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    I have "olfactory hallucinations" in which I smell smoke. What could be causing this?

    FEBRUARY/MARCH 2012

    BY RONALD DEVERE, MD

    I have "olfactory hallucinations" in which I smell smoke. What could be causing this?

    These perceived abnormal smells are not actually present in the physical environment. How long they last depends on the olfactory hallucination’s cause.

    Dr. Ronald DeVere responds:

    Olfactory hallucinations are perceived abnormal smells—usually unpleasant—that are not actually present in the physical environment. They can come from a number of different areas of the smell system. The length of time these smells last depends on the cause. If the smell of smoke occurs suddenly and continues for less than a few minutes, the site of origin is likely the smell region of the inner temporal lobe of the brain, called the uncus. The source could be an abnormal electrical discharge or "firing" in the brain (a seizure). Potential causes of this abnormality could be a brain tumor, inflammation, stroke, or an injury following head trauma. Confirming the cause requires an imaging study of the brain (MRI) and a brain-wave test (EEG). Usually, results of smell testing will be normal to minimally abnormal in a person who is experiencing this type of seizure. If a seizure disorder is suspected, antiseizure medications may be used to prevent a seizure and thus eliminate the smell.

    Olfactory hallucinations lasting more than a few minutes to several hours are usually due to a disturbance of the smell system in the nose (olfactory organ or olfactory nerves) or in the olfactory bulb, which sits just inside the skull above the upper nose level. The term for this type of olfactory hallucination is dysosmia. Common causes of dysosmia are head and nose injury, viral damage to the smell system after a bad cold, chronic recurrent sinus infections and allergy, and nasal polyps and tumors. The brain is usually not the source. In these instances, sense of smell for other odors is often impaired as well, and the results of smell testing typically are abnormal.

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    The source of olfactory hallucinations could be an abnormal electrical discharge or "firing" in the brain (a seizure). SMOKE: MROSS5013/DEVIANTART.COM

    Dysosmia usually disappears with time (three months to two years) without treatment. A thorough evaluation for the mentioned causes may include an MRI of the olfactory system and a nasal endoscopy, in which an ear, nose, and throat (ENT) physician looks inside nasal and sinus passages with a magnified scope. Dysosmia can be treated with normal saline nose drops administered with the head lowered (the top of the head should be pointing to the floor). It may also improve with some medications, such as gabapentin—a medication normally used for seizure disorders but that has also been shown to prevent unpleasant odors arising from injured smell receptors or their nerve branches. The use of gabapentin in this instance is considered off label, which means it is not approved by the FDA for this indication. This doesn't mean the medication is not effective and safe, but rather that the drug has not been officially studied and evaluated by the FDA for this condition.

    Source : www.brainandlife.org

    Why do I smell certain odors that aren’t real?

    A distorted sense of smell is quite common as people age. Called dysosmia, it can make people smell odors that are not there or be highly sensitive to certain smells. While it's not bothersome for most, people should see their doctor if the condition becomes persistent.

    DISEASES & CONDITIONS

    Why do I smell certain odors that aren’t real?

    October 1, 2020

    On call

    Q. What can cause someone to smell something bad, like heavy cigarette smoke or old garbage, when neither is nearby? Could it be caused by a vitamin deficiency? And why does it make some foods taste funny when it happens?A. Having an altered sense of smell is actually quite common. A survey of American adults found that two-thirds had experienced a problem with smell sometime during their lives. Smell disorders are often classified as one of the following:

    anosmia: complete loss of the ability to detect odors

    hyposmia: decreased sense of smell with some ability to detect odors

    dysosmia: distorted sense of smell.

    Hyposmia commonly happens as we age. But what you describe falls under the category of dysosmia. With dysosmia, the distorted smell may be dramatically different from what you expect (known as parosmia). Or it could be an odor that isn't actually present (known as phantosmia). Your symptoms suggest you have periods of phantosmia: your brain registers an odor when none is present in the environment. But at other times, it could be parosmia, meaning you are more sensitive to a smell that doesn't bother other people. When this occurs, the odor is usually described as unpleasant.

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    As to what might cause dysosmia, there are several possibilities. While vitamin or mineral deficiencies can cause an altered sense of smell, this would be unlikely unless you follow a restricted diet or have an intestinal problem that impairs the absorption of nutrients. Here are some other causes of altered smell:

    COVID-19 or a cold or sinus infection

    hay fever (allergic rhinitis)

    nasal polyps

    a medication, such as the cholesterol-lowering drug atorvastatin (Lipitor), the blood pressure drug amlodipine (Norvasc), or the antibiotic erythromycin (Erythrocin)

    a side effect of general anesthesia.

    Regarding food having a funny taste, our ability to fully enjoy food requires stimulation of many nerve endings in the mouth and nose. The strict definition of taste is the mouth's ability to identify what is salty, sweet, sour, or bitter. There's also a fifth, savory taste called umami (from the Japanese for delicious), which is triggered by the amino acid glutamate.

    But what we commonly refer to as taste is actually a food's flavor. Flavor is determined more by the food's aroma, which is a function of our sense of smell rather than pure taste. So it makes sense that your dysosmia also interferes with the flavor of certain foods.

    For most people who experience dysosmia, it's a temporary alteration in sense of smell, often without an identifiable reason. However, if it becomes persistent, speak with your doctor. He or she will likely refer you to an ear, nose, and throat specialist.

    — by Howard LeWine, M.D.

    Editor in Chief, Harvard Men's Health Watch

    Image: © ClarkandCompany/Getty Images

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    Disclaimer:

    As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.

    Source : www.health.harvard.edu

    Phantosmia

    Find answers to common questions about phantosmia (smelling odours that aren’t really there).

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    Phantosmia

    Medically reviewed

    IN THIS ARTICLE

    What causes phantosmia?

    Can pregnancy cause phantosmia?

    Can phantosmia cause difficulty catching breath and burning eyes?

    Is phantosmia dangerous?

    How is phantosmia treated?

    Why do I keep smelling smoke when there is no smoke around me?

    If you keep smelling odours that aren’t really there, like smoke when nothing is burning, you may have a condition called phantosmia. It can be unpleasant and affect how things taste to you, but is not usually serious and may go away by itself in a few weeks or months.

    Sometimes cleaning the inside of your nose with a salt water solution can help. You can make the salt water solution at home or buy sachets for making salt water solution from a pharmacy.

    What causes phantosmia?

    Phantosmia is typically caused by a minor infection such as a cold, flu, or sinusitis. It can also be caused by nasal polyps (growths inside your nose), migraines, epilepsy, a head or facial injury, or mental health issues like depression.

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    Can pregnancy cause phantosmia?

    A change in your sense of smell is common in early pregnancy. Your sense of smell may become more sensitive and things you once enjoyed may start to smell or taste unpleasant, but this is not the same as phantosmia.

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    Can phantosmia cause difficulty catching breath and burning eyes?

    Phantosmia tends to only affect your sense of smell. Speak to your doctor if you are struggling to catch your breath and your eyes are burning as this could be a sign of another condition. If you are struggling to breathe, go to a hospital or see a doctor immediately.

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    Is phantosmia dangerous?

    Phantosmia is usually due to a minor infection, and it may go away on its own within a few weeks or months. In some cases, phantosmia can be a sign of a more serious condition, so you should always see your doctor if you experience it.

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    How is phantosmia treated?

    Phantosmia may go away on its own. Sometimes cleaning the inside of your nose can help. You can try rinsing your nose with a saltwater solution to temporarily get rid of the smell. If the strange smell doesn’t go away in a few weeks you should see your doctor. They may refer you to a specialist to investigate the cause.

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