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Anosmia: a response

Smell & Taste Research Unit, Essex Neuroscience Centre, Oldchurch Hospital, Romford, Essex RM7 0BE, UK; chrishawkes@msn.com

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We entirely agree with Peter Harvey in the February issue of Practical Neurology that in medicolegal, and indeed any form of medical practice, it is desirable to test each nostril individually.¹ Unilateral anosmia can be a rewarding finding in head injury, or in regular neurological practice where it may indicate an olfactory groove meningioma—but there are caveats. Firstly, anosmia on one or both sides is quite common in the first few weeks after head injury due to local oedema, clotted blood, and displacement of the septum. Secondly, there is a little known phenomenon—the nasal cycle. In about 80% of healthy people only one nostril is open at a time, alternating throughout the day. Doctors unaware of this may overdiagnose unilateral anosmia.

Ammonia is rather a useless test. It is difficult for someone to deny not having smelled something when they cough, wince, have running noses, and eyes. And a genuine . . . [Full text of this article]