A re-examination of the rate of vocational dysfunction among patients with anosmia and mild to moderate closed head injury.

This study sought to verify two earlier reports that up to 93% of patients with closed head injury (CHI) and anosmia are vocationally dysfunctional due to executive impairments associated with orbitofrontal damage. Participants were 11 men and 4 women identified from a pool of 60 potential subjects referred for evaluation of trauma-related chemosensory dysfunction at the University of Pennsylvania Smell and Taste Center from 1988 to 1994. These 15 subjects met four criteria: (i) willingness to complete a brief semi-structured interview concerning their pre- and post-CHI work history; (ii) age <60 years; (iii) evidence of mild to moderate CHI; and (iv) scores on the University of Pennsylvania Smell Identification Test indicative of anosmia or severe microsmia and non-malingering. In contrast to the earlier reports, only 7% of the subjects were vocationally dysfunctional. This study calls into question previous reports suggesting that anosmia is a reliable predictor of post-CHI vocational outcome.