The Daily Telegraph
August 22, 2005

Scent is not to be sniffed at We underestimate the importance of our sense of smell to our wellbeing – as Barbara Lantin discovered when she lost hers. That’s on top of all the other duties it discharges

It was when my children sniffed the fish meant for supper and reeled backwards, holding their noses and pretending to vomit, that I knew I had to do something about my missing sense of smell. Until then, I had considered its absence inconvenient and somewhat depressing – mainly because I could not taste anything properly. Suddenly, I realised it could seriously damage my health.

“Smell is the Cinderella sense,” says Dr Glenys Scadding, consultant allergist and rhinologist at the Royal National Throat, Nose and Ear Hospital in London. “One per cent of our DNA is devoted to it – a huge amount. Two to three per cent of the population have a reduced sense of smell and these people often get quite depressed, because it is as if all the colour is washed out of life. They are also in danger because they cannot detect fire, gas leaks or rotten food.”

According to Prof Tim Jacob, of the School of Biosciences at Cardiff University: “We certainly underestimate the importance of smell to our wellbeing. There are suggestions that it can influence mood, memory, emotions, mate choice, and the immune and endocrine systems. Every experience has a smell associated with it and people with anosmia - a reduced sense of smell – do not have access to that memory link.

“Anosmia can affect people socially, psychologically and physiologically. It can lead to loss of libido – because a lot of human interaction is down to smell – and weight loss or gain, because people with no sense of taste either forget to eat or overcompensate by eating too much.”

The most common cause of smell loss is a nasal blockage, usually – as in my case – due to polyps. Damage to the olfactory nerves from a heavy cold, trauma or inhaling certain chemicals has the same effect. Some illnesses, including Parkinson’s and schizophrenia, impair the ability to smell, and loss of olfactory sensitivity can be an early indicator of Alzheimer’s.

Surgery used to be the only treatment for polyps, but doctors now carry out medical polypectomies using short-term oral and nasal steroids followed by mild steroid drops. This approach worked for me and though I’ll never make a wine taster or a parfumeur, I can now tell when the fish is off.

Individual smell

“We all have our own unique smell by which we can be recognised,” says Prof Jacob. “Children can distinguish between the smell of their siblings and other children of the same age. Babies recognise their own mother’s smell and mothers recognise their own baby’s.”

Research has shown that emotions, including fear, happiness and sexual arousal, can be communicated through smell. “Recent research has shown that women can discriminate between armpit swabs taken from people watching ‘happy’ and ‘sad’ films, though men were less good at this,” says Prof Jacob. Women have a more acute sense of smell, particularly during ovulation and pregnancy.

Scent and attraction

The role of smell in sexual attraction is more complex than perfume makers would have us believe. Pheromones, powerful chemicals emitted from the skin, are not smelled consciously, but are thought to be detected by the vomeronasal organ, a receptor in the nose.

“Smell is a very important component in partner choice,” says Prof Jacob, “because we are attracted to people with a dissimilar immune system to our own - so that our offspring have increased disease resistance – and your immune system determines your odour type.”

But male sweat is not an irresistible turn-on, he says.

“The male pheromone androstenol, the scent produced by fresh male sweat, is attractive to females,” says Kate Fox, author of the Social Issues Research Council’s Smell Report. “But androstenone, produced by male sweat after exposure to oxygen – in other words, when less fresh – is perceived as highly unpleasant.”

Aromatherapy

Different smells can produce various physiological effects, but it is not known exactly how. Studies show that aromatherapy treatments can reduce stress. Lavender has been shown to improve sleep and rosemary to act as a stimulant. When the air in a Moscow classroom was scented with peppermint, pupils performed better in some tests.

Some experts put these results down to conditioning, but Dr Judy Howie, an aromatherapist and scientist at Thames Valley University, believes that there is more to aromatherapy than mere suggestion.

“Certain components in aromatherapy oils interact with various biochemical receptors in the nervous system to help rebalance the body,” she says. “The combination of emotional and physiological effects occurring at the same time can be very powerful.”

Smell and memory

“Whole memories, complete with associated emotions, can be prompted by smell and this is entirely unconscious,” says Prof Jacob. This key to our sense of smell lies not in the nose but much farther up the nasal passage, in the olfactory epithelium, which contains olfactory receptor cells. These are directly connected to the limbic system, the most ancient and primitive part of the brain, thought to be the seat of emotion - which may explain why odours can trigger deep-seated feelings and memories. Although the sense of smell diminishes as we get older, odour memory remains when other recollections have faded.

New Scientist
September 24, 2005

The unbearable absence of smelling; Suddenly losing your sense of smell can remove all pleasure from food and drink. Doctors say it’s untreatable, but Mick O’Hare didn’t take no for an answer

ONE Friday in June 1998, I sat down with a curry for a self-indulgent night watching the soccer World Cup on TV. I had no idea how my next words would signal a momentous change in my life: “I can’t taste anything,” I told my wife.

She pointed out that I had a cold. True, I had struggled through the week with a dreadful sore throat, and by now the infection had spread to my nose and sinuses. But I knew immediately that my problem wasn’t simply the nasal congestion that everyone suffers now and then with a cold. It was a total absence of any sense of taste or smell.

I spent the next week sniffing everything from herb jars to dog muck: nothing. It was terrifying. As someone who loves food and drink, my life had been turned upside down in an instant. My wife and I were enthusiastic cooks – we even planned holidays based on local cuisines and took wine-tasting classes –and I was a member of CAMRA, the UK’s real ale club. It was all suddenly meaningless.

My general practitioner’s advice was less than encouraging. Like most GPs, she had no experience of my situation and could offer no helpful advice. Wait and see, was all she could say. So as many patients do, I hit the internet. I found the names of my afflictions: I had become ageusic, lacking a sense of taste, and anosmic, lacking a sense of smell.

I quickly realised that the anosmia troubled me more. Most of what we call taste is actually flavour produced by the smell of the food passing into our nasal cavities. True taste is only the bitter, sweet, salt, sour and “umami”, or savouriness, detected by the tongue’s taste buds. Bite into a strawberry and your tongue only tells you that it is sweet; it is the odours rising through your throat to your nose that tell you that particular sweetness is strawberry-flavoured.

I discovered the truth of this when, over the next couple of months, my sense of taste gradually returned. The bitterness of green peppers and the sweetness of chocolate began slowly to seep back. Yet agonisingly, smell and flavour remained entirely absent.

At my insistence, my GP referred me to a succession of ear, nose and throat (ENT) specialists. Their verdict was devastating: I had to live with it. My sense of smell – and with it, everything from the faint flavour of lettuce to the fierce assault of piri-piri chicken – had probably gone forever.

In desperation I continued my internet research. I discovered that while estimates vary, it is thought that anosmia affects about 0.66 per cent of the population in the US. Head injuries cause more than a third of cases, and cold and flu viruses account for about another third. Other causes include chronic sinus infections and nasal polyps.

I started to learn more about the sense I had taken for granted all my life. Our sense of smell, or olfaction, arises in a small patch of tissue high in the nasal cavity known as the olfactory epithelium . This contains about 50 million nerve cells, or neurons, that each bristle with minuscule hairs, or cilia, extending into the surface mucus. Airborne molecules that waft up the nostrils and dissolve in the mucus bind to receptor proteins on these cilia, triggering an electrical impulse in the neuron. The signal travels up to a kind of relay station called the olfactory bulb, just behind the olfactory epithelium. Further neurons, bundled together to form the olfactory nerve, pass these signals on to the brain.

Just how this system allows us to distinguish thousand of different smells was only discovered in the 1990s, in work that last year earned the US researchers, Richard Axel and Linda Buck, the Nobel prize for medicine. They discovered that each neuron in the olfactory epithelium makes just one type of about a thousand possible receptors. Each receptor is activated only by a specific odour molecule. Every odour produces its own characteristic pattern of firing neurons, which builds up the picture of the smell we experience, as if each odour has its own combinatorial bar code.

So what disrupts this system in anosmia? The standard medical opinion is that viral anosmia like mine, is a result of a cold or flu virus destroying olfactory epithelium neurons and damaging the cilia on any remaining ones. In rare cases the virus may also damage the olfactory nerve.

Alarmingly, a study by Thomas Hummell at the University of Dresden in Germany has shown that only a third of viral anosmics recover spontaneously. “If the damage is too great, the loss is permanent,” says Tim Jacob, an anosmia researcher at Cardiff University in the UK. “Currently, the standard belief is there is no effective medical treatment.”

As a future without flavour or smell beckoned, the sense of despair grew. I would wake at night consumed by the fear of never again tasting my mum’s Yorkshire puddings or my wife’s chocolate mousse. I began to dread eating. All I could experience was the colour and texture of the food while everyone else commented on the delicious flavours. And meals came round with agonising regularity, three times a day. They are unavoidable, because if you don’t join in, you die.

