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Emmanuel Ojo
Professor of Otorhinolaryngology and Consultant Ear, Nose and Throat Surgeon at the Bayero University, Kano, Abubakar Salisu, shares his views with EMMANUEL OJO about the common causes and management of anosmia, commonly referred to as smell blindness
What is anosmia?
Medically speaking, anosmia is the loss of the sense of smell either partially or permanently. That’s what anosmia is about.
Some describe anosmia as smell blindness. Do you think that description fits?
Well, it’s just a way of playing with words, but it’s true. It’s a way of playing around with English words, but it’s true.
When can it be said to be temporary or permanent?
First of all, you have to look at how a person perceives smell. When an odour comes to the nose; at the roof of the nose, there are some receptors there that receive this information and pass it through the nerve to the brain. When something obstructs the odour from reaching those receptors, it is possible that when the obstruction is removed, the receptors will be able to receive the odour; that is temporary. However, for the permanent, something is affecting the receptors or the nerves or the brain. It is possible that it may not recover.
What causes it?
It is a result of things that cause blockage, basically blocking the odour from reaching the receptors at the roof of the nose. The other cause is a result of having things that affect the receptors, the nerves, or even the brain. So, those that obstruct the cavity are the temporary ones that can be taken care of, but for those that affect the receptors, nerves, or the brain, majority of them are permanent.
How long does temporary anosmia last before normalcy is restored?
Those ones that are temporary have different causes. The most common one is the cold we all have, catarrh. When one has catarrh, there will be swelling of the walls of the nose. This swelling will prevent the odour from reaching the roof. So, the person may have some degree of anosmia. Then sometimes, a child may put something in the nose, maybe a foreign object and the object may block the odour from reaching the roof, and then some people have sinusitis. Many other things can cause it. Also, some viruses can actually affect the nerve and then can cause temporary anosmia. The most recent one is found with COVID-19. The virus can affect the nerve. Some people may recover, and some may not recover.
Anosmia is a symptom itself, not a disease per se, but it signifies that something is wrong, something is blocking odour from reaching the brain. So, patients who complain of anosmia will have to be examined. First of all, the nose is given priority, then, the tract between the nose up to the brain. In the hospital, there are ways of assessing all that; so, the anosmia per se is just a symptom of something else.
In the major cavity, apart from the common cold that was mentioned; rhinosinusitis and so on, some of them may be tumours, or cancer in the nose. Now, there are some subtle ones that may not easily be seen. For instance, the virus which attacks the nerve, and within seven to 10 days, the virus is gone, but their impact remains, and it may take about a year for the nerve to recover. In such a situation, you see the individual complaining of anosmia. They can’t find any cause; the only link may be when the patient says that he suffered something like catarrh or something, and that’s most likely the cause we have some ominous ones like brain cancer and it can come in different forms, and then you have trauma.
I have seen somebody who used a screwdriver to clean his nose. By doing such, they could injure the nose and cause damage to the receptors. Also, head injury; people involved in road accidents, had head injuries, and so on. This can cause anosmia. So, these are some of the causes of anosmia.
How common is it?
For the temporary one, there are chances that the cause will be what is disturbing the individual more. He is likely to present common complaints. You will only find out that it’s anosmia if you ask directly because there are other things like blockage of the nose, inability to breathe well, and so on. Those ones are more disturbing to the patient. For temporary anosmia, it usually takes a person who pays close attention to his health to observe before he complains, else, he is most likely going to complain of other things whereas, the permanent anosmia makes individuals who don’t have other complaints to complain of loss of smell. The nose is clear, they can breathe satisfactorily. Some of them may even come to say that they are not enjoying food anymore because they can’t find what it is directly linked to. For some in an extreme situation, they may come out to say that they are losing weight and you begin to wonder how come they are losing weight. It’s because they are eating less now, or they don’t have much interest in meals anymore because the flavour is missing. That’s how some of these things occur.
Those with permanent anosmia are likely to come to the hospital to complain that they can’t perceive things anymore while those with temporary anosmia are not likely to complain directly. They may just complain of other things disturbing, and then they may add that anosmia is also disturbing them.
There are other terms that are similar to anosmia. How are they related and what are their differences?
