Definition
The term anosmia means lack of the sense of smell. It may also refer to a decreased sense of smell. Ageusia, a companion word, refers to a lack of taste sensation. Patients who actually have anosmia may complain wrongly of ageusia, although they retain the ability to distinguish salt, sweet, sour, and bitter—humans' only taste sensations.
Description
Of the five senses, smell ranks fourth in importance for humans, although it is much more pronounced in other animals. Bloodhounds, for example, can smell an odor that is a thousand times weaker than one perceptible by humans. Taste, considered the fifth sense, is mostly the smell of food in the mouth. The sense of smell originates from the first cranial nerves (the olfactory nerves), which sit at the base of the brain's frontal lobes, right behind the eyes and above the nose. Inhaled airborne chemicals stimulate these nerves.
There are other aberrations of smell beside a decrease. Smells can be distorted, intensified, or hallucinated. These changes usually indicate a malfunction of the brain.
Causes and symptoms
The most common cause of anosmia is nasal occlusion caused by rhinitis (inflammation of the nasal membranes). If no air gets to the olfactory nerves, smell will not happen. In turn, rhinitis and nasal polyps (growths on nasal membranes) are caused by irritants such as allergens, infections, cigarette smoke, and other air pollutants. Tumors such as nasal polyps can also block the nasal passages and the olfactory nerves and cause anosmia. Head injury or, rarely, certain viral infections can damage or destroy the olfactory nerves.
Diagnosis
It is difficult to measure a loss of smell, and no one complains of loss of smell in just one nostril. So a physician usually begins by testing each nostril separately with a common, non-irritating odor such as perfume, lemon, vanilla, or coffee. Polyps and rhinitis are obvious causal agents a physician looks for. Imaging studies of the head may be necessary in order to detect brain injury, sinus infection, or tumor.
Treatment
Cessation of smoking is one step. Many smokers who quit discover new tastes so enthusiastically that they immediately gain weight. Attention to reducing exposure to other nasal irritants and treatment of respiratory allergies or chronic upper respiratory infections will be beneficial. Corticosteroids are particularly helpful.
Alternative treatment
Finding and treating the cause of the loss of smell is the first approach in naturopathic medicine. If rhinitis is the cause, treating acute rhinitis with herbal mast cell stabilizers and herbal decongestants can offer some relief as the body heals. If chronic rhinitis is present, this is often related to an environmental irritant or to food allergies. Removal of the causative factors is the first step to healing. Nasal steams with essential oils offer relief of the blockage and tonification of the membranes. Blockages can sometimes be resolved through naso-specific therapy—a way of realigning the nasal cavities. Polyp blockage can be addressed through botanical medicine treatment as well as hydrotherapy. Olfactory nerve damage may not be regenerable. Some olfactory aberrations, like intensified sense of smell, can be resolved using homeopathic medicine.
Prognosis
If nasal inflammation is the cause of anosmia, the chances of recovery are excellent. However, if nerve damage is the cause of the problem, the recovery of smell is much more difficult.
Resources
BOOKS
Bennett, J. Claude, and Fred Plum, eds. Cecil Textbook of Medicine. Philadelphia: W. B. Saunders Co., 1996.
Harrison's Principles of Internal Medicine. Ed. Anthony S. Fauci, et al. New York: McGraw-Hill, 1997.
"Olfactory Dysfunction." In Current Medical Diagnosis and Treatment, 1996. 35th ed. Ed. Stephen McPhee, et al. Stamford: Appleton & Lange, 1995.
PERIODICALS
Davidson, T. M., C. Murphy, and A. A. Jalowayski. "Smell Impairment. Can It Be Reversed?" Postgraduate Medicine 98 (July 1995): 107-109, 112.
J. Ricker Polsdorfer, MD
