The “Special Senses,” Special Testing, and the Occupational Health Practitioner
Dennis Shusterman, MD, MPHProfessor of Clinical Medicine, Emeritus
UCSF Division of Occupational & Environmental Medicine
Dwight Bond - https://slideplayer.com/user/9611824/
Disclosures: None
Topics to be covered: Distinction between general & special senses
Review of occupational disorders of the special senses
Distinction between electrophysiology & psychophysical testing
Review of psychophysical tests in the special senses
Definition of “General Senses” “…the general senses …are perceived [through]
receptors scattered throughout the body... rather than tied to a specific [organ]”
Mechanoreception Touch / Pressure / Vibration / Proprioception
Thermoreception
Chemoreception Exogenous & endogenous agents
Nociception
Definition of “Special Senses”
“…the special senses are the senses that
have specialized organs devoted to them”
Vision
Hearing
Vestibular function
Olfaction
Taste
Both general and special sensory systems employ specialized cell structures
Dr. Hugo Heyman - http://www.doctorhugo.org/synaesthesia/receptors.html
Cr. N’s. & Special Senses
https://en.wikivet.net/Cranial_Nerves_-_Anatomy_&_Physiology
Sensory Modality vs. Causal AgentPhysical Chemical Biological
Vision
Hearing
Vestibular function
Olfaction
Taste
Electrophysiology vs. Psychophysics
Electrophysiology PsychophysicsStimuli Physical Physical or ChemicalData type Objective BehavioralPatient effort Passive (mostly) ActivePotential for bias Low High ( “forced choice”)
Credit: James Joe, MBBS Credit: Kohitij Kar, PhD, MIT
Vision
UV-induced corneal “flash burns”
IR-induced cataracts
Source: Hunter D: The Diseases of Occupations (ed. 6) London, Hodder & Stroughton, 1978, p. 842.
Laser-induced retinal injury
https://www.laserlevelhub.net/protecting-your-eyesight-from-laser-injuries-when-using-laser-level/
AcuteMethanol retinopathy
Source: Dr. Anton Vurdaft - Tropical Opthalmology (Blog) - http://tropical-ophthalmology.com/2017/08/18/methanol-optic-neuropathy-rapid-blindness/
(with permission)
Amine-induced glaucopsia
Source: Hwang Y, Cho YK. Two cases of corneal edema due to vaporizedamine. J Korean Ophthalmol Soc 2018; 59(11):1077-81.
O.D. O.S.
Solvent-induced dyschromatopsia
Reference: Gobba F. Color vision impairment in workers exposed to neurotoxic chemicals. Neurotoxicology. 2003 Aug;24(4-5):693-702.
Epidemic kerato-conjunctivitis
Ref: Doyle L, Gallagher K, Heath BS, Patterson WB. An outbreak of infectiousconjunctivitis spread by microscopes. J Occup Med. 1989 Sep;31(9):758-62.
Hearing
Impetus for hearing screening:
Routine periodic surveillance
OSHA-mandated
PEL = 90 dBA as an 8-hour TWA
5 dBA “exchange rate” (havling of time)
85 dBA “Action Level” for hearing conservation
program (warning, IH, PPE & surveillance)
Symptomatic (hearing loss, tinnitus)
Self-reported
Other-reported (typically, spouse / partner)
Types of hearing loss: Conductive
External ear, e.g.: Cerumenous impactoin
Exostosis (“surfer’s ear”)
Middle ear, e.g.,: Otosclerosis; TM perf; Cholesteatoma
Sensorineural Presbyacusis
Ototoxicity (drugs & indust. chemicals)
Noise-related
High-frequency hearing loss
https://www.enteducationswansea.org/hearing-loss Lonsbury-Martin B: Noise-Related Hearing Loss https://clinicalgate.com/noise-induced-hearing-loss/
Age Noise
Asymmetric hearing loss
Asymmetric noise exposureLonsbury-Martin B: Hearing Loss https://
clinicalgate.com/noise-induced-hearing-loss/
Acoustic neuromaJohnson E: Audiological aspects of the diagnosis of acoustic neuromad. J Neurosurg 1966; 24(3):621.
Solvent-noise interaction in hearing loss
Nakhooda F, et al. The effects of combined exposure of solvents and noise on auditory function –
A systematic review and meta-analysis. S Afr J Commun Disord. 2019; 66(1):e1-e11.
