beastmaster said:
For someone with smell problems, are neurologists capable of devising therapeutic strategies or are they more concerned with detailed diagnoses for ENTs to deal with?
I'm wondering which of the two (neurologist / ENT) one should see first when dealing with problems of smell. Where do these two disciplines differ/overlap on the issue?
Olfaction is a pretty fascinating thing when you start looking at it. Both ENT and neuro get involved in this. I get patients with anosmia referred to me every once in a while. Usually, the first thing you want to do (because it would be really bad form to miss it) is get some imaging of the nasopharyngeal area and frontal lobes so you don't miss that big nasopharyngeal cancer or meningioma. If that's the problem, they obviously don't need a neurologist. If a neoplasm is ruled out, it gets really pretty tough. Chronic sinus disease, allergies, and long-term smoking are common culprits. Quite a lot of sudden or rapid-onset anosmia, however, is "idiopathic" (i.e., probably viral, kind of CNI equivalent of a Bell's palsy, and like Bell's, it may or may not get better on it's own). I've known people who were anosmic for years and then recovered just as mysteriosly as they got that way.
Interestingly, it's now recognized that decrease or loss of olfaction can be a very early finding in several neurodegenerative diseases such as Parkinson's and Alzheimer's, so a careful neurologic exam (including mental status) should be done and the patient should be followed up.
Unless the cause is clearly neoplastic, allergic, or infectious (i.e., bacterial), treatment is pretty limited. But don't underestimate the seriousness of this problem: Imagine not being able to smell or taste that rotten food in the fridge or not smell that gas leak . . .. You really have to warn these patients to be careful about lots of things most of us take for granted.
