Õlfato e paladar Flashcards
Como fazer uma avaliação objetiva da anosmia?
A number of standardized olfactory and taste tests are commercially available. Most evaluate the ability of patients to detect and identify odors or tastes. For example, the most widely used of these tests, the 40-item University of Pennsylvania Smell Identification Test (UPSIT), employs norms based on nearly 4000 normal subjects. A determination is made of both absolute dysfunction (i.e., mild loss, moderate loss, severe loss, total loss, probable malingering) and relative dysfunction (percentile rank for age and sex).
O que examinar em um doente com queixa de disgeusia?
The neural evaluation should focus on cranial nerve function, with particular attention to possible skull base and intracranial lesions. Visual acuity, field, and optic disc examinations aid in the detection of intracranial mass lesions that induce elevations in intracranial pressure (papilledema) and optic atrophy, especially when one is considering Foster Kennedy syndrome (ipsilateral optic nerve atrophy and contralateral papilledema usually due to a meningioma near the olfactory bulb or tract). The ORL examination should thoroughly assess the intranasal architecture and mucosal surfaces. Delayed puberty in association with anosmia (with or without midline craniofacial abnormalities, deafness, and renal anomalies) suggests the possibility of Kallmann syndrome
Quais os exames séricos da investigação da anosmia?
Blood serum tests may be helpful to identify conditions such as diabetes, infection, heavy metal exposure, nutritional deficiency (e.g., vitamins B6 and B12), allergy, and thyroid, liver, and kidney disease
Como tratar a disgeusia?
(1) Excessive dryness of the oral mucosa is a problem with many medications and conditions, and artificial saliva (e.g., Xerolube) or oral pilocarpine treatments may prove beneficial. Other methods to improve salivary flow include the use of mints, lozenges, or sugarless gum.
(2) Flavor enhancers may make food more palatable (e.g., monosodium glutamate), but caution is advised to avoid overusing ingredients containing sodium or sugar, particularly in circumstances in which a patient also has underlying hypertension or diabetes
(3) Medications that induce distortions of taste often can be discontinued and replaced with other types of medications or modes of therapy.
(4) In the case of intranasal and sinus-related inflammatory conditions such as those seen with allergy, viruses, and traumas, the use of intranasal or systemic glucocorticoids may be helpful. One common approach is a short course of oral prednisone, typically 60 mg daily for 4 days and then tapered by 10 mg daily. The utility of restoring olfaction with either topical or systemic glucocorticoids has been studied. Topical intranasal glucocorticoids were less effective in general than systemic glucocorticoids; however, nasal steroid administration techniques were not analyzed. Intranasal glucocorticoids are more effective if administered in Moffett’s position (head in the inverted position such as over the edge of the bed with the bridge of the nose perpendicular to the floor).
Quais as causas de disgeusia?
Nonetheless, taste can be influenced by (1) the release of foul-tasting materials from the oral cavity from oral medical conditions and appliances (e.g., gingivitis, purulent sialadenitis), (2) transport problems of tastants to the taste buds (e.g., drying of the orolingual mucosa, infections, inflammatory conditions), (3) damage to the taste buds themselves (e.g., local trauma, invasive carcinomas), (4) damage to the neural pathways innervating the taste buds (e.g., middle ear infections), (5) damage to central structures (e.g., multiple sclerosis, tumor, epilepsy, stroke), and (6) systemic disturbances of metabolism (e.g., diabetes, thyroid disease, medications).
