Skip to main content

Sinunasal bedingte Riechstörungen

Ursachen, Folgen, Epidemiologie und Therapie

Olfactory dysfunction due to sinonasal disease

Causes, consequences, epidemiology, and therapy

Zusammenfassung

Der Geruchssinn trägt nicht nur entscheidend zu dem bei, was gemeinhin als „Lebensqualität“ bezeichnet wird, sondern er lässt uns z. B. einen Brand frühzeitig erkennen oder schützt uns vor dem Genuss verdorbener Nahrungsmittel. In der Regel wird der Wert dieses Sinneswerkzeugs aber erst dann erkannt, wenn es verloren gegangen ist. Riechstörungen werden in 5 große Gruppen eingeteilt, die postinfektiösen, sinunasalen, posttraumatischen, neurodegenerativen und idiopathischen Ursachen entsprechen. Derzeit gibt es praktisch keine Aussagen hinsichtlich zuverlässiger prognostischer Faktoren, um die Remissionswahrscheinlichkeit auf individueller Ebene voraussagen zu können. Bei sinunasal bedingten Riechstörungen haben sich medikamentöse und operative Verfahren als effizient erwiesen. Dabei werden v. a. Kortikoide topisch und systemisch eingesetzt. Bei schweren mechanischen Behinderungen der Riechfunktion sowie bei fortgeschritteneren Stadien der nasalen Polypose hat sich die funktionelle endoskopische Nasennebenhöhlenchirurgie bewährt.

Abstract

Olfaction not only contributes to our quality of life but, among other functions, it is also necessary for identifying potential dangers, e.g., fire or spoilt food. In general the value of olfaction is only recognized when the sense of smell is impaired or lost. Olfactory dysfunction is diagnosed according to its cause (e.g., sinonasal, post-traumatic, post-upper respiratory tract infection, neurodegenerative, and idiopathic). At present little is known about prognostic factors for predicting resolution of olfactory loss on an individual basis. In cases of impaired olfaction due to sinonasal disease, both conservative and operative treatments have been established. Corticoids are used both topically and systemically. In cases of severe mechanical obstructions or advanced stages of nasal polyposis, FESS (functional endoscopic sinus surgery) seems to be the state of the art.

This is a preview of subscription content, access via your institution.

Literatur

  1. Blomqvist EH, Lundblad L, Bergstedt H, Stjarne P (2003) Placebo-controlled, randomized, double-blind study evaluating the efficacy of fluticasone propionate nasal spray for the treatment of patients with hyposmia/anosmia. Acta Otolaryngol 123: 862–868

    CAS  Article  PubMed  Google Scholar 

  2. Brämerson A, Johansson L, Ek L, Nordin S, Bende M (2004) Prevalence of olfactory dysfunction: The Skövde population-based study. Laryngoscope 114: 733–737

    Article  Google Scholar 

  3. Cain WS, Rabin MD (1989) Comparability of two tests of olfactory functioning. Chem Senses 14: 479–485

    Article  Google Scholar 

  4. Damm M, Jungehülsing M, Eckel HE, Schmidt M, Theissen P (1999) Effects of systemic steroid treatment in chronic polypoid rhinosinusitis evaluated with magnetic resonance imaging. Otolaryngol Head Neck Surg 120: 517–523

    CAS  Article  PubMed  Google Scholar 

  5. Damm M, Temmel A, Welge-Lüssen A et al. (2004) Epidemiologie und Therapie von Riechstörungen in Deutschland, Österreich und der Schweiz. HNO 52: 112–120

    CAS  Article  PubMed  Google Scholar 

  6. Damm M, Vent J, Schmidt M, Theissen P, Eckel HE, Lotsch J, Hummel T (2002) Intranasal volume and olfactory function. Chem Senses 27: 831–839

    CAS  Article  PubMed  Google Scholar 

  7. Delank KW (1998) Subjektive und objektive Methoden zur Beurteilung der Riechfunktion. HNO 46: W182–190

    CAS  Article  PubMed  Google Scholar 

  8. Delank KW, Stoll W (1998) Olfactory function after functional endoscopic sinus surgery for chronic sinusitis. Rhinology 36: 15–19

    CAS  PubMed  Google Scholar 

  9. Doty RL, Marcus A, Lee WW (1996) Development of the 12-item cross-cultural smell identification test (CC-SIT). Laryngoscope 106: 353–356

    CAS  Article  PubMed  Google Scholar 

  10. Doty RL, Shaman P, Kimmelman CP, Dann MS (1984) University of Pennsylvania Smell Identification Test: a rapid quantitative olfactory function test for the clinic. Laryngoscope 94: 176–8

