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18 THE NOSE AND PARANASAL SINUSES
abnormal opening of the jaw which does not show up on radiography of the
temporomandibular joints. Manipulation of the mandible gives instant
relief. A more chronic type of pain in the ear and face is Costerfs syndrome
which occurs in patients who have inadequate molar teeth to support the
joint, or have ill-fitting dentures. In either case proper dental treatment will
alleviate the pain.
Dental pain may arise from apicitis or apical abscess, or from the impaction
of unerupted teeth, particularly the wisdom teeth.
DISTURBANCES OF OLFACTION
Anosmia, or loss of the sense of smell, may be a symptom of nasal disease.
Any bilateral obstruction to the airborne odour which prevents it from
reaching the olfactory area is the most common cause, but anosmia may arise
from damage to the olfactory pathway. Acute rhinitis may temporarily annul
the sense of smell. A more permanent anosmia will occur in the presence of
atrophic rhinitis or of nasal pojypi. Inhalation of pungent fumes, or the toxic
effects of t:he virus of influenza may be the cause, while the excessive use of
tobacco may diminish olfactory acuity. A fracture involving the cribriform
plate or the skull base, cerebral haemorrhage or intracranial tumour may
damage the olfactory pathway. A proportion of cases are of psychological
origin. The olfactory sense is tested by volatile oils in various strengths, such
as cloves, camphor and asafoetida. Pungent odours such as ammonia should
not be used. Treatment is directed to the cause, and, if this is remediable, the
result is favourable, but in many instances no improvement is obtained.
Much of the distress is due to the associated disturbance with the sense of
Parosmia is a perversion of the sense of smell, and consists usually in the
perception of an unpleasant smell, when the term cacosmia is applied.
Investigation for infection in the sinuses, tonsils or teeth may reveal the
underlying cause, but in a number of cases no cause is found, and the condition
is considered to be of neurotic origin.
Hyperosmia, or increased sensibility of the olfactory sense, is found in
many normal individuals. It is never easy to determine normality of the sense
of smell, and its investigation is not accurate in terms of measurement. The
symptom is thus a subjective one, and may be complained of in neurotic
DISTURBANCES OF THE VOICE
The effect of nasal obstruction upon the voice is familiarly met with in the
common cold. Similar voice changes are found in chronic nasal obstruction
due, for example* to nasal polypi or the mucosal oedema of nasal allergy.
The changes affect certain consonants, m becoming b, n is changed to d, and
ng to g. The speech is muffled and lacks tone due to the absence of nasal
Sneezing is a protective mechanism in which a generalized reflex reaction is
initiated by an abnormal stimulation of the nasal mucous membrane. The