The thought of meeting friends in a social setting – which always, but always, involved a meal or a drink – meant I would find an excuse to decline invitations. But few people seemed to understand. Would you ask a deaf friend to a concert by the Royal Philharmonic Orchestra? And then, when you remember they can’t actually hear the soaring wonder of Beethoven’s ninth symphony, would you tell them they can at least watch the musicians pressing valves and waving bows? Nobody would be so insensitive. Yet that is how it is for an anosmic invited to dinner. “It sounds trivial and amusing, but it’s devastating,” one fellow sufferer told me soon after my condition arose. “Yet it’s the only disability where people laugh in your face when you tell them you have it.”

My options seemed to have run out. Then, about eight months later, I encountered Richard Firsten of Miami on an anosmia web forum. He had had symptoms identical to mine, yet he was now apparently recovering after treatment from Robert Henkin, a cognitive neurologist and director of the Washington DC Taste and Smell Clinic. Henkin has been studying taste and smell disorders since 1959, has published extensive research papers on taste and smell and founded the US National Institutes of Health’s first programme devoted to the evaluation of these senses.

My ENT doctors told me I’d be wasting time and money, but Richard’s testimony, coupled with what I learned of Henkin’s research, convinced me that Washington was my best hope. I headed there in May 1999, 11 months after the virus had struck.

Two days later, I had an entirely new perspective. Henkin was sceptical of the standard view that viral anosmia results from the virus killing olfactory epithelium cells. These normally regenerate constantly from a layer of stem cells that sits just above the olfactory epithelium. “The cells of the whole epithelium can be replaced via the stem cells within 30 days,” says Henkin. “So why doesn’t spontaneous recovery occur in all individuals?”

This paradox had caused Henkin to start looking for other explanations. “Something else was stopping olfaction being restored,” he says. He wondered if the virus’s lasting effect was not on the olfactory epithelium or nerve, but on something else. Henkin began to look at the structures that interacted with the epithelium, and this led him to the serous glands, which are located throughout the surface of the nasal mucosa.

These glands produce the nasal mucus that bathes the olfactory epithelium. This was already known to contain a number of substances such as enzymes and growth factors. Henkin began to speculate that the lasting damage done by the virus was actually to the serous glands, altering the composition of the mucus. Previous work by Henkin and others on cells grown in the lab had shown that the olfactory stem cells only grew and divided in the presence of nasal mucus, presumably because of the chemical growth factors it contained.

In the 1970s, Henkin started looking for these growth factors in nasal mucus. He concentrated on a small molecule called cyclic adenosine monophosphate (cAMP), which was known to act like a growth factor on nerve cells such as spinal cord neurons. Henkin measured levels of cAMP in the nasal mucus of viral anosmia patients. The results were intriguing. In patients with partial smell loss, or hyposmia, cAMP was lower than normal. In those with total loss, like me, it was lower still. The correlation was stark: the worse the smell loss, the lower the mucus cAMP (The FASEB Journal , vol 16, p A1153). Henkin concluded he had probably found the growth factor he was looking for. “Slowly, it clicked,” he says.

Henkin’s next task was to turn this finding into a treatment. He realised an existing medicine called theophylline might fit the bill. It had been used for decades to treat asthma because its main action is to open up the airways, but one of its other effects is to inhibit an enzyme called phosphodiesterase, which breaks down cAMP. So if someone’s serous glands were still producing a small amount of cAMP, theophylline treatment should help it hang around for longer, thus boosting levels of cAMP.

In 1977 Henkin began treating the first few anosmia patients with theophylline, selecting those who had failed to respond to any other form of treatment and who had low levels of cAMP. Within weeks many began to report improvements, to varying degrees. “If a patient naturally made little cAMP before their virus, it takes longer for theophylline to increase cAMP to the levels necessary to stimulate the stem cells,” says Henkin. In some theophylline had no effect, presumably because their serous glands no longer produced any cAMP.

Henkin continued to offer theophylline to the patients who came to his door, but he could not get funding to carry out a proper randomised controlled trial to compare theophylline with placebo. Drug firms were not interested in such a rare condition. “The companies do not feel that this old and common drug has much in it for them,” Henkin says.

Smelling the Coffee

By the time I turned up in 1999, although Henkin had published numerous papers on the possible mechanisms behind smell and taste disorders and how theophylline might increase cAMP levels, he had only published one small clinical trial of theophylline treatment. Out of four patients in the study, three had reported improvement. Henkin had, however, obtained objective confirmation of this result, because he had carried out brain scans using functional magnetic resonance imaging on the patients, before and after the treatment, and also on healthy volunteers. Beforehand, the patients showed much less activity than the controls in several areas of the brain that normally respond to smell. After treatment, the three who responded to theophylline showed increased activity in those brain areas, but the non-responder didn’t (Journal of Computer-Assisted Tomography , vol 22, p 760).

So should I go ahead with the treatment? Because I couldn’t spend the rest of my life anosmic and wondering “what if?”, there was simply no other option.

At first progress was slow. But within four months, hints of smell began to return. Early one morning as the coffee brewed at work, I recognised something that had been missing for more than a year. I could barely contain my emotion. By the time the week was out I had smelt perfume, tar setting on the London streets and herbs emanating from the local pizzeria – all muted, but present. It was another 18 months before I was back to normal, but once I knew I was on the road to recovery, my feeling of relief and my new-found appreciation of my returning sense was overwhelming.

But Henkin’s work has not become mainstream medical opinion. Bruce Jafek, professor of otolaryngology at the University of Colorado in Boulder, for example, agrees viral anosmia may well be caused by problems with regeneration of the olfactory epithelium, but says it is unclear whether this stems from changes in the mucus.

Theophylline is not approved for the treatment of anosmia, and in the absence of a placebo-controlled trial, it is unlikely to be widely accepted as such. And while it is generally considered a safe drug, it can cause side-effects similar to those of caffeine, such as agitation, headaches and gastrointestinal problems. At higher doses it can be positively dangerous, and can interact badly with other drugs such as the antibiotic ciprofloxacin.

“The use of theophylline is not proven,” says Jafek. “And the treatment has yet to be replicated by other researchers.” He acknowledges, however, that “theophylline has been used safely in asthma treatment for years, so is not, if administered correctly, hazardous”.

Henkin has still not gained funding for a trial, although he is preparing a paper reviewing 230 patients who have received theophylline at the clinic over the last 10 years. This will report that 70 per cent experienced significant improvement, which is certainly higher than the spontaneous recovery rate of 33 per cent seen in Hummell’s study. But then again, that figure may have been an underestimate, because people who suffer a temporary bout of anosmia are less likely to report it to their doctor. Only a formal trial would give us the true picture.

Henkin also reports that out of those who responded to theophylline, about a third have been able to stop treatment without regressing. Another third, however, found that their sense of smell diminished, although resumption of treatment restored it. The remaining third have not attempted to stop treatment.

I am in that last group. I know my recovery could have been a coincidence, but I am ecstatic that I can once again appreciate every smell, however nasty, and every meal, however ordinary. Of course, no two people are alike – we all have different ideas about what constitutes nectar from the gods – but here are some of mine: a pint of Black Sheep ale, my grandmother’s beef and potato pie, newly mown grass, a glass of Rioja, fish and chips from my home town of Cleckheaton, Serrano ham, freshly oiled cricket bats, roasted peppers, stilton cheese, my wife (these are in no particular order, you understand), my son... I could go on and on.

I Don’t Smell a Thing; When Your Nose Doesn’t Work Right, It’s Hard to Tell Chocolate From Vicks VapoRub. Maybe That’s Not So Bad.
By Jason Feifer

From across the apartment, my girlfriend smelled smoke. “Is something burning?” she called to me in the kitchen. No, everything’s fine, I yelled back. A few minutes later, she came in to investigate. She found me washing dishes, oblivious to the smoking George Foreman grill beside me. “You’re so dying in a fire,” she said as she yanked the plug from the wall.

I don’t know why I didn’t see the smoke, but there was good reason I didn’t smell it. Like an estimated 14 million Americans, I suffer from smell loss. Like a smaller number of them, I can’t taste, either. I can occasionally appreciate a flower’s aroma or food’s flavor, but only vaguely and superficially. My imagination helps fill in the blanks; but when I’m blindfolded, I confuse mint ice cream and peanut butter ice cream. My girlfriend, who has the olfactory capabilities of a bloodhound, has run me through this test numerous times. She, like most everyone else I tell about this, simply cannot understand my experience.

I have a hard time explaining it myself. It’s as if my tongue and nose can sense differences – water tastes different from juice, say, and unscented air smells different from perfume – but the differences are faint and forgettable, and I have no ability to identify them. Chocolate is strawberry is scrambled eggs.

I’ve known about this for years, but have no idea when it started. After all, I never had a basis for comparison. Unlike someone with vision problems, I couldn’t simply put on glasses and see what I was missing.

In a way, I’m lucky. People who suddenly lose their sense of taste or smell after decades of trusting it can find the change so devastating that they fall into depression, lose weight or develop anorexia, according to Norman Mann, director of the Taste and Smell Center at the University of Connecticut Health Center in Farmington, Conn. I’ve experienced none of that. In fact, I’m untroubled by it – except that after the smoking-grill incident, I’m determined not to die in a fire. So I signed up as a patient at Mann’s center and went through a battery of tests during three appointments in September.

The center is one of a few specialized taste and smell clinics across the country, including one on MacArthur Boulevard in the District. Their task is not easy. Chemosensory disorders come in numerous forms, each with its distinctive Greek tag: absent (anosmia for smell; ageusia for taste) , diminished (hyposmia/hypogeusia), distorted (dysosmia/dysgeusia), altered (aliageusia) and phantom smells and tastes (phantosmia/phantogeusia). And because malfunctions can be caused by a wide range of problems – from chemical exposure to brain tumors to even seemingly unrelated things like Alzheimer’s disease – the clinics subject patients to a host of tests in search of the problem’s origin.

In this multidisciplinary approach, a patient may see a dentist, neurologist and otolaryngologist (ear, nose and throat doctor), undergo a general physical examination and even receive an MRI scan. The tests run about $2,500 at UConn and are usually covered by major insurers.

Some patients are referred by doctors; others stumble across smell centers on the Internet after having had their problems shrugged off by clinicians who do not know how to treat them or do not believe they are serious.

“They don’t know what to do, they don’t know where to go,” said Robert Henkin, director of the Taste and Smell Clinic in Washington. At UConn, Mann has had patients break down and hug him.

For some patients, though, sympathy is all they’ll get. When smell and taste loss can be linked to a problem such as acid reflux or diabetes, treatment of that condition may restore the senses. However, if the loss resulted from olfactory-nerve damage caused by head trauma or a viral infection such as a cold, there is no reliable cure, said Barry Davis, director of the taste and smell program at the National Institute on Deafness and Other Communication Disorders, part of the National Institutes of Health. Sometimes the nerves will regenerate and senses will be restored, and other times they won’t.

“I expect that taste and smell clinics are frustrated to a certain degree, in the sense that they see people they cannot help,” Davis said. “They can’t give them bypass surgery, they can’t give them antibiotics, they can’t give them some magic bullet. All they can do is tell them the extent of their problems and say, ‘Sorry.’ “

Sometimes, patients come in complaining of a loss of taste, but only suffer a loss of smell, according to Henkin. They confuse the two because taste is so dependent upon smell. Then, too, olfactory nerves do not regenerate as quickly or effectively as taste cells do, and they are more delicate and open to exposure. “You can close your mouth. You can’t really close your nose,” Henkin said.

When food is chewed, odors go to the back of the mouth, where a properly functioning olfactory system translates them into flavor. When the system malfunctions, taste often remains intact – that is, the mouth can still distinguish among sweet, salty, sour and bitter. (It can also appreciate temperature and texture.) What’s missing is flavor – that sense that lets you savor a lemon drop as lemony, salsa as tangy, ice cream as not just sweet and cold but mint chocolate chip or pistachio. Many patients who complain of a loss of taste are really just experiencing a loss of flavor, and can sense the four categories of taste just fine, Henkin said.

This is what we established on my first visit to the UConn clinic, where I spent two hours smelling bottles of diluted alcohol, trying to identify canned scents, and swishing dozens of liquids around in my mouth to rank them by their taste. The scents were a failure: Of all those placed before me, I could recognize only Vicks VapoRub. Now, that’s depressing. Imagine if everything you smelled could only be categorized as either “Vicks” or “not Vicks.”

The liquids, however, were more promising. I could generally tell the difference among them, although they tasted weak and I continually confused bitter with sour. I was later told that one of my problems is hypogeusia (pronounced hypo-GOO-zee-uh) – or diminished taste. That may explain why, in college, I put melted M&Ms in my grilled cheese sandwiches.

When I’m at restaurants, friends sometimes ask me why I order what I do.

After all, if I can’t really taste food, why do I care? There are a few reasons. For one, I have to order something. No waiter has ever said to me, “We’ll make you a tasteless meal because you can’t appreciate our menu.” And although my preferences may be based on habit, they are real preferences. I enjoy food on my own terms – the texture, the modicum of flavor I can mentally expand upon – and never really focus on how I’m experiencing it differently from the people around me.

When people say they pity me, I tend to go lowbrow: At least I can’t smell farts, I joke. But in fact, my loss of smell may have helped define who I am. I became a vegetarian at 13, long before anyone else I knew had done it, and never fell victim to the cravings that undo some others’ resolve. I like to think my experience taught me to follow my convictions, although now I suspect success came too easily. A steak, to me, might as well have been soy.

On my second visit to UConn, I saw dentist Joseph D’Ambrosio, who checked for signs that my problem was mouth-based. Abnormal saliva production, such as saliva that is too thick or in short supply, can trigger taste loss because saliva is needed to disperse taste stimulants to the taste buds. Inflammation or infection inside the mouth can also be to blame, reducing blood flow to the tongue and thereby damaging cell receptors. My mouth was fine, though.

D’Ambrosio said visible signs of trouble in the mouth are often linked to more aggravating chemosensory problems, such as burning mouth syndrome or distorted taste. Patients may complain of smelling or tasting metal even when they’re not sniffing or eating anything. Washington’s Henkin said he recently treated a woman who described her experience as like having a dead mouse in her nose.

With an oral problem ruled out, my third visit began with the nose. I saw otolaryngologist Denis Lafreniere, who checked for any abnormalities that could lead to smell problems. Common causes include tumors or inflammations in the nasal canal, which can obstruct the flow of odors. They can be treated with corticosteroids, after which smell commonly returns. Lafreniere stuck a long, fiber optic telescope up my nose – a uniquely unpleasant sensation – but reported nothing overly troublesome. He did find that I have a deviated septum – meaning the cartilage dividing my nostrils is off-center – but he said that by itself does not cause smell loss.

So it was on to the final stop: Norman Mann, the director of the clinic. He gave me a full physical exam, because he said he sometimes discovers undiagnosed problems that cause taste and smell loss. He’s found diabetes in patients, and some who come to him learn their loss of senses is the first symptom of oncoming Alzheimer’s or Parkinson’s disease, he said. (For other elderly patients, the sensory loss is more natural. Smell and taste diminish with age.) With me, though, there was nothing noteworthy.

That leaves two possible diagnoses, he said. I have a slight loss of taste and a significant loss of smell, and that’s either because of a long-gone viral infection or because I was born with a defective olfactory system. The latter is unlikely, he said, because congenital loss is usually absolute, and I still have some semblance of smell. If it was a virus, he said, there’s only a minuscule chance the senses will return. Damaged olfactory nerves can regenerate, but they usually do so within a year of the smell loss. “If we see a patient who has loss of smell for two or three years, the prognosis is poor,” he said.

There is some hope: “We see strange things once in a while,” Mann said, including a man who regained his senses after seven years. Instead of holding out for that, he said, my best bet is to buy a gas detector and make sure the batteries in my smoke alarm are good. I may not smell things, but I still can avoid a fiery death.

As I went through this process, my friends joked about all the unfortunate outcomes that could result from a renewed sense of taste. What if I discovered I hate the foods I thought I like? Or what if I become so enamored with food that I ballooned in weight? (Mann said he’s heard of the second happening, but not the first.) Instead, though, all this talk made me consider for the first time what it would be like to really smell and taste – only to be more aware of what I’ll always be missing.

But then again, it’s not so bad. I can always go to a concert and not smell the sweaty people around me. I don’t mind talking to someone who has bad breath. And if I still wanted to put chocolate in grilled cheese sandwiches, nothing would stop me.

Doctors Get Better Sense of Smell Disorders
By Kim Norris

The smell of coffee, frequently celebrated as one of life’s most pleasurable experiences, even by people who don’t like the taste – nauseates Kathy Kurland.

“Coffee is the worst smell. ... I can’t even describe it,” she says.

Other smells, such as freshly made popcorn, used to make her physically ill. Now, thanks to medication, she can tolerate it.

Kurland has a range of olfactory disorders that block some smells, turn innocuous or pleasant smells offensive and produce phantom smells that can last for days.

Kurland says a chemical caused the condition. It started about three years ago and got progressively worse. “I thought I was going to have to live in Alaska by myself, where there were no smells,” says the “fortysomething” Farmington Hills, Mich., resident.

Her condition is not imagined or psychological. It’s real. It has a name and a growing cadre of doctors and researchers devoted to it.

There are support groups to help people like Kurland – those who have lost their ability to smell, a condition known as anosmia; those whose sense of smell is distorted, called parosmia, and those who smell things that aren’t there, phantosmia.

Kurland’s research led her to one doctor who prescribed a medicine that made the condition manageable, but it hasn’t eliminated it.

When organisms first swam in the primordial sea, the ability to smell chemicals is what kept them alive. Smell is the first bond between baby and mother. A scent can transport us to a place or time, draw us in or warn us of danger.

Yet of the five senses, smell is the least studied and least understood.

“It was ignored for many years by the medical community,” says Beverly Cowart, a psychologist who runs a clinic for the Monell Chemical Senses Center in Philadelphia, the first such institution to study the senses of smell and taste. “There are a lot more people out there who have these problems than we previously thought.”

An estimated 14 million Americans have olfactory dysfunction including hypernosmia, a heightened sensitivity to scents. As many as half the people older than 65 and three-fourths of those older than 80 have a reduced ability to smell.

Many things lead to smell loss or dysfunction – chronic sinus disease, chemotherapy, chemicals, medications and head injuries. But researchers are not sure precisely what causes the condition because of the unique function and location of the olfactory nerve cells that transmit information to the brain.

“Most of the time there is tissue damage,” says Nancy Rawson, a cellular neurobiologist with the Monell Center.

Olfactory tissue regenerates throughout a person’s life. However, when the sense of smell malfunctions, it usually is impossible to tell whether the tissue is so damaged it can’t repair itself or something else is preventing cells from working properly, Rawson says.

“There is no way to see nerve damage without a biopsy,” she says. And “there is no effective, noninvasive way to record nerve activity” in the olfactory system. Putting probes up the nose to detect signals doesn’t work because the probes detect signals from the irritation system, which is separate from the olfactory system. That explains why people who can’t smell still have allergic reactions.

Rawson has been studying the olfactory system since 1991. She was attracted by the implications the regenerative powers of olfactory receptor cells could have for Alzheimer’s disease, strokes and other conditions that affect the brain. Olfactory receptor cells are the only nerve cells connected to the brain directly.

Losing the ability to smell could have far-reaching implications that are just beginning to be explored. The most obvious consequence is the effect on the ability to taste. Although it is a separate sense, taste is irrevocably linked to smell. About 90 percent of taste comes from smell.

When you consider the role food plays in our society, you begin to understand how not being able to taste can be a disadvantage.

“Patients talk about going to Thanksgiving dinner and feeling like they’re in plastic bubbles,” says Dr. Alan Hirsch, a neurologist who founded the Smell and Taste Research Institute in Chicago. “They can’t smell the scents of cooking, and everything tastes like Styrofoam. It’s depressing.”

“In the beginning, I couldn’t tolerate being in a restaurant,” says Kurland. She went to see Hirsch in March 2003, when her condition had become almost unbearable.

“On my first visit to Dr. Hirsch, I didn’t do any sightseeing in Chicago because I couldn’t stand the smells.”

Beyond affecting the ability to taste, the sense of smell is thought to play a pivotal role in people’s physical, emotional and psychological well-being and quality of life. Everything from body weight, to sexual arousal to the ability to sense danger is affected by smell.

Hirsch, who is a psychiatrist, too, is intrigued by the connection between the sense of smell and the psyche. Because the sense of smell is derived from the same area of the brain as emotions, he speculates there could be a link between the loss of smell and depression. He sees it frequently in patients who have smelling disorders. Of course, he recognizes that having the disorder can lead to depression.

What about recovery?

Smelling disorder recovery rates aren’t high, but recovery can occur, sometimes years later. The improvement can be gradual or sudden.

“We’ve seen recovery in people up to five years,” Hirsch says.

People suffering from anosmia or parosmia learn quickly that there is little consensus about treatment, and the options are limited to begin with.

To the extent that Kurland has experienced relief, it’s thanks to Hirsch. After he conducted his usual exhaustive exam consisting of extensive questions, a physical and hours of smelling exercises, he prescribed Clonazepam, a drug commonly used to prevent seizures. Kurland says her condition improved enough to allow her to lead a relatively normal life

At one time, the only foods she could tolerate were milk, white bread and cereal. Now she is able to eat most foods, although she can’t taste much of it.

Still, she says: “I prefer to eat at home. I don’t go out that much the way I used to.”

Frequently, Hirsch prescribes Cerefolin, a vitamin B12 medication that’s often prescribed for Alzheimer’s patients. The theory is that it works by boosting the ability of the remaining undamaged nerve cells. But no one is entirely sure.

Cowart of the Monell Center says the only form of anosmia that can be treated is caused by nasal sinus disease, and even that treatment is iffy. Steroids are effective in treating the inflammation chronic sinus disease causes, but they can’t be used long-term, she says.

“It has been a little frustrating that we haven’t found more treatment,” she says.

Rawson says researchers have had success with vitamin A, when it’s administered to lab mice immediately after their olfactory nerves are cut, but there’s no parallel experience with humans. Researchers also found that if one side of a mouse’s nose is closed off, the receptor cells die from disuse.

“So it may help to exercise [nerve cells],” she says.

The issue is getting more attention, thanks partly to the work of researches Richard Axel and Linda Buck. They were awarded the Noble Prize in 2004 for their work in mapping how the human sense of smell works.

Axel and Buck published their findings on the molecular basis of smell in 1991. Before that, little was known about how people are able to recognize and remember 10,000 or more odors. Although the findings shed light on the way odors travel from receptors in the nose to the brain, there is much more research to be done on how smells can affect humans, Axel said in a recent interview with the Associated Press.

“What many studying the brain would like to understand is how the outside world ... can be represented in the brain, which is simply a collection of neurons,” Axel says. “Our efforts, combined with the efforts in other fields, are beginning to allow us to take apart this very, very, complicated question of how the world is represented in the brain.”

Texas Monthly
January 2006

Scent and Sensibility
By Suzy Banks

Gym shoes, chemical plants, and dirty diapers don’t bother me in the least. As a proud anosmic – a person who can’t smell – I’ve turned my defect into my greatest parlor trick.

When I was in the sixth grade, my sister, a couple of friends, and I each bought a little bottle of scented oil for about two bucks at the mall. In the car on the way home, we were passing them around and taking turns sniffing them. Though I suspect now that none of them smelled fabulous, Mom and Dad managed to mumble polite stuff like “Oh. Patchouli, right? Won’t take much of this.” “Mmm, very flowery. Special occasions only.” Then they got a nose-load of mine. Dad gagged, Mom rolled down the window, and everyone else ughed repeatedly. Mom screwed the cap back on my bottle and told me to put it as far in the back of the station wagon as possible.

I was hurt, but it finally got me thinking. How come I didn’t know that my bright-pink bubble gum-scented perfume smelled different from the others? Or, for that matter, different from Pledge or cat urine? As long as I was on this line of questioning, I asked myself why I never smelled the cinnamon toast blazing away under the broiler when I was in the kitchen, even though my sister could smell it from upstairs. How come it never bothered me if some boy threw an old, dead fish on me? Why didn’t I have to hold my nose when we drove by the petrochemical plants? That’s when it hit me: I couldn’t smell. I realized I’d probably been born this way, which made me kind of like that amazing Helen Keller, didn’t it? All this time I’d thought I just wasn’t paying attention or was too stupid to learn how to smell. Now I knew it wasn’t my fault. What a relief!

Instead of being a liability, my congenital defect, known as anosmia, became my best parlor trick, a welcomed alternative to stuffing my fist in my mouth. It was and continues to be a guaranteed conversation starter: You could never smell anything? Nope, nuthin’, not even when my mom was complaining about how stinky my sister’s goats were until she discovered it was me, wafting away beside her, or when my dad was searching high and low for a dead rat in our walls that turned out to be my gym shoes. How do you know you can’t smell? Well, maybe I can, and everything just smells the same. You can smell this, can’t you? (Whereupon a foot, a baby’s bottom, or a gardenia is waved under my nose.) No. What about your sense of taste? Just fine, I think, since true taste – salty, sweet, sour, and bitter – is generally the domain of the tongue and its taste buds. Flavors like basil and nutmeg, however, mean nothing to me. Ditto for spoiled milk, judging from the number of times I’ve sleepily consumed half a bowl of Raisin Bran before wondering where the little white marshmallow things came from.

And I never tire of the questions. The attention more than compensates for the dangers and neuroses triggered by anosmia. Sure, I wish I had a lottery ticket for every charcoal-briquette cookie I’ve baked, and no amount of therapy is going to cure me of my phobia of lighting pilots. But I muddle through, sticking my clothes under my longsuffering husband’s nose to see if washing is needed, throwing out lunch meat before the use-by date, and choosing my fine wines by the picture on the label. (I like animals, preferably a group of mammals.) Despite the difficulty of describing odors without referring to other odors or flavors (go on, try it), on rare occasions I enjoy a vicarious olfactory kick thanks to writers like Diane Ackerman, who, in A Natural History of the Senses, depicts the powers of a vanilla bean in a way that makes complete sense to me: “Its aroma gives the room a kind of stature, the smell of an exotic crossroads where outlandish foods aren’t the only mysteries.”

I tried only once to get to the bottom of my anosmia. When I told my parents I couldn’t smell, they took me to see a neurologist in Houston who held a couple of vials under my nose, became increasingly frustrated by my inability to guess their contents, and pronounced that, yes indeed, I couldn’t smell. Despite my strong feeling that this doc was nuts – decades later I can still picture him, slumped so far down in his office chair that he seemed to be sitting on his neck, his wide tie as filthy as a napkin in a rib joint – I couldn’t get mad at him for his ignorance. Back when I was a teenager, during the age of bloodletting and balancing humors, no one knew exactly how smell worked, much less how it didn’t.

