1/3. taste and smell disturbance with the alpha-adrenoceptor agonist midodrine.OBJECTIVE: To report a case of a disturbance of taste and smell associated with the alpha-adrenoceptor agonist midodrine. CASE SUMMARY: A 64-year-old white man with autonomic failure was started on midodrine 5 mg/day as treatment for orthostatic hypotension. After 3 months, the dose was increased to 12.5 mg/day, whereupon he noted a new onset of taste and smell disturbance. These symptoms made eating so unpleasant that the man greatly reduced his food intake, leading to significant weight loss. In addition, he experienced well-recognized adverse effects of midodrine, such as scalp pruritus, after the dose increase. All symptoms resolved with a dose reduction of midodrine (to 5 mg/day), and the patient increased his food intake, resulting in a return to his initial body weight. DISCUSSION: midodrine is commonly associated with dose-dependent adverse effects, such as scalp pruritus and cutis anserina. Disorders of taste and smell have not been previously reported with midodrine, although it has been suggested that other sympathomimetic drugs may have effects on the olfactory threshold. Severe disorders of taste and smell may impact not only on a patient's quality of life, but also on their physical well-being, with significant weight loss being reported in this case. According to the Naranjo probability scale, this patient's taste and smell disturbance was probably associated with midodrine. CONCLUSIONS: The use of midodrine may be associated with taste and smell disturbance. This case suggests that such an association is likely to be dose dependent.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/3. Initial otolaryngologic assessment of patients with taste and smell disorders.patients are often referred to otolaryngologists to evaluate dysfunctions of taste or smell. A history and physical examination focused on signs and symptoms of chemosensory disorders, in combination with screening tests for taste and smell function, can quickly and easily delineate the general type and cause of the dysfunction. Several centers for chemosensory disorders referred to in this issue are available for referral to patients who need detailed testing and evaluation. Although treatment options for most taste and smell dysfunctions are limited, by categorizing disorders, we can give the patient an idea of the probable cause and prognosis of the dysfunction.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/3. Olfactory sarcoidosis. Report of five cases and review of the literature.Changes in the olfactory system in five patients with sarcoidosis were studied by clinical and histopathological examination. Every patient studied had hypogeusia and/or hyposmia as measured by psychophysical testing. In two patients who died with this disease, the olfactory bulbs and tracts were involved by granulomatous infiltration. Two other patients showed granulomas and chronic inflammation in nasal biopsy specimens. The fifth patient was studied only clinically. Changes in olfactory and gustatory acuity are rarely searched for in patients with sarcoidosis, but they may be important indicators of major and later irreversible damage to the CNS. If diminished olfaction is established in suspect patients, nasal biopsy and examination of the CNS should be performed to confirm the presence of active sarcoidosis. Appropriate therapy may prevent damage to the patient's sensory capabilities and CNS function.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |