M HYPERSENSITIVITY TO SMELL

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Here’s a differential diagnosis (DDx) list for hypersensitivity to smells (also called hyperosmia):

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Differential Diagnosis: Hypersensitivity to Smells (Hyperosmia)

• Neurological Causes:

  • Migraine: Smell sensitivity (osmophobia) often precedes or accompanies migraines.

  • Seizure Disorders: Especially temporal lobe epilepsy can present with altered olfactory perception.

  • Neurodegenerative Disorders: Early stages of Parkinson’s disease or Alzheimer’s may involve olfactory changes.

• Psychiatric Causes:

  • Anxiety Disorders: Heightened sensory awareness, including smell sensitivity.

  • Depression: Some forms can be associated with sensory changes.

  • Autism Spectrum Disorder (ASD): Sensory processing differences often include hypersensitivity to odors.

  • Obsessive-Compulsive Disorder (OCD): Hyperawareness of environmental stimuli, including smells.

• Endocrine and Metabolic Causes:

  • Pregnancy: Particularly in the first trimester due to hormonal shifts.

  • Thyroid Disorders: Hyperthyroidism can sometimes heighten sensory perceptions.

  • Adrenal Disorders: Stress and adrenal dysregulation may amplify sensory sensitivities.

• Toxin and Medication-Related Causes:

  • Substance Withdrawal: Withdrawal from substances like nicotine or certain drugs may heighten smell sensitivity.

  • Medication Side Effects: Some medications (e.g., antimicrobials, antidepressants) can alter sensory perception.

• ENT (Ear, Nose, Throat) and Respiratory Causes:

  • Chronic Rhinosinusitis: Less common, but post-treatment recovery of smell can initially feel hypersensitive.

  • Nasal Polyps (post-treatment phase): After surgery, some patients experience temporary heightened smell.

  • Upper Respiratory Infections: Acute phase can sometimes cause transient changes.

• Genetic and Rare Causes:

  • Hereditary Hyperosmia: Rare, but some individuals naturally have a heightened sense of smell.

  • Multiple Chemical Sensitivity (MCS): Controversial, but patients report extreme sensitivity to environmental odors.

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Would you also like a quick flowchart-style evaluation approach for clinical use? 🩺✨
(Example: "Is it sudden onset? Associated with headaches? Psychiatric symptoms?")