Vestibular Function
Characterization & DDX of “dizziness” Lightheadedness
Orthostatic hypotension Hyperventilation (e.g., panic attacks) Intoxication (e.g., solvents) Post-concussive
Vertigo Benign positional Labyrinthitis / Meniere’s Rotation / Acceleration / Opticokinetic Barometric (“alternobaric”)
Caroline Ayinon Yale Scientific Review 12/24/13 12:43http://www.yalescientific.org/2013/12/qa-how-do-
dancers-spin-without-becoming-dizzy/
Aircraft Review: Extra 330SC by Vertigo Design https://xplanereviews.com/index.php?/forums/topic/537-
aircraft-review-extra-330sc-by-vertigo-design/
Vertigo: Rotation / Acceleration / Opticokinetic
“Conveyor-beltvertigo”
https://commons.wikimedia.org/wiki/User:Soljaguar
Vertigo: Alternobaric
Dix-Hallpike Maneuver
Source: Huh Y-E: Bedside evaluation of dizzy patients. J Clin Neurol 2013; 9:203-213
“Miner’s nystagmus”
Source: Fishman RS: The rise and fall of miner’s nystagmus. Arch Opthalmology 2006; 124:1637
Olfaction
Olfaction vs. Trigeminal Sensation
Maxillary N.
Ethmoidal N.
Infraorbital N.
Source: Frasnelli J, Hummel T, Shusterman D. Clinical disorders of the trigeminal systm.In: Welge-Luessen: Management of Smell and Taste disroders. Stuttgart: Thieme, 2014.
Olfactory N.
Source: Ishman SL: Calcification of the olfactory bulb in three patients with hyposmia.Am J Neuroradiol 2003; 24:2097–2101.
Olfactory Disorders
Decreased olfaction
Hyposmia
Anosmia
Dysosmias (distorted olfaction)
Cacosmia
Torquosmia
Phantosmia
DDX of Acquired Olfactory Loss Age / Neurodegenerative disorders
Conductive loss
Allergy, infection, neoplasm
Head trauma
Smoking
Occupational chemical insults Metals (Cd, Ni, Cr, Zn…)
Irritants (NH3, Cl2, SOx…)
Solvents (acetone, benzene, dibasic esters…)
21 y/o/m boatbuilder with OR, hyposmia, OA & ACD
Vapor-phase stimuli
Doty & Kamath, 2014
Olfactory Testing
Qualitative (Odor ID)
Microencapsulated
Felt-tipped pens
Quantitative (Odor detection) Squeeze bottles
Felt-tipped pens
Alcohol Sniff Test
Sci News 9/8/17
Arnold W: Smell Disorders
Taste
Quantitative Disorders Hypergeusia
Hypogeusia
Ageusia
Qualitative Disorders Dysgeusia
Parageusia
Phantogeusia
Gustatory Dysfunction
Special Senses: Causal AgentsPhysical Chemical Biological
Vision IR, UV, lasers; Computer Ergo
Amines, Methanol, Misc. Solvents, CO
Viral conjunctivitis
Hearing Noise Solvents, Pb Viral ?
Vestibular functionAccelerationOpticokinetic
Miner’s nystagmus
Solvents, Organo-phosphates, Hg,
etc?Viral ?
Olfaction Head traumaMetals (Cd, Cr, Ni)Solvents (various)
Acids, CausticsPost-viral
Taste Ionizing radiationCd, Hg, Sb, Cr, Pb, Se, Te, H2Se Bell’s palsy?
ReferencesDavidson T, Murphy C. Rapid clinical evaluation of anosmia: The alcohol sniff test.
Arch Otolaryngol – OHNS 1997; 123:591-4.
Doyle L, et al. An outbreak of infectious conjunctivitis spread by microscopes. J Occup Med. 1989 Sep;31(9):758-62.
Fishman RS: The rise and fall of miner’s nystagmus. Arch Opthalmology 2006; 124:1637
Gobba F, Cavalleri A. Color vision impairment in workers exposed to neurotoxic chemicals. Neurotoxicology. 2003 Aug;24(4-5):693-702.
Huh Y-E: Bedside evaluation of dizzy patients. J Clin Neurol 2013; 9:203-213
Hwang Y, Cho YK. Two cases of corneal edema due to vaporized amine. J Korean OphthalmolSoc 2018; 59(11):1077-81.
Hunter D: The Diseases of Occupations (ed. 6). London: Hodder & Stroughton, 1978, p. 842.
Nakhooda F et al. The effects of combined exposure of solvents and noise on auditory function - A systematic review and meta-analysis. S Afr J Commun Disord 2019; 66(1):e1-e11.
Shusterman D, Sheedy J: Occupational and environmental disorders of the special senses. Occ Med State of Art Reviews 1992; 7(3): 515.
Werner S, Nies E: Olfactory dysfunction revisited: A reappraisal of work-related olfactory dysfunction caused by chemicals. J Occup Med Toxicol 2018; 13:28.