Monday, February 22, 2010

Sjogren's Syndrome and Hyposmia

Judging by the comments on my last post about anosmia and my natural gas escapade, I think I should clarify things a bit further on the status of my non-functioning sniffer.

Although my ability to detect odors is seriously compromised, I can occasionally smell things completely randomly. What a gift it is to stick my nose in a bouquet of flowers and smell their fragrance. The senses of smell and taste are closely related : sometimes I can smell and taste a food on first exposure - like lifting the lid of a pot, or opening the door of an oven, or taking that first bite of moist carrot cake. With tangy cream cheese frosting. And crunchy pecans and sweet golden raisins.

*blink* OK. I'm back.

Perhaps the first bite, or two or three, will be abundantly flavorful. But once the initial rush to my senses has hit, it diminishes, so that by bite four or five, the characteristics of the food's scent and taste fade away. What I can count on, however, is the ability of my tongue to detect those basic tastes: sweet, sour, salty, and bitter. It's the nuances of flavor and scent that are lacking.

I can never count on being able to smell something, as my recent experience with natural gas demonstrated so vividly. Sometimes I have wonderful dreams in which I'm able to smell and taste with exceptional acuity. Sigh.

Technically, the fact that I have a limited ability to smell stuff means that my problem should be more accurately described as hyposmia. Anosmia means the ability is completely gone, and hyperosmia describes the abnormally increased ability to smell.

There can be a zillion things that impact one's ability to smell, and to understand those things, we probably should back up a bit and take a look at how our sense of smell works. Here is an illustration of a cross-section of our nasal passages. At the top of the passage, the olfactory bulb detects molecules that carry scent, and transmits this information as an electrical charge to the cranial nerve 1, and into specific areas of the brain: the hippocampus, amygdala, olfactory cortex, and hypothalamus.

Images found here

Any condition that alters the olfactory system to detect scent carrying molecules will change the system's effectiveness. Here's a list of just a few of the conditions that can snuff out your sniffer capabilities: 
 Adrenal cortical insufficiency
 Cushing's syndrome
 Diabetes mellitus
 Kallman's syndrome
 Primary amenorrhea
 Turner's syndrome
Local diseases and mechanical obstruction of the airways
 Adenoid hypertrophy
 Allergic rhinitis
 Atrophic rhinitis (Ozena)
 Bronchial asthma
 Deformity secondary to trauma
 Exposure to toxic chemicals
 Malignant disease of paranasal sinuses with extension into the nasal cavities
 Nasal polyposis
 Sjogren's syndrome
 Tumors of the nasopharynx with extension into the nasal cavities
 Vasomotor rhinitis
 Alzheimer's disease
 Head trauma
 Huntington's chorea
 Intracranial surgery
 Multiple sclerosis
 Parkinson's disease
 Chronic renal failure
 Cyanocobalamin (vitamin B12) deficiency
 Korsakoff's psychosis
 Olfactory reference syndrome
  Aneurysms of the anterior communicating bifurcation
  Frontal lobe glioma
  Internal carotid aneurysms extending over the pituitary fossa
  Suprasellar meningioma
  Sphenoidal ridge meningioma
  Other meningiomas
  Inverted papilloma
  Squamous cell carcinoma
Viral and infectious
 Acute viral hepatitis
 Herpes simplex
 Influenza-like infections
Source: From Doty RL, Kimmelman CP. Smell and taste and their disorders. In: Asbury AK, McKhann GM, McDonald WI, eds. Diseases of the nervous system. Philadelphia: W.B. Saunders, 1986;469.

My hyposmia is most likely due to Sjogren's syndrome, probably as a result of lymphocytic activity in the mucous layer of my nasal passages. 

A diagnosis of Sjogren's syndrome does NOT mean that hyposmia or anosmia is a certainty. We all know that everyone's experience with this strange disorder is different. Some medical literature classify Sjogren's related anosmia as being one of the less-encountered symptoms. I guess I'm just one of the lucky ones. 

You can read more about the olfactory bulb and the ruckus that it can cause here, here, and here


Anonymous said...

Seems like this illness is really hard to understand. Symptoms are so differents from one person to another.
Like when you rad that 90% of the people who contract are 50 year old.
Well I'm in the 5% under this age. I'm a "lucky one", like you.

annie said...

I agree with Jazzcat. The more I'm reading and researching, the more confused I'm getting with the information given. There is so much going on with the body on a daily basis that it's difficult to comprehend, even the doctors aren't sure if some of the symptoms are part of sjogren's.It is a very complicated disease, it makes sense to me now that it can take so many years to be diagnosed.
Thank you Julia, for another lesson in dealing with sjogren's. No one has as much info as you are very helpful to us (read me), as I am still a newbie to this disease. Like some other illnesses (i.e. fibromyalgia and chronic fatigue syndrome), we may manifest some of the basic symptoms, but then everyone has his/her spin on the disease.

Anonymous said...

Your description of diminished sense of smell sums up my experiences exactly.
I have never mentioned it to a Doctor and since diagnostics have become so expensive I may never. I was once told by a Doctor that I had a deviated septum but other than that my health is quite good for a 65 yo man. Keep up the good work!