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The sensations of smell (olfaction) and taste (gustation) are suitably considered together. Physiologically, these modalities share the singular attribute of responding primarily to chemical stimuli; that is, the end organs that mediate olfaction and gustation are chemoreceptors. Also, taste and smell are interdependent clinically, as the appreciation of the flavor of food and drink depends to a large extent on its aroma, and an abnormality of one of these senses is frequently misinterpreted as an abnormality of the other. In comparison to sight and hearing, taste and smell play a less critical role in the life of the individual. However, chemical stimuli in communication between humans are probably very important for some functions that have not been fully explored. Pheromones (pherein, “to carry”; hormon, “exciting”), that is, odorants exuded from the body, as well as perfumes, play a part in social and sexual attraction; noxious body odors may repel. In certain vertebrates the olfactory system is remarkably well developed, rivaling the sensitivity of the visual system. Though humans were thought to be capable of discriminating as many as 10,000 different odorants (Reed), more recent experimental studies have shown that this may be a vast underestimation (Bushdid and colleagues).

Disorders of taste and smell can be persistently unpleasant, but only rarely is the loss of either of these modalities a serious handicap. Nevertheless, as all foods and inhalants pass through the mouth and nose, these two senses serve to detect noxious odors (e.g., smoke) and to avoid tainted food and potential poisons. The loss of these senses could then have serious consequences. Also, because a loss of taste and smell may signify a number of intracranial, neurodegenerative, and systemic disorders, they assume additional clinical importance.


Anatomic and Physiologic Considerations

Nerve fibers subserving the sense of smell have their cells of origin in the mucous membrane of the upper and posterior parts of the nasal cavity (superior turbinates and nasal septum). The entire olfactory mucosa covers an area of about 2.5 cm2 and contains three cell types: the olfactory receptor cells, which number between 6 and 10 million in each nasal cavity; sustentacular or supporting cells, which maintain the electrolyte (particularly potassium) levels in the extracellular milieu; and basal cells, which are stem cells and the source of both the olfactory and sustentacular cells during regeneration. The olfactory cells are actually bipolar neurons. Each of these cells has a peripheral process (the olfactory rod) from which project 10 to 30 fine hairs, or cilia. These hair-like processes, which lack motility, are the sites of olfactory receptors.

The central processes of these cells, or olfactory fila, are very fine (0.2 mm in diameter) unmyelinated fibers that converge to form small fascicles enwrapped by Schwann cells that pass through openings in the cribriform plate of the ethmoid bone into ...

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