    CAS  Article  PubMed  Google Scholar 

  11. Downey LL, Jacobs JB, Lebowitz RA (1996) Anosmia and chronic sinus disease. Otolaryngol Head Neck Surg 115: 24–28

    CAS  Article  PubMed  Google Scholar 

  12. El Naggar M, Kale S, Aldren C, Martin FJ (1995) Effect of Beconase nasal spray on olfactory function in post-nasal polypectomy patients: a prospective controlled trial. J Otolaryngol 109: 941–944

    Google Scholar 

  13. Fein BT, Kamin PB, Fein NN (1966) The loss of sense of smell in nasal allergy. Ann Allergy 24: 278–83

    CAS  PubMed  Google Scholar 

  14. Frasnelli J, Landis BN, Heilmann S et al. (2003) Clinical presentation of qualitative olfactory dysfunction. Eur Arch Otorhinolaryngol 11: 11

    Google Scholar 

  15. Frye RE, Schwartz BS, Doty RL (1990) Dose-related effects of cigarette smoking on olfactory function. JAMA 263: 1233–1236

    CAS  Article  PubMed  Google Scholar 

  16. Getchell TV, Getchell ML (1991) Peripheral mechanisms of olfaction: biochemistry and neurophysiology. In: Finger TE, Silver WL (eds) Neurobiology of taste and smell. Krieger, Malabar, pp 91–123

  17. Glusman G, Yanai I, Rubin I, Lancet D (2001) The complete human olfactory subgenome. Genome Res 11: 685–702

    CAS  Article  PubMed  Google Scholar 

  18. Golding-Wood DG, Holmstrom M, Darby Y, Scadding GK, Lund VJ (1996) The treatment of hyposmia with intranasal steroids. J Laryngol Otol 110: 132–135

    CAS  Article  PubMed  Google Scholar 

  19. Goodspeed RB, Gent JF, Catalanotto FA, Cain WS, Zagraniski PT (1986) Corticosteroids in olfactory dysfunction. In: Meiselman HL, Rivlin RS (eds) Clinical measurement of taste and smell, Macmillan, New York pp 230–242

  20. Gudziol H, Schubert M, Hummel T (2001) Decreased trigeminal sensitivity in anosmia. ORL J Otorhinolaryngol Relat Spec 63: 72–75

    CAS  PubMed  Google Scholar 

  21. Heilmann S, Hüttenbrink KB, Hummel T (2004) Local and systemic administration of corticosteroids in the treatment of olfactory loss. Am J Rhinol 18: 29–33

    PubMed  Google Scholar 

  22. Hosemann W, Görtzen W, Wohlleben R, Wolf SR, Wigand ME (1993) Olfaction after endoscopic endonasal ethmoidectomy. Am J Rhinol 7: 11–15

    Article  Google Scholar 

  23. Hotchkiss WT (1956) Influence of prednisone on nasal polyposis with anosmia. Arch Otolaryngol 478–479

  24. Hummel T (2003) Therapie von Riechstörungen. Laryngorhinootologie 82: 552–554

    CAS  Article  PubMed  Google Scholar 

  25. Hummel T, Kobal G (2001) Olfactory event-related potentials. In: Simon, SA, Nicolelis MAL (eds) Methods and frontiers in chemosensory research. CRC, Boca Raton/FL, USA, pp 429–464

  26. Hummel T, Konnerth CG, Rosenheim K, Kobal G (2001) Screening of olfactory function with a four-minute odor identification test: reliability, normative data, and investigations in patients with olfactory loss. Ann Otol Rhinol Laryngol 110: 976–981

    CAS  PubMed  Google Scholar 

  27. Hummel T, Rosenheim K, Knecht M, Heilmann S, Murbe D, Huttenbrink KB (1999) Der gustatorische Riechtest in der Technik nach Güttich: Eine Überprüfung der klinischen Brauchbarkeit. Laryngorhinootologie 78: 627–31

    CAS  Article  PubMed  Google Scholar 

  28. Huttenbrink KB (1997) Riech- und Schmeckstörungen: Bewährtes und Neues zu Diagnostik und Therapie. Laryngorhinootologie 76: 506–514

    CAS  Article  PubMed  Google Scholar 

  29. Klimek L, Eggers G (1997) Olfactory dysfunction in allergic rhinitis is related to nasal eosinophilc inflammation. J Allergy Clin Immunol 100: 159–164

    Article  Google Scholar 

  30. Klimek L, Hummel T, Moll B, Kobal G, Mann WJ (1998) Lateralized and bilateral olfactory function in patients with chronic sinusitis compared with healthy control subjects. Laryngoscope 108: 111–114

    CAS  Article  PubMed  Google Scholar 

  31. Kobal G (1981) Elektrophysiologische Untersuchungen des menschlichen Geruchssinns. Thieme, Stuttgart

  32. Kobal G, Klimek L, Wolfensberger M et al. (2000) Multicenter investigation of 1,036 subjects using a standardized method for the assessment of olfactory function combining tests of odor identification, odor discrimination, and olfactory thresholds. Eur Arch Otorhinolaryngol 257: 205–211

