Timothy Trone, M.D., right, administers a smell and taste test to Meghan Geiser as Justin Turner, M.D., Ph.D., left, Paul Russell, M.D., and Rick Chandra, M.D. discuss the case. (photo by Mandy Whitley)
VANDERBILT UNIVERSITY MEDICAL CENTER
Imagine being a chef who loses the sense of taste, or a sommelier who no longer has a keen sense of smell.
Or consider the possibility of not being able to detect a gas leak, or determine whether the milk has gone sour.
People who have problems with their sense of smell or taste and don’t know the cause have a new treatment option at the Vanderbilt Bill Wilkerson Center.
The Vanderbilt Smell and Taste Center kicked off in January with a monthly clinic designed to diagnose and begin treatment of smell and taste disorders. Rick Chandra, M.D., professor of Otolaryngology, said Vanderbilt has long treated these disorders as symptoms of other issues that bring patients here for treatment, and this clinic will focus on people with undiagnosed smell and taste issues.
“We’re trying to capture this unmet group of patients who feel like that’s their only and primary problem,” he said, “making sure that the patient’s history has really been examined for a cause, doing testing to really stratify the severity and then suggesting treatment strategies which may include referrals.”
Patients who come to the center may undergo different types of smell tests to determine the problem, such as discrimination, identification and threshold tests. In discrimination tests, patients are presented with a smell and asked what it is. In identification tests, patients are presented with a smell and must identify it from multiple-choice answers. And in the threshold tests, patients are given increasing concentrations of an odor to determine when they can detect it.
“These tests all do different things,” Chandra said. “Some of them measure what’s going on in the nose itself, where the odor sensations are first detected, and others measure how the odor detection is processed in the brain.”
Because the sense of smell and taste are connected, taste issues are measured with the same tests. “The vast, vast majority of taste problems are really smell problems,” Chandra said.
Possible causes for smell and taste problems range from chronic allergies to nerve loss and neurological issues. The most common issue is chronic rhinosinusitis, caused by allergies, nasal polyps or both. Chandra and his team specialize in the treatment of such disorders.
Less common causes include infections that kill smell nerves. Certain types of head trauma can also lead to smell and taste loss.
The clinic includes Chandra, Paul Russell, M.D., assistant professor of Otolaryngology and Neurological Surgery; Timothy Trone, M.D., assistant professor of Otolaryngology; Justin Turner, M.D., Ph.D., associate professor of Otolaryngology and Biomedical Engineering; and Cindy Dorminy, M.Ed., LPN.
Clinicians will focus on diagnosing the issue and treating it, either at the Bill Wilkerson Center, or by referral to another Vanderbilt specialist.
“A lot of these patients just need someone who understands the condition to spend the time and effort to really look at their history, physical, whatever testing data they’ve had and imaging studies in the past, try to elucidate a cause and then also to stratify the subtype and severity of smell disease that they have using some testing that’s been validated for that,” Chandra said.
“The smell and taste senses are not yet as well served clinically nor studied as extensively, for example, as hearing,” said Ron Eavey, M.D., Guy M. Maness Professor and chair of Otolaryngology and director of the Vanderbilt Bill Wilkerson Center.
“Yet suboptimal smell/taste function unfortunately impacts many patients, including professionals such as chefs and sommeliers. Very few centers exist nationally to test such patients in a systemic and programmatic fashion. We look forward to trying to serve, educate and to discover.”