The time may have come, however, to re-submit my nose to scrutiny. In the past 15 years or so, science has begun to shine the light of intellectual curiosity into the mysterious depths of the collective human nose. The Nobel committee upped the glamour quotient of digging around in noses considerably when it awarded the 2004 prize for physiology or medicine to Richard Axel and Linda Buck for their work mapping the olfactory system from a cellular to a molecular level. Alan Hirsch, the founder of the Smell and Taste Treatment and Research Foundation, in Chicago, who’s been probing noses for more than 25 years, recently unleashed a product called Timeless View, a scent that can make a woman seem up to six years younger to men. Of more practical interest to us anosmics may be the electronic nose developed by NASA that is sensitive enough to detect the difference between Pepsi and Coke, or the successful treatment of smell loss, discovered by Robert Henkin, of the Washington, D.C., Taste and Smell Clinic, using the asthma drug theophylline.

But I wonder if I would even want to be cured. What if I couldn’t stand the smell of my three beloved dogs, my husband, or, worse yet, beer? What if I became a wine snob or an aromatherapy addict? What if I cried out involuntarily the first time a stranger in an elevator let rip with one of those notorious Silent But Deadlies? But most important, if I were cured, how would I get attention, besides screaming in elevators? What would make me special?

Actually, ever since I discovered a slew of anosmia Web sites about a year ago, my feelings of specialness have disappeared anyway. Evidently, there are a bunch of us out there, between two and three million in North America alone. And, boy, do those of us born without a sense of smell share some eerily identical feelings and experiences. We all want a smelling-nose dog. We’ve all endured smell experiments conducted by siblings that invariably involved searing our mucus membranes with whiffs of straight ammonia. We all remark on the importance of texture in our food. (I’d rather eat car parts than boiled okra.) We also universally suffer paranoia (rooted in reality, in my case) about our own body odors.

For many of us, the fear of stinking outweighs any fear of death by smoke, gas leak, or spoiled food. At times, the social stress of not knowing if I have BO (the kind of stress that makes me sweat and, I worry, makes me stink and thus stresses me out even more in a self-fulfilling, olfactory version of a catch-22) has been so intense that I’ve considered chucking the Mennen Speed Stick and moving in with the Temiar people of Malaysia, who believe that personal stench is our “odor soul” and one of the six components people are made of.

Still, I’ve always tried to maintain a sense of humor about my condition, incessantly tossing out my corny one-liners, like “I can’t smell, but I can stink,” and startling strangers by sticking my nose in their armpits to prove my disability. But from the online postings, I’ve learned I’m about as lighthearted as Dick Cheney compared with some sunny-side anosmics who wrote:

“Changing diapers is like cleaning chocolate.”

“On occasion, it has occurred to me that a dead skunk in a box would be a good way to clear space in the computer lab in school.”

“I realized that I could be the ‘perfect girlfriend’ if I couldn’t smell stinky feet and farts.”

Ah, my people.

Such flippancy, however, is strictly limited to lifelong anosmics. Sure, we can get a little wistful when we think about never having smelled our child or baking bread or freshly cut grass, a few of the top wish-listed aromas, but those poor souls who have lost their sense of smell due to, say, head trauma, viral infections, or medications are nearly suicidal on the subject, their postings generally dissolving into heartbreaking pleas for cures. Evidently, if you know what you’re missing, you really miss it. And vice versa.

So in some ways I consider myself lucky, a smugness reinforced every time I drive by a feedlot or open a magazine packed with perfumed inserts or use a construction-site Port-A-Potty late in the day or dance cheek-to-cheek with a cologne-soaked gigolo or survive a packed flight from Denver on which bean burritos are served (true story).

And face it, all humans are olfactory slackers compared with the rest of the animal kingdom; dogs’ noses, for instance, are one thousand times more sensitive than ours (which does little to explain their fondness for cat poop). From this, some researchers have hypothesized that our species’ ability to smell is diminishing as that sense becomes less important for our survival. From this, I have concluded that my fellow congenital anosmics and I are therefore simply more highly evolved. No? Okay, then at least admit we were born better unequipped to sail through this stinky world, noses held high, in blissful oblivion.

The Scent of a Woman – Lost
By Anita Chang

January 5, 2006

NEW YORK (AP) – I spent a good part of Saturday morning over my bathroom sink, hand-washing clothes – scrubbing my cheery red sweaters and wringing out my Victoria’s Secret bras.

The clothes may or may not have been dirty. They might well have still smelled sunshine fresh. I wouldn’t know.

In August, I was hit by an SUV. I was crossing the street when it turned the corner and knocked me to the ground. When I fell, the back of my head hit the pavement and my brain smashed into the front of my skull. That’s where the olfactory nerves grow – down the front of your brain, behind your forehead.

Since that night, I haven’t been able to smell anything. Nothing.

It’s like living behind a film of Saran Wrap. I’m in a world where, if my eyes were closed, I wouldn’t know the difference between walking into a bakery and stepping into a gas-station bathroom.

I suppose I should consider myself lucky. My neurologist told me about an artist known for painting in vivid colors. After a brain injury, he could see only black and white. To cope, the artist would walk outside at night, when everything was reduced to those two colors.

After the accident, my parents immediately installed a natural-gas detector in my apartment. I have a gas stove; if it leaked, I would have no idea. I have to make sure my smoke alarm works, because I would sleep right through a fire.

That’s the obvious stuff. Other things I’ve had to figure out day by day.

Milk is tricky. How do you tell if it’s spoiled if you can’t smell it? Out of habit, I still stick my nose into the crusty top of the bottle, trying to sniff out sourness. I hold it to the light. I shake the bottle, watching the milk slosh against the sides while I look for chunkiness. Usually, I end up pouring out the milk, just to be safe. Same with leftovers.

I like girly bath products that come in all those delicious scents. I ran out of body wash a couple months ago. As I stood in the bath aisle at Kmart, I wanted to cry. I used to open the top of every bottle to sniff the candy-colored contents. Now I go with qualities that don’t make you close your eyes and say mmmm – “For extra dry skin.” “With aloe vera.” “33 percent bonus.” Boring. I thought about switching to bar soap, but I don’t want to smell like a man.

Imagine the holidays without your sense of smell. On Thanksgiving, my brother cooked a huge spread and I missed out on the smells. Turkey skin sizzling to a perfect crispiness? Nothing. Jalapeno cornbread browning in the oven? Nothing. The savory yumminess of stuffing on the stove? Nope. My mom and I made mini pecan pies, and she wanted to use a block of cream cheese that was right around the expiration date. Smell it, she told me – see if it’s still good. Sometimes, my mom forgets.

I’ll tell you a secret. Not having my sense of smell has made kissing quite dull. What’s the point when you can’t smell aftershave/sweat/beer on a hunky boy? The excitement, the intimacy of knowing a person’s smell is gone. Why do we close our eyes when we kiss, anyway? Is it so we can focus on the way our partner smells, to give us something to remember later that night when we’re falling asleep? For me now, kissing is like eating theater popcorn without the butter. I KNOW I’m missing the best part.

When I tell people I can’t smell, many try to spin it positive. “Well, I guess you’ll be saving money on laundry! And cat litter!” Or, “Good thing! New York City stinks!” Truth is, I don’t save money on laundry, because I wash everything even if I could wear that sweater one more time. I change the cat litter more than I used to. True, I can’t smell trash ripening in the sun or fish guts at the seafood counter. But onions still make me cry.

The biggest side effect is that I’ve lost most of my sense of taste. I can only detect simple flavors. This Slurpee is sweet, but is it cherry or blueberry? That broth is salty, but I can’t tell if it’s chicken or beef.

This may be the hardest part. I love food. I’ve tried to cope with my new eating limitations, but it’s difficult for a glutton like me. I adore breakfast foods, but most have subtle flavors. Sometimes I forget: I take a big bite of a breakfast sandwich, expecting smoky sausage, spicy pepper and buttery biscuit.

The doctors say they don’t know if my sense of smell will return. Acupuncture didn’t help. Recovery from a brain injury can be as hard to predict as the weather on the day of an outdoor wedding.

But I haven’t given up hope. Every morning I wake up and stick my nose into the pillow, hoping to smell traces of my fruity conditioner. Nothing yet.

But that hasn’t stopped me from planning the awesome meal for when my sense of smell comes back: sea scallop ceviche, shrimp cocktail, stinky cheese, sweet potato fries, big fat ribeye (bone in, please, medium rare), mint chocolate chip ice cream and crème brulee.

Treat yourself to a happy smell today – gingerbread, expensive coffee, even the top of a baby’s head. Sip from a glass of wine and enjoy the nuanced flavors. I never, ever thought those simple pleasures could be taken away.

The Calgary Herald
February 3, 2006

Cold remedy blamed for smell loss: Company holds nose, settles suits

Imagine a world without the aroma of morning coffee or buttery popcorn.

Hundreds of people in the United States blame a common over-the-counter cold remedy for taking that joy from them: Zicam nasal gel, which is designed to ease symptoms and shorten the duration of colds.