    CAS  Article  PubMed  Google Scholar 

  33. Kremer B, Klimek L, Mösges R (1998) Clinical validation of a new olfactory test. Eur Arch Otorhinolaryngol 255: 355–358

    CAS  Article  PubMed  Google Scholar 

  34. Landis BN, Hummel T, Hugentobler M, Giger R, Lacroix JS (2003) Ratings of overall olfactory function. Chem Senses 28: 691–694

    CAS  Article  PubMed  Google Scholar 

  35. Landis BN, Konnerth CG, Hummel T (2004) A study on the frequency of olfactory dysfunction. Laryngoscope 114: 1764–1769

    CAS  Article  PubMed  Google Scholar 

  36. Leopold D (1995) Distorted olfactory perception. In: Doty RL (ed) Handbook of olfaction and gustation, Marcel Dekker, New York, pp 441–454

  37. Leopold DA, Hummel T, Schwob JE, Hong SC, Knecht M, Kobal G (2000) Anterior distribution of human olfactory epithelium. Laryngoscope 110: 417–421

    CAS  Article  PubMed  Google Scholar 

  38. Lildholdt T, Rundcrantz H, Lindqvist N (1995) Efficacy of topical corticosteroid powder for nasal polyps: a double-blind, placebo-controlled study of budesonide. Clin Otolaryngol 20: 26–30

    CAS  Article  PubMed  Google Scholar 

  39. Meltzer EO, Jalowayski AA, Orgel A, Harris AG (1998) Subjecive and objective assessments in patients with seasonal allergic rhinitis: effects of therapy with mometasone furoate nasal spray. J Allergy Clin Immunol 102: 39–49

    CAS  Article  PubMed  Google Scholar 

  40. Miwa T, Furukawa M, Tsukatani T, Costanzo RM, DiNardo LJ, Reiter ER (2001) Impact of olfactory impairment on quality of life and disability. Arch Otolaryngol Head Neck Surg 127: 497–503

    CAS  PubMed  Google Scholar 

  41. Mott AE, Cain WS, Lafreniere D, Leonard G, Gent JF, Frank ME (1997) Topical corticosteroid treatment of anosmia associated with nasal and sinus disease. Arch Otolaryngol Head Neck Surg 123: 367–372

    CAS  PubMed  Google Scholar 

  42. Nakamura H, Fujiwara M, Kawasaki M, Nonomura N, Takahashi S (1998) Age-related changes in dividing cells of the olfactory epithelium of the maturing guinea pig. Eur Arch Otorhinolaryngol 255: 289–292

    CAS  Article  PubMed  Google Scholar 

  43. Seiden AM, Duncan HJ (2001) The diagnosis of a conductive olfactory loss. Laryngoscope 111: 9–14

    CAS  Article  PubMed  Google Scholar 

  44. Simmen D, Briner HR, Hess K (1999) [Screening of olfaction with smell diskettes]. Laryngorhinootologie 78: 125–30

    CAS  Article  PubMed  Google Scholar 

  45. Stuck BA, Blum A, Hagner AE, Hummel T, Klimek L, Hörmann K (2003) Mometasone furoate nasal spray improves olfactory performance in seasonal allergic rhinitis. Allergy 58: 1195

    CAS  Article  PubMed  Google Scholar 

  46. Temmel AF, Quint C, Schickinger-Fischer B, Klimek L, Stoller E, Hummel T (2002) Characteristics of olfactory disorders in relation to major causes of olfactory loss. Arch Otolaryngol Head Neck Surg 128: 635–641

    PubMed  Google Scholar 

  47. Toft A, Wihl JA, Toxman J, Mygind N (1982) Double-blind comparison between beclomethasone dipropionate as aerosol and as powder in patients with nasal polyposis. Clin Allergy 12: 391–401

    CAS  Article  PubMed  Google Scholar 

  48. van Camp C, Clement PA (1994) Results of oral steroid treatment in nasal polyposis. Rhinology 32: 5–9

    Google Scholar 

  49. von Skramlik E (1926) Handbuch der Physiologie der niederen Sinne. Thieme, Leipzig

Download references

Interessenkonflikt:

Der korrespondierende Autor versichert, dass keine Verbindungen mit einer Firma, deren Produkt in dem Artikel genannt ist, oder einer Firma, die ein Konkurrenzprodukt vertreibt, bestehen.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to T. Hummel.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Hummel, T., Hüttenbrink, KB. Sinunasal bedingte Riechstörungen. HNO 53, S26–S32 (2005). https://doi.org/10.1007/s00106-005-1233-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00106-005-1233-2

Schlüsselwörter

  • Riechen
  • Entzündung
  • Hyposmie
  • Anosmie
  • Riechstörung

Keywords

  • Smell
  • Inflammation
  • Hyposmia
  • Anosmia
  • Olfactory dysfunction