Smell Loss or Smell Distortions

by , last modified on 1/9/22.
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There are a number of reasons why a person's ability to smell normally may become diminished or even disappear altogether. Sometimes the sense of smell is normal... but there is a phantom smell that is present all the time. Collectively, any dysfunction of the smell sense is called dysosmia.

Hyposmia is diminished smell.

Anosmia is complete absence in the ability to smell things.

Parosmia is a distorted sense of smell. For example, smelling sewage when a cookie smell should be present instead.

Phantosmia is a phantom smell. For example, smelling smoke when nobody else can.

It is possible to have more than one type of dysosmia. For example, one can have hyposmia, phantosmia, and paraosmia.

Before going into what may be going on, it is important to understand how the sense of smell works normally.


Think of normal smell as all the different colors one can see. BUT, when it comes to vision, the human eye really only has 3 different color photoreceptors: red, blue, and green. Colors beyond these main three are due to mixing among the red, blue, and green photoreceptors.

Similarly, the smell sense is due to about 400 different olfactory receptors. Quite a bit more than the 3 used in vision. A given smell perception is due to a specific combination of activated olfactory receptors just like how a particular color perception is due to a specific combination of activated red, blue, and green photoreceptors.

For example, a cookie smell may be perceived when olfactory receptors #30, #216, #223, and #373 are triggered.Not only that, but #30 must be activated by 25%, #216 by 5%, while #223 and #373 are fully activated at 100%.


Now imagine if some type of injury damages the olfactory nerves whether traumatic, viral, or inflammatory. This is, of course, assuming there is no nasal obstructive problem present like nasal polyps or "hidden" sinus infection.

Anosmia and Phantosmia

Anosmia occurs if all 400 olfactory nerves are completely non-functional and no smell signal is sent to the brain at all whereas phantosmia is when some olfactory nerves activate when it should not have triggered in the first place.

Normal taste depends on normal smell. As such, if a person is suffering from anosmia, BUT the sense of taste is normal... that means there is still some smell function present which is great news as it suggests that the anosmia may be reversible or treatable. However, if the taste sense is completely lost as well, that usually has a worse prognosis.

Parosmia

Parosmia happens if most of the 400 olfactory nerves DO work, but some are only able to work partially or not at all. As you can imagine, parosmia is analogous to being color blind where for example, the red color receptor is absent preventing visual perception of not just the red color… but any other color that requires red mixing with the blue and green color receptors.

So… to take the cookie smell example from the introduction, a patient may smell rotten smoke instead because one or more of the 4 smell receptors typically required is no longer working.

Perhaps only #30 and #373 activates but not #216 and #223 which unfortunately equals a smoke smell.

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Treatment

When a patient is suffering from dysosmia, organic causes are first evaluated for including nasal polyps, sino-nasal masses, and occult sinus infections. In children, nasal foreign bodies may be present.

Once organic causes have been ruled out, treatment regimens are quite varied. In our clinic, we typically start smell therapy, steroid nasal spray in the morining, and theophylline nasal spray at bedtime. If the smell change occurred recently, a course of oral steroids may also be prescribed. Depending on the circumstances of initial onset of dysosmia as well as the presence of any taste alterations as well, supplements like TriMagnesium, Zinc Gluconate, and alpha lipoic acid may also be recommended.

Smell therapy or olfactory training is a supportive technique to help people who have lost their sense of smell after a virus or injury or is suffering from parosmia. For people who start smell training immediately after smell loss, they can improve their chances of smell recovery.

Keep in mind that smell training is not a cure, but a way of assisting in smell recovery. Every time you do it, you are stimulating the olfactory nerves that help you smell and encourage them to heal. Think of it as physical therapy for the nose. The nice thing with olfactory training is that you can easily do this at home.

First, you will need to purchase four different essential oils: lemon, rose, clove, and eucalyptus. You can easily obtain them online or from aromatherapy stores.

You will also need four small amber colored empty glass jars with lids to store and utilize the oils during treatment sessions.

For each, pour some of the essential oil quarter-way up into the jar and place a disc of watercolor paper.

Keep the lid screwed on tight in between treatment sessions. The reason you only partially fill the jar is to allow airspace over the liquid for volatile odor molecules to build up in order to improve availability for sniffing. The paper increases surface area. Similarly, prepare the other 3 essential oils the same way.

Step 1: Hold the first jar about an inch away from the nose. The order in which you smell the oils does not matter.

Step 2: Perform tiny little "bunny sniffs" into the nose. Do not sniff too quickly or deeply otherwise the essential oil vapor will pass too quickly through the nose and down into the throat and lungs where it does no good. You want to try and concentrate the smell to be wholly contained within the nose.

Step 3: Do this a couple more times, but overall, there is no need to spend more than 10 seconds for each smell. Then rest for a minute to allow time for the smell to wash out of the nose.

Step 4: Move on to the next smell and repeat as above.

Step 5: Perform these steps 2 times every day for a minimum 4 months though you can certainly do this for longer.

Some things to keep in mind. Do smell train during a quiet moment of the day without distractions while focusing on what smell you are trying to perceive. If the smell seems distorted, that is ok. Any type of smell perception is a good sign. Don’t smell train straight out of the original essential oil bottle as the small opening won’t give you a very powerful smell experience. That’s why jars are always recommended to use instead.

Do keep your essential oil bottles in the fridge and away from sunlight to keep them fresh. Essential oils are expensive and have a limited shelf life. The jars used for treatment sessions should be kept at room temperature, but away from sunlight. Do change out the oils every 4-5 months. They should keep fresh during this time if you keep them tightly capped and out of the sun.

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