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Because distinct flavors depend on aromas to stimulate the olfactory chemoreceptors, smell and taste are physiologically interdependent. Dysfunction of one often disturbs the other. Disorders of smell and taste are rarely incapacitating or life threatening, so they often do not receive close medical attention, although their effect on quality of life can be severe.
Taste:
Although abnormal taste sensations may be due to mental disorders, local causes should always be sought. Glossopharyngeal and facial nerve integrity can be determined by testing taste on both sides of the dorsum of the tongue with sugar, salt, vinegar (acid), and quinine (bitter).
Drying of the oral mucosa caused by heavy smoking, Sjögren's syndrome, radiation therapy of the head and neck, or desquamation of the tongue can impair taste, and various drugs (eg, those with anticholinergic properties and vincristine) alter taste. In all instances, the gustatory receptors are diffusely involved. When limited to one side of the tongue (eg, in Bell's palsy), ageusia (loss of the sense of taste) is rarely noticed.
Smell:
The inability to detect certain odors, such as gas or smoke, may be dangerous, and several systemic and intracranial disorders should be excluded before dismissing symptoms as harmless. Whether brain stem disease (involvement of the nucleus solitarius) can cause disorders of smell and taste is uncertain, because other neurologic manifestations usually take precedence.
Anosmia (loss of the sense of smell) is probably the most common abnormality. Hyperosmia (increased sensitivity to odors) usually reflects a neurotic or histrionic personality but can occur intermittently with seizure disorders. Dysosmia (disagreeable or distorted sense of smell) may occur with infection of the nasal sinuses, partial damage to the olfactory bulbs, or mental depression. Some cases, accompanied by a disagreeable taste, result from poor dental hygiene. Uncinate epilepsy can produce brief, vivid, unpleasant olfactory hallucinations. Hyposmia (diminished sense of smell) and hypogeusia (diminished sense of taste) can follow acute influenza, usually temporarily.
Rarely, idiopathic dysgeusia (distorted sense of taste), hypogeusia, and dysosmia respond to zinc supplementation.
Last full review/revision October 2008 by Marvin P. Fried, MD
Content last modified October 2008
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