Phantosmia: Smelling Smoke All the Time?

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You may be experiencing phantosmia or “phantom smell,” defined as smelling something (often unpleasant, such as rotten food, sewage, or something that is metallic or chemical) that simply isn’t there. The good news is that this condition often goes away on its own over time and usually doesn’t stem from anything serious. It seems to be more common in women than men and tends to occur most frequently between the ages of 15 and 30. Approximately 14 percent of pregnant women experience it, usually only early in pregnancy. (Smell and taste disorders affect an estimated 76 percent of pregnant women, according to a Swedish study published in 2004.)

Phantosmia usually begins with an episode lasting five to 20 minutes that disappears on its own with no after effects but appears again about a month later. It can occur in one or both nostrils. Over time, episodes become more frequent and last longer, according to a review by Donald Leopold, M.D., an otolaryngologist at the University of Vermont Larner College of Medicine and an expert in smell distortions. He reports that most people complaining about phantom smells have no history of upper respiratory infection or head trauma, and that aging isn’t a factor. Unfortunately, if the odor is very unpleasant – such as that of something rotten – it can spoil the taste of food and drink and seriously impact quality of life. Dr. Leopold has written that some of his patients have considered suicide because of the “hopelessness of living a life where all food smelled like spoiled meat or worse.”

In 2009, The New York Times published an article by a woman who vividly described her experience with phantosmia. She wrote that she smelled dirt all the time, which she at first attributed to her potted plants until she found that the smell followed her where ever she went, even when no dirt or potted plants were nearby. Once she learned that she suffered from phantosmia, she had a round of medical tests, including “an M.R.I. of my brain (ruling out a tumor), a CT scan of my sinuses (to check for infection), and finally an EEG,” because olfactory hallucinations can occur with seizure disorders. She received a clean bill of health and about a year later realized that the smell was gone. But then the smell of burnt chili replaced the smell of dirt, eventually to be replaced by the smell of lavender.

Phantosmia has been associated with epilepsy and migraine headaches. (Episodes linked to migraines usually disappear when the headache resolves.) It also is linked to brain tumors and may occur in patients suffering from depression or schizophrenia. But just because phantosmia can affect individuals with these disorders doesn’t mean that all cases are related to serious illness. Most aren’t. If your phantosmia doesn’t resolve on its own, you might want to consult an ear, nose and throat specialist with experience in treating distortions in smell. Available treatments include nasal saline drops, antidepressants, antiseizure medications, and sedatives. If all else fails and patients can no longer deal with the unwelcome smell, surgery to sever parts of the olfactory nerves can help resolve the problem.

Andrew Weil, M.D.

Source:
Donald Leopold, “Distortion of Olfactory Perception: Diagnosis and Treatment.” Chemical Sense, September 2002, doi.org/10.1093/chemse/27.7.611