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Smell and taste disorders can be thought of on a spectrum, anywhere from total loss of smell, which would be anosmia, to a blunted sense of smell. Anytime our sense of smell is affected, it's going to affect our sense of taste. Remember that our sense of taste is just basically there are a group of taste buds on the tongue that help us come up with our rudimentary ability to detect taste. It's bitter, sweet, salty, and sour. Beyond that, our sense of smell is the big driver of how we taste and appreciate things. It can be anywhere from, again, a total loss of smell with anosmia, to a blunted sense of smell which will blunt our sense of taste.

Treatment options for smell and taste disorders would be, first, to contact your physician and possibly get in to see your ear, nose, and throat, head and neck surgery specialist who has advanced training in both the diagnosis and treatment of smell and taste disorders. If you are someone that suffers from allergic rhinitis or chronic sinus and possibly with nasal polyps, you would come into your ear, nose, and throat, head and neck surgeon's office and have a full evaluation. After examining your ears, nasal passageways, oral cavity, [inaudible 00:11:14] and neck, we would do a specialized test with a small pencil-sized endoscope that we would place in the nose after decongesting it and placing some anesthesia in it to look at the extent of possible chronic polyps or disease that would be causing the obstruction.

The people at risk for developing smell and taste disorders, probably the biggest group would be those suffering from chronic sinusitis, particularly those with nasal polyps. Nasal polyps are inflammatory lining of the nose or nasal mucosa that gets adenomatous, and they act as basically a conductive block. They won't allow odorants or other molecules to get into the olfactory grove area and allow us to perceive how things smell and taste. Additionally, those with allergic rhinitis - allergies, hay fever, and chronically suffering - will have more inflammatory lining of the nose and drainage that would also act as a conductive block. People suffering from choric allergies and chronic sinus disease as probably, as far as number-wise, those that would be most at risk for smell and taste disorders.

When a person says they're losing their voice, usually what they describe is hoarseness. That can mean a wide range of things. We, as ENT physicians, will typically describe that hoarseness or dysphonia. It can be characterized by roughness or breathiness, increased effort or strain when talking. Sometimes it can be characterized by pain with voicing or speaking. For professional voice users, like a professional singer, it may mean that their speaking voice is totally normal but they have a hard time hitting their falsetto. For them, that is losing their voice. It can mean different things to different people. When we, as ENTs evaluate it, we actually give it a more descriptive term than just losing a voice or hoarseness.

By far, the most common cause of laryngitis is a virus. I would say 90 to 95% of laryngitis is viral, which means no antibiotic is necessary. It will resolve on its own with rest, including voice rest as much as possible, as well as lots and lots of hydration. We would anticipate that the voice would return back to normal within one to three weeks as that virus runs its course. Very rarely patients can get a bacterial laryngitis. That typically is associated with being short of breath, difficulty breathing. Those patients typically wind up in the ER because of those shortness of breath symptoms, so that's very rare. 

Another type of laryngitis is called fungal laryngitis, where we see that more commonly in patients who are on inhaled steroids for asthma or COPD. That steroid puts them at higher risk of a fungal infection. If a patient is on a steroid inhaler, their voice isn't getting better after that one to three weeks, where we would anticipate a virus running its course, would be appropriate to have a scope evaluation. We can very clearly see when we're able to look at the vocal cords, there's white plaques on the vocal cords that are consistent with a fungal infection. They respond very well to just an anti-fungal medication.

There are certain instances when losing your voice or going hoarse is a cause for concern. The one we already spoke about is if you use your voice suddenly and forcefully and go very hoarse, that would be concern for a vocal cord hemorrhage and should be evaluated right away. That is typically not associated with pain. The other reasons for concern, there are malignant or cancerous processes that can happen to the voice box, especially in patients with a smoking history. Anyone who has associated trouble swallowing, unintentional weight loss, that sort of thing, needs to be evaluated sooner rather than later. Any smoker who has hoarseness that's lasting more than two to three weeks should be evaluated.

For patients who do develop a viral laryngitis, symptoms will typically resolve on their own within one to three weeks, but there are things patients can do on their own to help speed up recovery. One is voice rest, as much as patients are able to rest the voice. It will help. Things like throat clearing, coughing and whispering though have the same impact as speaking normally. So when we say voice rest, we want you to limit all of those things. Also, lots and lots of hydration and rest will help speed up recovery, and non-mentholated cough drops. The menthol can actually have a drying effect on the vocal cords. So even though they can feel nice in the back of the throat, they can actually hinder recovery.