Last month, Matrixx Initiatives Inc. of Phoenix, maker of the popular Zicam products for colds, flu, sinuses and allergies, agreed to pay $12 million to settle lawsuits involving 340 plaintiffs. The plaintiffs said they suffered anosmia, or smell loss, after using the zinc-based gel, which is put into the nose with a pump.

The firm admitted no wrongdoing and vowed to continue to “vigorously defend itself” in court. Sixty-one additional cases are pending, some involving

Zicam’s nasal swabs. The company’s sprays and lozenges are not at issue.

Robert J. Murphy, a spokesman for Matrixx, said the company had spent $12 million in legal fees since the first Zicam product-liability suit was filed about 21/2 years ago. He called the settlement, announced in the midst of cold season, “strictly a business decision.”

And business is good. Matrixx’s net sales rose 40 per cent to more than $46 million for the nine months ending Sept. 30, 2005, compared with the same period in 2004. The firm makes 22 products in the $3.5-billion retail cough and cold category and says its nasal gel is the only one on the market. Last year, Matrixx introduced a new, gentler spray tip to replace the pump.

Zicam products are widely considered “alternative,” and are classified by the Food and Drug Administration as homeopathic remedies. That means they can be marketed as drugs but are held to a lower standard for safety and effectiveness.

According to the FDA’s adverse-event database, 133 Zicam users reported having problems in 2004, the latest year available. Most involved the nasal gel and loss of smell, but because smell heavily influences taste, these people likely also suffered taste loss.

The Sunday Telegraph
February 12, 2006

Scents Appeal
By Bronwyn McNulty

Helen Ralston was 48 when she realised that her sense of smell wasn’t what it used to be. “I don’t know how it happened. It just gradually came on and got worse and worse,” says Ralston, a retired senior administrative officer at Swinburne University of Technology in Melbourne.

“I became very upset. I’ve always been conscious of sense of smell-flowers, dirt, animals ... The worst thing was that I couldn’t smell my own body. You don’t know if your deodorant’s working. You don’t know if you’ve worn your jumper once too often.”

While most people will experience a gradual dulling of their sense of smell from about the age of 70, losing it suddenly can lead to depression and even suicide, says associate professor Graham Bell, from the University of NSW’s School of Medical Sciences, and managing director of E-Nose Pty Ltd (a company developing “electronic nose” techniques to monitor pollution and use in medical diagnosis).

“Some people are born without their sense of smell and they tend to not worry about it because they’ve never had the sense built into their quality of life,“ he says. “People who lose it halfway through life can become very disturbed.”

Basic instinct

Fading of this sense can be dangerous, especially for the elderly, says Bell. “Your nose gives crucial early warning of something starting to burn. Also, older people become very prone to food poisoning because they get forgetful, leave food out and then eat it.”

Of all the senses, smell is the most underrated. But life without it, Ralston says, “is like living in black and white in a world of colour.”

If you can’t smell, you can’t taste properly. You have no access to your smell memories either, and you can become depressed.

“The beauty of breathing disappears to some extent,” Bell says.

There’s evidence to suggest that sense of smell affects everything from mood and emotions to memory, libido, the immune and endocrine systems and even your choice of mate.

In fact, the human genome contains 347 olfactory genes, yet there are only four for vision, says professor Patrick Mac Leod, president of the Institute of Taste in France. “The human sensory system for odours has attained maximum sensitivity,” he says.

Bell says that while it’s known that mammals such as mice and rats will choose mates based on smell, when it comes to humans sniffing out a potential partner, the jury is still out.

“But common anecdotes suggest that if you don’t like the smell of somebody, there’s no way you’re going to get cosy with them,” he says.

Smell can be partially compromised or disappear altogether. Sometimes it returns after a period of time.

The recovery process itself can cause a deviation in sense of smell, known as phantosmia, which makes everything smell disgusting.

“That can last for years and can drive people to suicide,” Bell says. Fortunately for Helen Ralston, after more than a year of trying mainstream and alternative medicine, she hit on something that helped fix her problem.

“I started taking selenium drops, and after about a week, everything began to improve,” she says.

Her sense of smell is now back to what it was before the loss.

“When it came back I was thrilled. It’s probably diminishing a bit now, because I’m nearly 69, but that’s normal.”

How can you lose your sense of smell?

“Smell loss is very common after head injuries,” associate professor Graham Bell says. “Nearly every head injury case involves a period of anosmia [loss of sense of smell]. Nasal polyps can cause it-any obstruction to the nose. Sometimes surgeons will give someone a nose job and it might damage some of the olfactory-sensitive cells.”

Chemicals can also damage olfactory nerves, as can diseases of the hormonal system, diseases of the nervous system, nose injuries and drugs such as amphetamines, cocaine, morphine and vasoconstrictors.

“People working in the spray-painting business, subjected to solvents, have to be careful,” Bell says.

Old age is the other threat to our sense of smell.

“After 80, most people don’t have a normal sense of smell, with most of them not being able to smell well at all.”

The Philadelphia Inquirer
April 20, 2006

Smell the Roses, and be Grateful; Anosmics – Those without a Sense of Smell – Miss Something Often Taken for Granted.
By Bryan David Finlayson

I was 13 when I lost my sense of smell.

Skateboarding downhill in Santa Barbara, Calif., my stepbrother Christian and I were racing. It was not important where we were going; there was no reward for winning, no punishment for losing.

We were competitive.

Gaining speed, I broke ahead of Christian, who was 17. I remember feeling elated over seizing the road from him.

Then the road disappeared.

Minutes passed before I came to, with Christian carrying me to the curb. My transition into the accident that turned my world upside down, for me, is seamless because I cannot remember. The fall was sudden, resulting in the direct impact of my head on the hard asphalt.

I was not wearing a helmet.

A week later, after I was released from the hospital, Christian described what he had seen.

“When your head hit, your glasses went flying straight up, 10 feet in the air,” he said.

Doctors at the Santa Barbara Cottage Hospital told me that I had received a brain contusion, a more traumatic form of a concussion, involving bruised tissue. When the back side of my head hit the asphalt, the impact caused my brain to first bash into the back of my skull, then ricochet strongly against the front.

The ricochet did the damage.

There was extreme bleeding over my frontal lobe, there was the possibility of blood clots leading to seizures, and pressure was mounting inside my skull from the excess blood and swelling brain tissue.

They would have to drill if the pressure worsened, doctors said. I was given morphine and other medications to prevent seizures and reduce the swelling.

The medication worked, and the swelling subsided. They didn’t have to drill.

Four days later, though dizzy and groggy, I went home from the hospital.

It was over a plate of spaghetti at dinner that I realized I couldn’t smell the food. In fact, since leaving the hospital, I had not smelled anything.

My family dismissed my condition as temporary and said once I was off the anti-swelling medication my sense of smell would come back.

They were wrong.

Weeks later it hadn’t come back. It has been eight years now, and I am still waiting.

My head injury left me with more lasting damage than I or anyone else in my family could have predicted.

After consulting a neurologist, I learned the violent ricocheting of my brain against my skull had severed the nerve endings connecting my olfactory glands to the lower cortex of my brain. I was not regaining my sense of smell because scar tissue had formed over the bone, blocking the nerves from regenerating.

I am among nearly 14 million Americans who are anosmics – people who have lost their sense of smell. For us, there is next to nothing in the way of medical treatment.

The medical community sees anosmia as a minor disability, like the common cold.

Generally, treatment is a choice between a biopsy or Cerefolin, a seizure medication.

Biopsy involves drilling into the skull. Noninvasive recovery with Cerefolin has been limited.

A reality of medical research is that smell is the most understudied and least understood of our five senses. The impact of losing your sense of smell on your physiological well-being is just beginning to be explored.

To an anosmic, there is no difference between smoky air in a pool hall and the fresh air outside, save for a lighter feeling on the skin.

I never smell the cologne or deodorant I apply to myself every day. I have no knowledge of the smell of my girlfriend. At the beach, I used to relish the salty smell of the ocean; now my skin just feels sticky.

Smell is a sentimental sense, and missing it can cause depression in anosmics.

Some of my fondest memories are smells: a rose, fresh-cut grass, the ocean. Smell is a valuable sense that is too often taken for granted and sorely missed when it is gone.

It is frustrating that there isn’t more treatment for anosmia. For now, I must accept that I lost my sense of smell over nothing, a silly race down a hill in California leading nowhere in particular.

That’s what stinks.

Inside Bay Area
May 29, 2006

There is Help if You Can’t Smell the Roses When You Stop
By Virgil Williams and Ron Eisenberg

A surprisingly common problem is the loss of the sense of smell, which is estimated to affect 2 to 5 million Americans (1-2 percent of the population). To smell, odors must be breathed into the nose and carried up to the roof of the nose, where they stimulate the olfactory (smell) center in the brain. Any of several conditions that prevent odors from reaching this center will cause a loss of the sense of smell, which is termed “anosmia.”

The sense of smell usually decreases somewhat as a person ages, but generally not to the extent of decreases in hearing and vision. Trauma to the forehead or back of the head can cause anosmia by damaging the nerves near the top of the nose.

