Olfaction

The patient and surgeon often overlook the importance of sense of smell (Simmen et al., 1999). There are few reports on the incidence of the loss of sense of smell following endonasal surgery, but it may be as much as 1 % (Kimelman, 1994; Briner et al., 2003). The patient who has a sense of smell often takes it for granted, but should it be lost, there are likely to be bitter recriminations. By assessing it, not only will you be able to document whether it is already absent or reduced, but you will also be reminded to mention to the patient the risks of surgery to their sense of smell (Fig. 8.6). You might also discuss the possible benefits of surgery to their sense of smell if it is poor. It will also help you to get an idea about how important the sense of smell is to the patient. If there is a partial loss of smell, then surgery has the potential to improve it in approximately 70% of patients. However, in severe polyposis, especially associated with late-onset asthma or sensitivity to nonsteroidal anti-inflammatory drugs, it is worth warning the patient that any improvement in their sense of smell may not be sus-tained—thus you may avoid disappointment.

Olfactory tests are many and varied. The use of smell bottles has not been validated, and the "leading" questions that often accompany them can give undesirable false-positive results. The 20-page UPSIT scratch-and-sniff test is good but is time-consuming and expensive, and many of the options for each card are not recognizable outside North America, for example, "root beer." The Zurich smell identification test (Briner and Simmen, 1999) has multi-use numbered pull-out capsules with cross-cultural visual options. This test is quick and the kit can be reused for more than a year. It has been validated, and a score of the eight smells offered can be recorded in the notes. A commercial test for olfactory threshold is available but is primarily used in research as it is time-consuming (Wolfensberger et al., 2000). Serial dilutions in "sniff" bottles can be made up relatively easily (Robson and Woolons, 1996), but these have not yet gained acceptance in clinical practice. A threshold olfactometer is used in research (Fig. 8.7).

Upsit Test For Olfactometry
Fig. 8.6 We strongly recommend that you test your patient's sense of smell before surgery.
Olfactometer
Fig. 8.7 An olfactometer.
Cure Tennis Elbow Without Surgery

Cure Tennis Elbow Without Surgery

Everything you wanted to know about. How To Cure Tennis Elbow. Are you an athlete who suffers from tennis elbow? Contrary to popular opinion, most people who suffer from tennis elbow do not even play tennis. They get this condition, which is a torn tendon in the elbow, from the strain of using the same motions with the arm, repeatedly. If you have tennis elbow, you understand how the pain can disrupt your day.

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