Yes, those are terminologies used to describe an abnormal smell. For instance, cacosmia means that the person is having bad breath. Maybe he has sinusitis, lung abscess, or other related illnesses. So, cacosmia happens generally when you have pus collection somewhere along the way. The air that one is breathing will follow that pus and then the person will perceive it. He may complain that he is having bad breath.
There is another one called parosmia which has to do with mental battles. The person perceives odour that is not present in the environment. It’s like a hallucination. With the complaint of this, the patient is likely to be treated by a psychiatrist.
When someone has a hallucination, there are chances that there are chemical imbalances in the brain and the psychiatry clinic will try to give medications that will compensate for those chemical imbalances and hopefully, the person recovers.
Back to anosmia; how is it diagnosed?
Either temporary or permanent, when one complains of it, he has to go through a series of investigations, and the first one is to have an examination of the nasal cavity. We can examine it by using direct light and we can also use major endoscopy, but major endoscopy will give us a much clearer view. We will be able to see the roof clearly and identify the obstruction that is on the roof of the nose that is blocking the receptors. So, the major endoscopy will be able to find the obstruction. We use ETA (Emergency Treatment Area) when we suspect trauma but for those ones that are permanent, maybe we suspect a nerve problem or maybe there is a brain problem, we will need a CT scan (Computer Tomography scan) and sometimes it may require an MRI scan. They are the final things that we can do and the reason for doing those things is to exclude some of these very terrible causes of anosmia. Once these ones are excluded, the patient can be reassured and that will assure us and go a long way in treating the patient.
Is there a treatment for permanent anosmia?
Yes. First of all, one of the causes of permanent one is degeneration; that is somebody is ageing. So, all the tissues in the body are slowing down, and some of them are dying off. Therefore, you can’t really recover those ones; hence, you need to ask the patient to do some lifestyle changes. For instance, for the meal, the flavour should be increased so that the taste bud of the individual and the smell sense will be protected. For instance, if food has spoilt, it’s your smell sense that will tell you not to consume it and that it is bad. When the electrical wires in the house are melting, before the house is set on fire, it is first of all the nose that helps with the first information, so, someone that has anosmia will miss out on all these.
One of the things to do is to make sure that this individual pays attention to food. No left-over food. Anybody staying with the individual should make sure that foods are monitored to avoid eating spoilt food. Just like when one perceives the smell of burning wires, the next thing is to start seeing flames. So, you should make sure that you install fire alarms at least to warn the patient early enough.
There are many causes of anosmia and when they are identified, they have their own method of treatment. As long as the treatment does not involve removing the nerves that are responsible for smell, the hope is that once you treat the whole thing, the person will come back to normal.
Are there complications that come with this condition?
Yes, as I mentioned, its protective functions will be lost and then, one important thing is that it has to do with food. If an individual is not enjoying the meal, you see the person losing weight. The overall quality of life of the individual will be affected by just losing the sense of smell. As a symptom, there are other complications. The complications will be from the cause of the anosmia.
What are the preventive measures?
The preventive measures will have to be seen around the cause. If someone has suffered some catarrh for instance, and the catarrh has gone but the sense of smell has not come back, then the person needs to go to the hospital. Again, the fact that the person had anosmia may mean that the person has brain cancer or some serious problems in the head. One should not just stay back. There are some funny situations whereby you cannot just fully explain the anosmia. If you have anosmia, then you should stop taking alcohol.
There are people who are malnourished. Anosmia develops in malnourishment. If there is a good diet, then anosmia will disappear. There are others who are working in places where dust forms on the roof of their nose, like carpenters for instance, and people who work in the wood industry; they are constantly exposed to this wood dust. What will this wood dust do? They block transmission. So, they won’t primarily complain that they have catarrh or something. They will just complain that they have anosmia.
You also have people who are exposed to some toxic things. For instance, those dealing with chemicals as you have in the petroleum industry, people who make a lot of other chemicals. Again, the people who are working in such situations may develop anosmia from that workplace and the smell may end up improving. It all depends on the situation.
There are also some drugs. It is known that some people who are hypertensive and take some anti-hypertensive drugs may develop anosmia. So, they can go back to their doctor and lay a complaint that it may be related to the drug they are taking, so that they may switch to the other drugs.
Can anosmia be inherited?
It is quite possible for it to be inherited but the one that is more common is for somebody to be born without a sense of smell. We don’t conduct studies to find out the genetic basis to it but certainly, for someone who is born with a loss of sense to smell, the chances are high that the person inherited it.
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