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Do You Smell What I Smell? Phantom Odors Are Real

man sniffing friend

Aug. 23, 2018 -- Some say they bite into a sandwich that suddenly smells like a burnt cigarette. Others report smelling burnt rubber and can't figure out where the stench is coming from. In a better-case scenario, the smell of peaches fills their nose 24/7, proving that too much of even a pleasant odor can make you feel a little wacky.

It all may sound like a Saturday Night Live skit in the making.

But doctors and those affected say these phantom odors are real -- and troubling. The medical term is phantosmia.

It's not life-threatening, but there are no reliable treatments, and it can make your life much worse. There isn't even good information on how many people are walking around asking co-workers or spouses: “What is that smell?”

So the National Institutes of Health nosed into the topic further, concluding that one in 15 Americans have phantosmia.

Most likely affected are women 40 to 60, says lead author Kathleen Bainbridge, PhD, a researcher with the National Institute on Deafness and Other Communication Disorders (NIDCD). The problem is less likely in those 60-plus. In most cases, it tends to go away after a year or less, but while it’s happening, it can be upsetting and distracting.

Survey Details

To get to the one in 15 estimate, Bainbridge and her colleagues used data collected from 2011 through 2014 as part of the National Health and Nutrition Examination Survey. This sample included 7,417 adults ages 40 years and older. They found 534 men and women in the survey were affected. That translates to 6.5% of the U.S. population. The group most likely to be affected: women 40 to 60.

Most people with phantom odor issues, about 89%, don't broach the problem with their health care provider, the researchers found. Anyone can get this condition, but lower-income people -- researchers aren’t sure why that is -- as well as those with dry mouth problems or anyone with a history of head injury is more likely to.

As for why more women than men? "Women are more in tune with their chemical world,'' says study co-author Donald Leopold, MD, an ear, nose, and throat specialist and professor of surgery at the University of Vermont Medical Center, Burlington. They buy fragranced products more often than men, for instance, he suspects.

The study is published in JAMA Otolaryngology -- Head & Neck Surgery.

A Patient's Story

Mike Gonzales, 41, an auto mechanic in Loveland, CO, has had phantom odor issues since 2015, he says. First was the hotel room that he describes as smelling of rotting fast food. "I wrote it off at first that it was just the hotel," he says. But ''it followed me home."

Then came the dirty feet smell around the computer desk at home. A dinner his wife prepared smelled burned, but it wasn't, she assured him. "Around this time, I also started getting a smell of burnt plastic, seemed to be mostly when I'd wake up in the morning."

The phantom odor affects him at least once a day and sometimes as many as three times, he says. He's tried nasal sprays and washes, among other suggested remedies, he says, but nothing seems to work. He saw a therapist for a while to deal with the depression that has resulted, he says.

"I've been trying to laugh about it some, best way for me to deal with the depression," he says.

Causes and What to Do

People should mention the phantom odor problem to their health care provider, experts say. It's been linked with medical conditions such as epileptic seizure, depression, head trauma, and migraine. So ruling those out is wise.

Those affected often try finding the source for days or weeks before seeing their doctor, Leopold says. At that point, any sense of humor about the issue that may have been there originally has dissipated, he says. People want relief. "I've had people rip up carpets," he says, to try to uncover the source of the smell.

"It's an unrecognized problem," says Nina Shapiro, MD, a professor of head and neck surgery at the UCLA David Geffen School of Medicine and a co-author of Hype: A Doctor's Guide to Medical Myths, Exaggerated Claims and Bad Advice. She was not involved in the NIH study.

She understands that people don't bring it up but agrees they should. "It can certainly affect quality of life.''

The problem is, doctors can't really say what causes it. "It's somehow related to airflow," Leopold says. He has had patients report to him that they wake up without smelling anything unusual. But then they sniff or sneeze, and the odor without a source is back.

"The biologic cause of phantom odor remains unknown," Bainbridge says. Overactive nerve cells in the nasal cavity may play a role, she says, or something may be miswired with the central nervous system related to how odors are interpreted in the brain. Leopold's money is on the brain theory.

Some success has been reported, Leopold says, with using anti-seizure medications or antidepressants.

A simple at-home treatment may work, too, he says. Patients get a squeeze bottle and fill it with salt water. They ''get on their hands and knees, forehead to the floor." They squeeze the bottle to inject saltwater into each nostril. "That will unclog the upper nasal cavity." And sometimes the phantom odor disappears.

Leopold used to perform an operation to destroy the sense of smell. "I have stopped doing it," he says. "I don't think it's very good therapy."

Time alone may solve the problem. "I will often advise people to live with it, deal with it," he says. "It's a huge hit to their quality of life."

WebMD Article Reviewed by Neha Pathak, MD on August 23, 2018

Sources

JAMA Otolaryngology -- Head & Neck Surgery: "Prevalence and Risk Factors for Olfactory Hallucinations."

JAMA Otolaryngology -- Head & Neck Surgery: "Factors Associated with Phantom Odor Perception Among US Adults."

Nina Shapiro, MD, professor of head and neck surgery, UCLA David Geffen School of Medicine, Los Angeles.

Donald Leopold, MD, ear, nose, and throat specialist, professor of surgery, University of Vermont Medical Center, Burlington.

Kathleen Bainbridge, PhD, epidemiologist, NIH's National Institute on Deafness and Other Communication Disorders.

Mike Gonzales, auto mechanic, Loveland, CO.

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