Making Sense Of Smell, Taste Disorders ... Parkinson's Disease can cause problems

Hilary Waldman
Hartford (Conn.) Courant
Jan. 21, 2004 12:00 AM

There were moments on his Connecticut farm when James Northrop's bum nose was a blessing. But he sure missed the aroma
of a roasting prime rib or the fragrant garlic in a sizzling pan of shrimp scampi. Mostly, he was frightened that his
sudden loss of the ability to smell portended some horrible disease, perhaps a brain tumor or cancer invading his
sinuses.

Northrop's seemingly unusual problem brought him to the smell and taste clinic at the University of Connecticut's
Health Center in Farmington, one of a half-dozen such centers in the country.

There, after a three-hour work-up that included inhaling and tasting a variety of nasty liquids and examinations by an
internist, a dentist, an ear, nose and throat specialist and a neurologist, Northrop came away with mixed news.

He was not dying. But there was only a slim chance that the aroma of shrimp scampi or the odor from the wrong end of
his cows might ever be strong again.

Doctors said Northrop's problem might have been caused by a common virus that damaged the nerve receptors in his nasal
canal. Colds are among the leading causes of smell and taste problems, said Dr. Norman M. Mann, director of the UConn
clinic. Northrop was given nose drops and medication for acid reflux, which also can cause smell and taste disruptions.

Each year, about 200,000 people visit a doctor for help with a smell or taste disorder, according to the National
Institutes of Health. But the study of such disorders is in its infancy, and often patients and doctors do not
recognize the symptoms.

Frequently, patients had a recent viral respiratory infection before the loss. Colds can damage nerve receptors in the
tongue and nose. While there is no medical treatment, time can reverse some of the damage.

"This nerve blessedly regenerates," said Linda Bartoshuk, who researches taste disorders and oral pain at Yale School
of Medicine. While the nerve repair can take years in some cases, it can be very rapid in others.

Other more treatable causes of smell and taste loss include mouth fungus, polyps or tumors in the nose, certain
medications, and depression. Head injuries, neurological conditions such as Alzheimer's and Parkinson's diseases, gland
diseases such as diabetes, old age and exposure to toxic chemicals also can cause problems.

While clinics cannot cure everyone, they can provide answers.

"People come here; they are unhappy; food tastes like cardboard," said Lawrence Savoy, a research assistant at the
UConn clinic.

Savoy is the first stop for patients entering the Farmington clinic. Sitting behind a table in a white lab coat, he
opens plastic bottles containing various concentrations of butyl alcohol.

To the healthy nose, it smells like rotten eggs. With one hand, the patient closes off one nostril. Savoy waves a
bottle of plain water and another containing the weakest concentration of butyl alcohol under the patient's nose. The
patient is asked to identify the alcohol. The process is repeated with each nostril, and the concentration of butyl
alcohol is increased each time. The patient is given a score indicating whether the sense of smell is normal, impaired
or lost.

To test taste, patients swish solutions in their mouths. The solutions taste salty, sweet, sour or bitter, the four
sensations the tongue is programmed to pick up. Patients' responses are analyzed by computer to determine the extent
and location of taste problems.

The trick is to determine where the problem originates: in the nose or the mouth. The two must work together to convey
the subtleties of flavor.

A mouthful of smooth chocolate or the morning's first sip of robust coffee would be nothing without the combination of
smell and taste. Smell, taste and the sensations of pain, texture and temperature, which also are picked up by the
tongue, work in concert to deliver what we recognize as flavor.

Sensations perceived by the tongue are delivered directly to the brain. Smells are interpreted by the olfactory nerves
behind the eyes.

Although surgery can help people whose sense of smell is stifled by blockages such as nasal polyps, and medications can
be successful for phantom tastes and pain, doctors still have little to offer many patients. Mann and Bartoshuk said
research is needed to find ways to prevent smell and taste losses and treat problems when they occur.

Mann said the dearth of treatment options also should not discourage patients from seeking help.

"Even if I can't fix it, I can pinpoint the source of the problem," Mann said.

That was sufficient for Northrop, who discovered his loss of smell about two years ago while visiting an animal trapper
in Vermont. His trapper friend opened a jar containing a mixture of skunk gland and Crisco that he said worked wonders
for luring fisher cats. Another man inside the trapper's tiny shack almost passed out from the odor. Northrop could
barely smell it.

Since his visit to the UConn clinic two years ago, Northrop said his ability to smell has returned somewhat. And he
does not miss the full odor of his cows.

"Once I found out that it was not cancer or something, I felt, heck, I can live with that," said Northrop, 54. "It
cleared my mind."

SOURCE: Arizona Republic, AZ
http://www.azcentral.com/arizonarepublic/arizonaliving/articles/0121smell.html

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