About 30 percent of patients with post-traumatic loss of smell will regain this ability (almost always within the first year).Viruses, chemical burns (especially cleaning agents like ammonia) and certain psychiatric illnesses can cause anosmia, while irritants such as tobacco smoke can interfere with one’s ability to smell.

Any impairment of breathing (nasal obstruction) can cause anosmia. This may be due to a structural abnormality (deviated nasal septum, or a “crooked nose” or because of an inflammatory process. Both allergies (allergic rhinitis) and infections cause swelling of the lining of the nose and decrease the area through which air can flow. This causes the characteristic “stuffy nose” that is felt by patients with allergic reactions to pollen or those who are suffering from the common cold. Allergic rhinitis may lead to the development of nasal polyps, growths that can cause obstruction of the breathing passages and result in anosmia.

An unusual cause for anosmia is a brain tumor extending into the nose or situated adjacent to the olfactory smell center.

A number of medications have been found useful in the treatment of patients with partial or complete loss of the sense of smell. Relief of nasal obstruction in patients with allergic or viral rhinitis can be obtained with decongestants and antihistamines. Antibiotics may be required if there is an infection of the adjacent sinuses. Relatively new medicines for controlling the symptoms of allergic rhinitis include both steroidal and non-steroidal nasal sprays. Although there are a variety of other nasal sprays available (such as Neo-Synephrine and Afrin), these are unfortunately addictive. If taken for more than two or three days, the individual may become dependent upon them, and therefore some doctors do not recommend their use for chronic problems.

Zinc and other trace metals occasionally are used to treat anosmia. Although evidence for their success is weak, they are essentially harmless in the doses prescribed and can be worth a try.

For the treatment of nasal obstruction and sinus disease, a relatively new technique is endoscopic sinus surgery. By passing a small tube through the nose, the surgeon can directly examine the interior of the nose and the openings of the sinuses. Abnormal and obstructive tissue can be cut away, and normal drainage through the sinuses can be restored. This surgical procedure often permits a return of the sense of smell, without leaving an external scar and with infrequent complications. Outcome studies have documented that the benefits of endoscopic sinus surgery are most dramatic in those patients who have substantial impairment.

People who have lost their sense of smell should observe some simple precautions at home. You should always have smoke detectors, especially in the kitchen, any room with a fireplace, and your bedroom. An electric stove is preferable to a gas stove, unless it is equipped with an automatic pilot. If you use gas heat, appropriate detectors are essential wherever a gas leak might occur. It is also important to be very careful in preparing food, particularly leftovers, since spoiled food that is undetected by its smell can be hazardous. When in doubt, discard leftovers or have a family member with a normal sense of smell confirm that the food is not spoiled.

Prospect
November 16, 2006

Turning up our noses
By Lara Feigel

They haven’t got no noses
The fallen sons of Eve
Even the smell of roses
Is not what they supposes
But more than mind discloses
And more than men believe.
–GK Chesterton, “The Song of Quoodle”

I plead guilty to Chesterton’s charge. Mine is a mediocre specimen of a post-lapsarian nose. As a fallen daughter of Eve – or, more accurately, a fallen granddaughter of a sharp-nosed chimpanzee – I am conscious of smell only a few times each day. I put on perfume in the morning, but because I use the same concoction every day and therefore suffer from what the perfumers call “nasal fatigue,” I apply far more than I should, and end up fatiguing the noses of my fellow passengers on the train en route to work.

Occasionally I sniff the milk to see if it’s off, but more often I just glance at the sell-by date. Visual clues are more reliable than olfactory ones for a two-legged fallen human. On buses or tube trains, forced during rush hour into sardine-like proximity with a smelly person, I might – with due subtlety – shade my nose from the worst of his (or her) emissions. But for most of the day, it is unusual for me to notice any particular smells.

I do eat food, of course, but with the illusory impression that I am tasting rather than smelling the myriad different flavours that make up even an ordinary meal.

I am not alone in my olfactory bubble. We have been turning up our noses at smell for centuries. Some 2,000 years after Aristotle blithely labelled smell the most undistinguished of all our senses, Immanuel Kant denigrated it as the “least rewarding and the most easily dispensable” of the five. He viewed it as more likely to bring disgust than pleasure and as, at best, a “negative condition” of our wellbeing. In other words, we can use smell to avoid noxious air and rotting food. Kant, perhaps, would have been grateful for sell-by dates and the chance to abandon such an inferior sense altogether.

Predictably, it was left to the French to champion the sensual in a rationalist age. In 1754 Jean-Jacques Rousseau extolled smell as “the sense of imagination” and his contemporary Jean-Francois Saint-Lambert lauded the nose for giving us “the most immediate sensations” and “a more immediate pleasure, more independent of the mind” than the eye.

A century later, French olfactory enthusiasm had seeped across the border into Germany, where in 1888 Friedrich Nietzsche somewhat bewilderingly announced: “All my genius is in my nostrils.” Should we, like Nietzsche, be guided by our nostrils?

Whether or not they will kindle our imaginative genius, they might at least aid our physical survival. We no longer need to smell prey or predators, but there is evidence to suggest that we can use our sense of smell to recognise and avoid illness. In 1896 Gould and Pyle suggested in their medical handbook that lunatics could be identified by their smell: “Fevre says the odour of the sweat of lunatics resembles that of yellow deer or mice... Burrows declares that in the absence of further evidence he would not hesitate to pronounce a person insane if he could perceive certain odours.”

A century of medical science later, some doctors still claim to be guided by the nose. Psychiatrists talk about an odour specific to schizophrenia and Lewis Goldfrank recently told the National Geographic that he uses his nose to make snap decisions in the emergency ward. Apparently the breath of a diabetic in coma smells sweet, and a whiff of garlic can signify arsenic poisoning. Specially trained dogs seem able to detect some cancers by examining the odours of a patient’s breath, and it is not beyond the realm of possibility that canine medical staff will pace the corridors of our future hospitals.

Perhaps our first step in raising ourselves from our fallen state should be simply to notice the ordinary smells that surround us. The people most vociferous in their praise of smell tend to be anosmics – people who have lost their olfactory powers. In the words of one anosmic man I spoke to: “More than 24 years later, I deeply miss certain scents and smells. Life is lived rather like the boy in the bubble who suffered from total allergy. Many people have observed how fortunate I am to be unaware of the many unpleasant smells in our world; many people are ignorant fools. Without the constant reinforcement one forgets... the smell of flowers, of fresh cut grass, of a lover, of one’s children, a glass of wine, a bonfire, the sea, the countryside after rain. The list is endless and timeless.”

It is important to bear in mind that losing one’s sense of smell involves losing almost all of one’s sense of taste. We are able actually to taste only six flavours: sweet, sour, salt, bitter, umami (richness) and astringent, and all tastes are a combination of these.

The sense of taste is comprised of 1m receptor cells, as compared with around 40m for smell, and the possible palette of smells is literally infinite. When we think we are tasting, we are usually smelling. This knowledge may help us appreciate the privations of the anosmic.

The literary champion of smell, more than Marcel Proust or Patrick Suskind, is Helen Keller. Growing up blind and deaf, Keller had to rely on her sense of smell for basic information about her surroundings, and found in the process that it became a source of intense pleasure. She lamented the fact that smell “does not hold the high position it deserves among its sisters,” adding, “I doubt if there is any sensation arising from sight more delightful than the odours which filter through sun-warmed, wind-tossed branches, or the tide of scents which swells, subsides, rises again wave on wave, filling the wide world with invisible sweetness.” She went so far as to claim that she could judge character by sniffing, and modern scientific studies have backed her up.

Generally, partners who like the smell of each other’s pheromones are more likely to get married than partners who don’t. Perhaps we could teach ourselves to sniff out future irascible wives and slobbish husbands.

Reading Helen Keller, we can perhaps learn something of what life was like for our primate ancestors. In primitive animals the bulk of the brain was formed by the limbic lobe, which is still the locus for immediate sensations such as smell. Millennia of development in the brain have led to the reduction of the limbic lobe, which has become covered with cerebral cortex.

Humankind, even in its most primitive form, had a brain very similar to ours now, yet we have a much weaker sense of smell than our cave-dwelling ancestors. Indeed, congenital anosmia is on the increase, so the whole human race may be heading for an anosmic future.

Characteristically, Freud suggests that ancient psychosexual anxieties are behind this decline in our nasal capabilities. For him, it all began when man raised himself from the ground to walk on two feet, flashing his genitals to all and sundry. The shame of this sudden exposure, the theory goes, triggered a species-wide repression of the sense of smell. Humans found genitals less embarrassing when they were seen but not smelt. This meant that men were no longer able to smell menstruation or ovulation. Smell became less important in creating sexual excitement, and humans began to be turned on more by the look of each other’s bodies than the odour. As evidence for this view of smell as a forbidden, repressed sensation, Freud cites the fact that his hysterical patients often had extremely sensitive noses.

