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The physiology of olfaction is less well understood than that of the other special senses The taste of foods is
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pressure on the bleeding site When this is inadequate, various nasal tamponade methods are usually effective Predisposing factors include nasal trauma (nose picking, foreign bodies, forceful nose blowing), rhinitis, drying of the nasal mucosa from low humidity or supplemental nasal oxygen, deviation of the nasal septum, hypertension, atherosclerotic disease, hereditary hemorrhagic telangiectasia (Osler-Weber-Rendu syndrome), inhaled nasal cocaine or other drug use, alcohol use, and anticoagulation or antiplatelet medications Most cases of anterior epistaxis may be successfully treated by direct pressure on the bleeding site The nasal alae should be firmly compressed for 5 15 minutes Venous pressure is reduced in the sitting position, and leaning forward lessens the swallowing of blood Short-acting topical nasal decongestants (eg, phenylephrine, 0125 1% solution, one or two sprays), which act as vasoconstrictors, may also be helpful When the bleeding does not readily subside, the nose should be examined, using good illumination and suction, in an attempt to locate the bleeding site Topical 4% cocaine applied either as a spray or on a cotton strip serves both as an anesthetic and as a vasoconstricting agent If cocaine is unavailable, a topical decongestant (eg, oxymetazoline) and a topical anesthetic (eg, tetracaine) provide equivalent results When visible, the bleeding site may be cauterized with silver nitrate, diathermy, or electrocautery A supplemental patch of Surgicel or Gelfoam may be helpful Occasionally, a site of bleeding may be inaccessible to direct control, or attempts at direct control may be unsuccessful In such cases there are a number of alternatives When the site of bleeding is anterior, a hemostatic sealant, pneumatic nasal tamponade, or anterior packing may suffice There are a number of ways to do this, such as with several feet of lubricated iodoform packing systematically placed in the floor of the nose and then the vault of the nose, or with various manufactured products designed for nasal tamponade About 5% of nasal bleeding originates in the posterior nasal cavity Such bleeds are more commonly associated with atherosclerotic disease and hypertension If an anteriorly placed pneumatic nasal tamponade is unsuccessful, it may be necessary to consult an otolaryngologist for a pack to occlude the choana before placing a pack anteriorly Because this is uncomfortable and because it may require oxygen supplementation to prevent hypoxia, hospitalization for several days is indicated Opioid analgesics are needed to reduce the considerable discomfort and elevated blood pressure caused by a posterior pack Ligation of the nasal arterial supply (internal maxillary artery and ethmoid arteries) is an alternative to posterior nasal packing, as is endovascular embolization of the internal maxillary artery This is certainly necessary when packing fails to control life-threatening hemorrhage On rare occasions, ligation of the external carotid artery may be necessary After control of epistaxis, the patient is advised to avoid vigorous exercise for several days Nasal saline should be applied to the packing frequently to keep the packing moist
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strongly affected by our sense of smell, and studies have shown a moderate correlation between taste discrimination ability and odor discrimination ability In the past few years, discovery of the family of odor-receptor genes as well as inositol phosphate and cyclic nucleotide signaling pathways has led to a molecular basis of olfactory reception Clinically, odorant molecules traverse the nasal vault to reach the cribriform area and become soluble in the mucus overlying the exposed dendrites of receptor cells Anatomic blockage of the nares is the most common cause of olfactory dysfunction (hyposmia or anosmia) Polyps, septal deformities, and nasal tumors may prevent air from reaching the area of the cribriform plate high in the nose where these receptors are located Transient olfactory dysfunction often accompanies the common cold, nasal allergies, and perennial rhinitis About 20% of olfactory dysfunction is idiopathic, although it often follows a viral illness Some have suggested administering large doses of vitamin A and zinc to such patients, although little evidence supports their use Central nervous system neoplasms, especially those that involve the olfactory groove or temporal lobe, may affect olfaction Head trauma accounts for less than 5% of cases of hyposmia Absent, diminished, or distorted smell or taste has been reported in a wide variety of endocrine, nutritional, and nervous disorders In particular, olfactory dysfunction in Parkinson s disease and Alzheimer s disease has been the subject of recent research A great many medications have also been implicated Evaluation of olfactory dysfunction should include a thorough history of systemic illnesses and medication use as well as a physical examination focusing on the nose and nervous system Most clinical offices are not set up to test olfaction, but such tests may at times be worthwhile if only to assess whether a patient possesses any sense of smell at all Odor identification and discrimination can be tested using standardized choices (see references) Odor threshold can be tested using increasing concentrations of various materials In permanent hyposmia, counseling should be offered about seasoning foods with spices (eg, pepper) that stimulate the trigeminal as well as olfactory chemoreceptors and about safety issues such as the use of smoke alarms and electric rather than gas home appliances
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Holbrook EH et al An updated review of clinical olfaction Curr Opin Otolaryngol Head Neck Surg 2006 Feb;14(1): 23 8 [PMID: 16467634] Welge-Lussen A et al Olfactory disorders following upper respiratory tract infections Adv Otorhinolaryngol 2006;63: 125 32 [PMID: 16733337]
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