonance, functional magnetic resonance imaging, positron emission computed tomography (PET-CT) and other techniques, which can evaluate the lesion nature of olfactory disorders.
I can't smell anymore, how can I treat it?
- Treatment is directed at the cause. For those with a clear cause, appropriate treatment measures are taken for the primary disease. Such as sinusitis, allergic rhinitis, and olfactory disorders caused by colds, standardized treatment can obtain more ideal results.
- Drug therapy. Such as glucocorticoids, vitamin A, ginkgo biloba extract, sodium citrate buffer, etc. Corticosteroids are the most commonly used drugs to treat olfactory disorders. It is mostly used to treat inflammatory, traumatic and retrosensory olfactory disorders, among which inflammatory olfactory disorders have the best therapeutic effect.
- Surgical treatment. Abnormal anatomical structures can be corrected or lesions (eg, obstructive nasal lesions such as deviated septum, olfactory fissure polyps, etc.), and olfactory function can be improved in some patients with surgery.
- Olfactory training. Olfactory training refers to a treatment in which patients actively and repeatedly sniff various types of olfactory agents to improve olfactory function. May improve olfactory disturbances associated with post-sensation, traumatic, idiopathic, and neurodegenerative diseases. Phenylethanol (rose), eucalyptol (eucalyptus), citronellal (lemon), eugenol (cloves) 4 odors are mainly used, each smell is about 10 s, and the interval between the two olfectors is 10 s. Each training session lasts 5 minutes, once a day before breakfast and once a day before bedtime. The training course is not less than 16 weeks.
5. Other treatments. It can also be combined with traditional Chinese medicine, acupuncture and other methods to treat olfactory disorders.
In general, after rhinitis, sinusitis, nasal polyps, etc. are cured, the olfactory disorder can be restored. However, if left untreated, the sense of smell fails for a long time, and the nerve damage will be irreversible, resulting in the inability to recover the sense of smell. If others can smell the smell, but they or someone in the family can't smell it, such as the smell of vegetables, perfume, odor, alcohol, etc., it is recommended to go to the hospital otolaryngology-head and neck surgery as soon as possible to check for nasal diseases.
Introduction to the Nasal Specialist Clinic
In order to better serve the majority of patients, the Department of Otorhinolaryngology, Head and Neck Surgery, Jiangxi Hospital, Children's Hospital Affiliated to Chongqing Medical University, has set up a nasal specialist clinic, arranging specialists with many years of clinical work experience to sit and provide professional, effective and all-round diagnosis and treatment services for children.
Scope of treatment: allergic rhinitis, acute and chronic rhinitis, sinusitis, nosebleeds, fungal sinusitis, nasal polyps, posterior nostril atresia, nasal bone fracture, nasal sinus mass, nasal vestibular cyst, nasal vestibulitis, nasal septum deviation, nasal foreign body, nasal trauma, external nasal mass and other diseases.
Features of Nasal Specialist Clinic:
1. With high-definition nasal endoscopic camera system, electronic nasopharyngoscopy equipment. Endoscopy has the advantages of small stimulation, high definition, visual and fast. Lesions in the narrow cavity of the nose and nasopharynx can be directly observed, and parallel photographs, videos, treatment operations, etc. can be taken to improve the level of diagnosis and treatment.
2. Allergen detection: allergen skin prick test, serum allergen-specific IgE detection, and the province's leading dust mite component-specific IgE/IgG4 detection to screen for the truly sensitized protein components in the allergen. The detection method is safe and reliable, with high specificity and sensitivity, and a variety of methods can meet the needs of different patients to ensure the precise treatment and effective prevention of allergic rhinitis and other diseases.
3. Exhaled nitric oxide determination: Nitric oxide breath test is a method to evaluate airway inflammation and airway hyperresponsiveness. It has the characteristics of non-invasive, precise, safe and repeatable. "Blowing to identify disease", through the patient's blowing, detecting the concentration of exhaled nitric oxide to determine whether there is an eosinophilic inflammatory response in the airway. It is used for the auxiliary diagnosis and guidance of allergic rhinitis, nasal polyps, sinusitis and other diseases, and the evaluation of treatment effect and prognosis.
4. Nasal resistance detection: It is an objective indicator to evaluate the degree of nasal ventilation. It is a quick, accurate, non-invasive, and painless examination. Nasal congestion is one of the most common symptoms of nasal disease, and the subjective perception of nasal resistance is often inaccurate. Nasal resistance measurement provides an objective understanding of the actual ventilation of the nasal cavity and is important for diagnosing nasal diseases and evaluating efficacy.
5. Nasal local drug burning method: nosebleeds are common diseases of ENT, but some children have repeated nosebleeds, which cause physical and mental distress to children and their families. Our outpatient clinic has a nasal local drug burning method, which is fast and has significant curative effects. For bleeding in the hidden or deep position of the nasal cavity, there are methods such as anterior and posterior nasal tamponade, transnasal endoscopic nasal electrocoagulation hemostasis.
6. Nasal negative pressure replacement: commonly known as "nasal washing". It can clean the secretions of the nasal cavity, achieve the effect of cleaning the nasal cavity and synergistic drug treatment. Such as sinusitis, allergic rhinitis, acute upper respiratory tract infection, postoperative nasal surgery, etc. resulting in nasal congestion, runny nose, cough caused by nasal reflux, can be treated with nasal negative pressure replacement to improve symptoms.
7. Low-temperature plasma equipment: For chronic rhinitis, allergic rhinitis, turbinates are obviously hypertrophy, and drug treatment is ineffective, nosebleeds, nasopharyngeal hemangioma, etc., patients with indications for surgery can be operated with low-temperature plasma equipment, minimally invasive and fast recovery.
Hours: Every Saturday morning (8:00-12:00).
Clinic location: Jiulonghu Campus Pediatric Outpatient Round Building D340 Consultation Room.
Registration method: 1. WeChat public account of Jiangxi Provincial Maternal and Child Health Care Hospital (medical service - outpatient registration - children's treatment or adult treatment - Jiulonghu campus - otolaryngology-head and neck surgery - nasal specialist clinic); 2. Registration window on the first floor of the outpatient clinic; 3. Self-service machine registration.
Hospital address: Jiangxi Hospital (Jiangxi Children's Medical Center), Children's Hospital Affiliated to Chongqing Medical University (No. 508, West Railway Station Street, Honggutan District, Nanchang City, Jiangxi Province, Metro Line 2 Longgang Station Exit 1).
(Xiong Wenwen, Lei Shengqin)