From the Research
The initial workup for a patient presenting with phantosmia should begin with a thorough history and physical examination, followed by a complete neurological examination, and imaging studies such as MRI of the brain to evaluate for structural abnormalities affecting the olfactory pathway. This approach is supported by recent studies, including one published in 2023 1, which highlights the importance of a comprehensive evaluation to determine the underlying cause of phantosmia.
Key Components of the Workup
- A thorough history and physical examination to identify the onset, duration, and characteristics of the phantom smells, as well as any associated symptoms
- A complete neurological examination, with special attention to cranial nerve testing, particularly the olfactory nerve (CN I) 2
- Nasal endoscopy to evaluate for sinonasal pathology
- Laboratory tests, including a complete blood count, metabolic panel, thyroid function tests, and tests for autoimmune disorders
- Imaging studies, with MRI of the brain being the preferred modality to evaluate for structural abnormalities such as tumors, stroke, or inflammatory conditions affecting the olfactory pathway
Additional Considerations
- Formal olfactory testing using standardized smell identification tests can quantify the degree of dysfunction 1
- Electroencephalography (EEG) may be considered if seizure activity is suspected as a cause
- CT scanning of the sinuses may be appropriate if sinonasal disease is suspected
Importance of a Comprehensive Approach
Phantosmia can result from various conditions, including sinonasal disease, neurological disorders, psychiatric conditions, medication side effects, or exposure to toxins. Identifying the underlying cause is crucial to guide appropriate treatment, as highlighted in a study published in 2018 3. A comprehensive approach, as outlined above, is necessary to ensure that all potential causes are considered and that the patient receives appropriate care.