Imagine a world without smell, where crushing a sprig of lavender produces – nothing. Where the sound of a lawnmower is not accompanied by the smell of freshly cut grass; where you can see the steam rise from your coffee but there’s no rich aroma. That’s the world for people with anosmia.
Related: Smell training for anosmia
Of all the five senses, you might think that smell would be the one you could most afford to lose. Yet lack of it has far-reaching effects.
At the practical end of the spectrum there’s the safety aspect – eg, being unable to detect a gas leak. At the emotional end there’s the overwhelming depression when you can no longer pick up a jumper and breathe in the comforting smell of a partner or child. Then there is the awful realisation that 80% of food’s flavour comes from its smell, so that meals become little more than joyless refuelling stops.
Anosmia is a neglected area of health care. The medical profession’s attitude has generally been: ‘Well there’s not much we can do’. Apart, that is, from a few enlightened individuals.
ENT consultant surgeon Carl Philpott runs the Smell and Taste Clinic at James Paget University Hospital in Norfolk – until recently the only one in the UK. ‘Anosmia is a relatively common problem that goes under the radar because patients don’t think anything can be done about it,’ he says. ‘It’s the sense we most take for granted, but when it goes wrong it has a profound effect.’
Duncan Boak lost his sense of smell after a severe head injury in 2005 but it was only six years later, reading about someone else’s experience, that he fully appreciated how it had affected him. ‘I felt not fully immersed in the world. It’s isolating and lonely.’ He started to research the condition, got in contact with Carl Philpott, and set up the support group Fifth Sense. As well as being a hub of information for sufferers, it also works with ENT consultant surgeons to research and develop new treatments and to educate medical professionals and the public. ‘If we can develop a better understanding of the largely hidden role of this sense in our lives, hopefully patients will no longer be turned away by doctors.’
What causes anosmia?
It can be anything from nerve damage from a head injury to blockages such as polyps, swollen airways or a crooked nasal septum.
The most common cause is chronic sinusitis; another is a viral infection of the upper respiratory tract, especially in older people, notably women over 50; current thinking is that catching colds over the years causes repeated damage to receptor cells. Less commonly, anosmia can be linked to liver disease, diabetes or an underactive thyroid. In a tiny number of cases it can be an early warning sign of diseases of the nervous system such as Parkinson’s or Alzheimer’s. A very few people are born without a sense of smell.
And for some the onset is as mysterious as it is unwelcome. The best estimate is that as many as 5% of the UK population have olfactory disorders.
Can anosmia be treated?
Antibiotics, rinses and steroids can be prescribed for sinus disease, and in some cases surgery may be necessary to remove polyps or to straighten air passages. Often a combination of treatments is needed, with surgery opening up the nose for medicines to get to work.
When anosmia has been due to a viral infection the chances of recovery within three years are 32-66%. After a head injury the outlook is 30-35% within five years, possibly 50% after ten. Where there is no known cause – and in some cases after a viral infection – some anosmics find acupuncture or homeopathy can help. ‘Smell training’ can increase the range of smells you can detect, as well as help to counteract age-related decline. The technique uses essential oils and is simple to try at home (see below).
Should I be worried?
If you’ve been caught unawares, say when a saucepan’s boiled dry, do see your GP. The first step will be a fibre-optic examination of the nose; in an ideal world you’d also be sent for smell testing (not widely available on the NHS); and in certain cases a CT or MRI scan may be needed, to check for swelling or tumours. Don’t be fobbed off – refer your GP to the Fifth Sense website.
Where to get help
Visit fifthsense.org.uk for background advice, plus research projects to join.
There are smell and taste clinics at James Paget University Hospital in Great Yarmouth and at Queen Elizabeth Hospital, Birmingham, plus a sinus clinic at the Royal Surrey County Hospital, Guildford. You will need to ask your GP for a referral.