Clinical Evaluation of Olfactory and Gustatory Disorders

There are four basic components in the clinical evaluation of the patient with a chemosensory disorder: the history, the physical examination, the psychophysical evaluation, and the medical imaging. The history plays a very important role in the etiologic diagnosis. Often associated events with the onset of the chemosensory complaint give the most important clue as to the cause of the disorder. Although the principal strategy is to make an anatomic diagnosis and subsequently to make an etiologic diagnosis, the first step in the clinical evaluation, which is the history, often provides important etiologic information from the beginning. Indeed, the experienced interviewer always keeps in mind the mission of finding the cause and pursuing a line of inquiry that seeks causal information. The physical examination also plays an important role in the etiologic diagnosis. Abnormalities seen in the nasal and oral cavities may provide key etiologic information and focus attention to a local factor in the nose or oral cavity to explain the development of the chemosensory disorder. The normal examination leaves the etiologic possibilities open. That there may be no current evidence of a pathologic process in the nose or oral cavity does not exclude the possibility of such a process in the past that could have resulted in the chemosensory disorder. Taken together, the history and physical examination will provide the basis for the anatomic and etiologic diagnosis in the majority of patients. The role of imaging is in many ways an extensiorrof the physical examination and may in the case of inflammatory processes in the nose and paranasal sinuses provide anatomic and etiologic diagnostic information that can be obtained in no other way. The psychophysical evaluation is essential to corroborate the patient's complaints, determine the efficacy of treatment, and measure the degree of permanent impairment. The psychophysical evaluation has not been as contributory to either the determination of the site of the lesion or the cause of the chemosensory disorder as has been the case in the auditory system. Medical imaging is essential to exclude the lifethreatening causes of chemosensory disorders and, as mentioned, is of great value in identifying and quantifying inflammatory processes in the nose and paranasal sinuses (see Chap. 29 by Kimmelman on medical imaging) . Special studies employing rhinomanometry to evaluate the airway resistance and patency are an essential feature of the evaluation of a patient with an olfactory J. B. Snow, Jr.: National Institute on Deafness and Other Communication Disorders, Bethesda, Maryland 20892. R. L. Doty: Smell and Taste Center, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania 19104. L. M. Bartoshuk: Department of Surgery (Section of otolaryngology), Yale University School of Medicine, New Haven, Connecticut 06510.