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Clinical Problem Solving
November 2014

Anosmia in a 9-Year-Old Boy

Author Affiliations
  • 1Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey
  • 2Massachusetts General Hospital, Boston
  • 3Massachusetts Eye and Ear Infirmary, Boston
JAMA Otolaryngol Head Neck Surg. 2014;140(11):1083-1084. doi:10.1001/jamaoto.2014.2081

A 9-year-old boy presented with anosmia of unknown duration. His parents thought it had been present since birth, noting that he had lacked interest in food for many years. The patient had no history of sinusitis, chronic congestion, snoring, or mouth breathing. His medical history was significant for recurrent otitis media (tympanostomy tubes had been placed at age 4 years), high-frequency hearing loss, and cryptorchidism (orchiopexy at age 18 months). He was also seeing an endocrinologist for short stature. His endocrinology records showed that his size was appropriate for his family (his mother was 157 cm, his father 165 cm) and that his rates of growth and weight gain were normal. He was prepubertal, with no family history of anosmia or delayed puberty. On a smell identification test performed in the office, he placed in the first percentile.1 He failed the 12-in alcohol smell test. Anterior rhinoscopy revealed septal deviation but no other abnormalities. Flexible fiber-optic examination of the nose revealed no masses, polyps, or cysts, with a minimal adenoid pad. A magnetic resonance image (MRI) of the nasal cavity obtained under anesthesia is shown in Figure 1.