Disclosures: None Topics to be covered: Distinction between - PDF document

The “Special Senses,” Special Testing, and the Occupational Health Practitioner Dwight Bond - https: / / slideplayer.com/ user/ 9611824/ Dennis Shusterman, MD, MPH Professor of Clinical Medicine, Emeritus UCSF Division of Occupational & Environmental Medicine 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 Agent Physical Chemical Biological Vision Hearing Vestibular function Olfaction Taste Electrophysiology vs. Psychophysics Electrophysiology Psychophysics Stimuli Physical Physical or Chemical Data type Objective Behavioral Patient effort Passive (mostly) Active High (  “forced choice”) Potential for bias Low 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/ Acute Methanol 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 O.D. O.S. Source: Hwang Y , Cho YK. Two cases of corneal edema due to vaporized amine. J Korean Ophthalmol Soc 2018; 59(11): 1077-81 .

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 infectious conjunctivitis 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 Age Noise Lonsbury-Martin B: Noise-Related Hearing Loss https: / / www.enteducationswansea.org/ hearing-loss https: / / clinicalgate.com/ noise-induced-hearing-loss/ Asymmetric hearing loss Asymmetric noise exposure Acoustic neuroma Lonsbury-Martin B: Hearing Loss https: / / Johnson E: Audiological aspects of the diagnosis of clinicalgate.com/ noise-induced-hearing-loss/ 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”)

Vertigo: Rotation / Acceleration / Opticokinetic Caroline Ayinon Yale Scientific Review 12/ 24/ 13 12: 43 Aircraft Review: Extra 330SC by Vertigo Design http: / / www.yalescientific.org/ 2013/ 12/ qa-how-do- https: / / xplanereviews.com/ index.php?/ forums/ topic/ 537- dancers-spin-without-becoming-dizzy/ aircraft-review-extra-330sc-by-vertigo-design/ “Conveyor-belt vertigo” Vertigo: Alternobaric https: / / commons.wikimedia.org/ wiki/ User: Soljaguar

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 Ethmoidal Olfactory N. N. Infraorbital N. Maxillary 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. 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… )  I rritants (NH 3 , Cl 2 , SO x … )  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 Sci News 9/ 8/ 17  Quantitative (Odor detection)  Squeeze bottles  Felt-tipped pens  Alcohol Sniff Test Arnold W: Smell Disorders Taste Gustatory Dysfunction  Quantitative Disorders  Hypergeusia  Hypogeusia  Ageusia  Qualitative Disorders  Dysgeusia  Parageusia  Phantogeusia

Special Senses: Causal Agents Physical Chemical Biological IR, UV, lasers; Amines, Methanol, Viral Vision Computer Ergo Misc. Solvents, CO conjunctivitis Hearing Noise Solvents, Pb Viral ? Acceleration Solvents, Organo- Vestibular function Opticokinetic phosphates, Hg, Viral ? Miner’s nystagmus etc? Metals (Cd, Cr, Ni) Olfaction Head trauma Solvents (various) Post-viral Acids, Caustics Cd, Hg, Sb, Cr, Taste Ionizing radiation Bell’s palsy? Pb, Se, Te, H 2 Se References Davidson 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 Ophthalmol Soc 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.