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

The “Special Senses,” Special Testing, and the Occupational Health Practitioner

Dennis Shusterman, MD, MPH Professor 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 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 Potential 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/

Acute Methanol retinopathy

Source: Dr. Anton Vurdaft - Tropical Opthalmology (Blog) - http: / / tropical-

• phthalmology.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 vaporized

• amine. 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 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

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 exposure

Lonsbury-Martin B: Hearing Loss https: / / clinicalgate.com/ noise-induced-hearing-loss/

Acoustic neuroma

Johnson 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: 43 http: / / 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-belt vertigo”

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…

)

• I rritants (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 Agents

Physical Chemical Biological Vision

IR, UV, lasers; Computer Ergo Amines, Methanol,

• Misc. Solvents, CO

Viral conjunctivitis

Hearing

Noise Solvents, Pb Viral ?

Vestibular function

Acceleration Opticokinetic Miner’s nystagmus Solvents, Organo- phosphates, Hg, etc?

Viral ?

Olfaction

Head trauma

Metals (Cd, Cr, Ni) Solvents (various) Acids, Caustics

Post-viral

Taste

Ionizing radiation Cd, Hg, Sb, Cr, Pb, Se, Te, H2Se Bell’s palsy?

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.