The Taste and Smell Clinic, Washington, DC, USA.
Am J Otolaryngol. 2011 Jan-Feb;32(1):38-46. doi: 10.1016/j.amjoto.2009.10.001. Epub 2009 Dec 22.
Olfactory and gustatory distortions in the absence of odors or tastants (phantosmia and phantageusia, respectively) with accompanying loss of smell and taste acuity are relatively common symptoms that can occur without other otolaryngologic symptoms. Although treatment of these symptoms has been elusive, repetitive transcranial magnetic stimulation (rTMS) has been suggested as an effective corrective therapy.
The objective of the study was to assess the efficacy of rTMS treatment in patients with phantosmia and phantageusia.
Seventeen patients with symptoms of persistent phantosmia and phantageusia with accompanying loss of smell and taste acuity were studied. Before and after treatment, patients were monitored by subjective responses and with psychophysical tests of smell function (olfactometry) and taste function (gustometry). Each patient was treated with rTMS that consisted of 2 sham procedures followed by a real rTMS procedure.
After sham rTMS, no change in measurements of distortions or acuity occurred in any patient; after initial real rTMS, 2 patients received no benefit; but in the other 15, distortions decreased and acuity increased. Two of these 15 exhibited total inhibition of distortions and return of normal sensory acuity that persisted for over 5 years of follow-up. In the other 13, inhibition of distortions and improvement in sensory acuity gradually decreased; but repeated rTMS again inhibited their distortions and improved their acuity. Eighty-eight percent of patients responded to this therapeutic method, although repeated rTMS was necessary to induce these positive changes.
These results suggest that rTMS is a potential future therapeutic option to treat patients with the relatively common problems of persistent phantosmia and phantageusia with accompanying loss of taste and smell acuity. Additional systematic studies are necessary to confirm these results.
嗅觉和味觉失真，在没有气味或味觉刺激物的情况下（分别为幻嗅和幻味），同时伴有嗅觉和味觉敏锐度下降，是相对常见的症状，可能没有其他耳鼻喉症状。虽然这些症状的治疗一直难以捉摸，但重复经颅磁刺激（rTMS）已被提议作为一种有效的矫正治疗方法。
本研究旨在评估 rTMS 治疗幻嗅和幻味患者的疗效。
研究了 17 名持续性幻嗅和幻味伴有嗅觉和味觉敏锐度下降的患者。在治疗前后，通过主观反应和嗅觉功能（嗅觉计）和味觉功能（味觉计）的心理物理测试对患者进行监测。每位患者均接受 rTMS 治疗，包括 2 次假程序和 1 次真实 rTMS 程序。
在假 rTMS 后，没有患者的失真或敏锐度测量值发生变化；在初始真实 rTMS 后，有 2 名患者没有受益；但在其他 15 名患者中，失真减少，敏锐度增加。这 15 名患者中的 2 名完全抑制了失真并恢复了正常的感觉敏锐度，这种情况持续了 5 年以上的随访。在其他 13 名患者中，失真的抑制和感觉敏锐度的改善逐渐下降；但重复 rTMS 再次抑制了他们的失真并提高了他们的敏锐度。88%的患者对这种治疗方法有反应，尽管需要重复 rTMS 才能产生这些积极的变化。
这些结果表明，rTMS 是治疗持续性幻嗅和幻味伴有味觉和嗅觉敏锐度下降的相对常见问题的潜在未来治疗选择。需要进行更多的系统研究来证实这些结果。