More recently, Michael Stoddart has rethought Freud’s theory in more anthropological terms. Like Freud, Stoddart believes that when humans became bipedal, it ceased to be desirable for women to advertise menstruation and ovulation through smell signals. Stoddart, however, does not attribute this to a new sense of shame, but to the increased importance of the pair bond. Upright, earth-bound offspring-toddlers-needed more looking after than their more chimp-like predecessors. It was therefore no longer socially advantageous for the father to be tempted away from the family unit by the irresistible smells of his friends’ ovulating wives. The problem here, as Stoddart himself admits, is that evolution tends to fulfil the needs of the individual rather than of the community. It still seems useful for the individual male to be attracted to other women at reproductively auspicious times, just as it seems useful for his pair-bonded partner to have the attention – and seed – of other virile men.

Colourful as they are, both Freud’s and Stoddart’s theories have a somewhat tenuous logic. The most persuasive explanation of the decline in our nasal powers remains the most obvious: in a society where food is packaged and predators tend to attack from afar with bombs, smell has become relatively unimportant.

Despite the general decline in the human sense of smell, there are still many people in the world for whom smells are a continual source both of information and of pleasure. These people tend not to live in the west. In parts of the developing world, where food comes straight from the forest rather than the supermarket and is not wrapped in plastic, people rely on their noses to stay alive.

Unsurprisingly, some of these cultures privilege smell as a mystical, life-giving sense. For the Onge, who live in the Andaman islands in the south Pacific, smell provides the vital force in the universe. Onge people sign “me” by pointing to their noses and greet each other with the question “How is your nose?”

A reverence for smell can persist even in cultures where it is not necessary for survival. In both China and Japan, it still forms the basis for important rituals such as the tea ceremony, and in Japan people play a game called kodo, which involves identifying specific scents.

Some ordinary people can identify 2,500 different smells. Our lamentable sense of smell in the west seems to stem from laziness as well as evolution. The example of Helen Keller suggests that we could do better if we really needed to. One contemporary daughter of Eve whose nasal powers seem to have bucked the evolutionary trend is Evelyn Lauder, daughter-in-law of Estee Lauder and chief nose for the Lauder perfume industry. While pregnant with her second child, she awoke one morning to discover that her sense of smell had become peculiarly acute. Happily, this new-found sensitivity has endured beyond pregnancy, and, like Helen Keller (but unlike Kant), Lauder finds that her nose brings her more pleasure than pain.

When I spoke to her, she had just been to Central Park in New York to “see” the spring flowers. But for her the experience was more about smelling than seeing. “The whole air was perfumed with all the lilac bushes which were in bloom and my delight in going up there was to smell the exquisite aromas of all the various flowers.”

She is saddened by how little we notice smell in the west, and points out that our children tend to be more nasally driven than we are. Lauder temporarily doffs her perfume magnate hat to caution nursing mothers against wearing perfume or perfumed creams, as they can hamper the natural bonding process and even prevent the baby from recognising the mother. I find this rather unnerving. If perfume inhibits babies’ natural reactions to other people’s smells, surely adults are to some extent also affected – particularly adults with a sense of smell as precarious as ours.

It is strange that, in a culture so desensitised to smell, most women still wear perfume almost every day, and, according to Evelyn Lauder, about 50 new fragrances are produced each year. Two millennia ago, Pliny made the same observation, complaining about the time and money wasted on perfume given that the wearer doesn’t even derive much pleasure from it him or herself. Several men I’ve spoken to in the course of my research have bemoaned the way women cover up their natural smells of sweat and pheromones. One American man lamented his failure to find a vagina that really smells of vagina. He longs to bottle what he sees as the true scent of a woman.

In seeking to cover up our own pheromones and sexual secretions, we have traditionally turned to the pheromones of animals. Until recently, the majority of perfumers used musk and civet in their concoctions. Musk is produced in small quantities by young Himalayan musk deer during the mating season; the animal has to be killed in order to remove the small pod in which it is contained. Civet is scraped from the anal pouches of civet cats of both sexes: a disagreeable but not necessarily fatal procedure. Over the centuries, civet and musk have been sources both of delight and danger for perfume wearers. In 1688, Petrus Castellus extolled the wonders of civet for increasing sexual appetite, and in 1896 Gould and Pyle warned of the sticky predicament of a couple who over-indulged in musk.

Perfumers can now produce a synthetic copy of both musk and civet, and nobody in America or Europe uses actual animal secretions. Nevertheless, it seems anomalous that we go to such lengths to disguise our own pheromones, merely to replace them with the simulated pheromones of other animals. For Evelyn Lauder it is not a question of disguising, but rather of accessorising our natural smell: “Women should have a wardrobe of fragrances, the way they have a wardrobe of clothing, the way they have a wardrobe of shoes.” She is adamant that perfumes complement rather than crush natural odours, and that each person’s body chemistry makes the oils project differently. For her, perfume seems to be at once an aesthetic and a sensual pleasure, much like art or music. In this she resembles Coco Chanel, who also had an amazing sense of smell.

Lyall Watson, in his book Jacobson’s Organ and the Remarkable Nature of Smell, points to some of the potential benefits of rescuing “our most underrated sense from obscurity.” He suggests that with a little training we could smell “which way the children went, who their friends are, who last used this chair or slept in that bed, and whether they were alone, when the girl next door ovulates and is likely to be attractive to or a threat to others, what our spouses had for lunch, and who they spent that time with, and whether or not we are going to need a lawyer.”

These are spectacular claims, and if Watson’s imaginary sniffer existed, he would surpass Coco Chanel or Evelyn Lauder, and even Sherlock Holmes, the cohort of a more famous Watson. For Watson, the issue is not so much the sense of smell itself as the vomeronasal organs, commonly known as Jacobson’s organs. These are small pits near the front of the nasal septum, about a centimetre and a half in from each nostril, just above the floor of the nose. They do not register ordinary odours. Instead, they respond to substances that have large molecules and no particular odour, including pheromones. It is Jacobson’s organ, if trained well, that can help us “smell a rat” or “smell something fishy,” or smell whether someone we’ve just met is more likely to be a future enemy or a future spouse.

If smell is the sense of the imagination, then writers are the best placed to translate it into words. Yet writing about a sense as un-literary or indeed anti-literary as smell is surely one of the most difficult challenges a writer can undertake. One time-honoured way to write fragrantly is to use synaesthetic metaphors. The poet Martial starts out on this route with his “smell of a silvery vineyard flowering with the first clusters of grass that a sheep has freshly cropped.” Do we smell the sheep, we might ask, or are they part of a visual image that is somehow equivalent to the smell?

Proust, of course, is the master of synaesthesia and extended metaphor. For him the countryside reverberates with odours so evocative that they assume human traits: “smells lazy and punctual as a village clock, roving and settled, heedless and provident.” The scent of the hawthorn takes on the intensity of music: it has a “rhythm which disposed the flowers here and there with a youthful light-heartedness.”

More recently, Thomas Pynchon’s description of breakfast in Gravity’s Rainbow has undertones of Proust and of Martial. The “musaceous odour of Breakfast” is “flowery, permeating, surprising, more than the colour of winter sunlight.” Like Martial, Pynchon colours the smell.

Perhaps colour is one of the most effective ways of describing an odour: our reactions to both tend to be immediate and emotional. A new arrival on the synaesthetic literary scene is Luca Turin, a chemist whose chief contribution to olfactory science is his theory of how we smell. In The Secret of Scent, he rumbustiously dethrones the widely accepted notion that the smell of a molecule depends solely on its shape, asserting instead that the vibrations within the molecule play the crucial role.

However, Turin is motivated by more than just scientific curiosity in his search for the olfactory holy grail, and his perfume guide, Parfum, published in 1992 during a break from scientific pursuits, reads like a Proustian remembrance of fragrances past. Nombre Noir, for instance, is “halfway between a rose and a violet” and “glistening with a liquid freshness that made its colours glow like a stained-glass window.”

Turin believes that his edge in turning smell into language is due to the fact that for him “smell has always had an utterly solid reality,” and he is astonished that others do not share this experience. For Turin, every perfume he has ever smelled has been “like a movie, sound and vision.” While Proust’s synaesthetic descriptions remain metaphorical, Turin seems genuinely to experience smell in several dimensions, and it is this that gives power to his writing.

Other writers strive to categorise smells, rather than to find emotional or visual analogues for them. Coleridge is being literal when he observes in his notebook that a dead dog smells like elderflowers. Similarly, the Depression-era novelist Thomas Wolfe conveys complex smells to the reader by itemising their component parts, listing odours that may be more familiar: “He knew the good male smell of his father’s sitting room, of the smooth worn leather sofa, with the gaping horsehair rent, of the blistered varnished wood upon the hearth; of the heated calf skin bindings; of the flat moist plug of Apple tobacco.”

The most famous practitioner of this kind of writing is Patrick Suskind. In his 1985 novel Perfume, the smells of a baby are listed as warm stone, butter, and a pancake soaked in milk, while the smell of the most beautiful girl Grenouille has ever smelt is likened to a combination of silk and pastry soaked in honey-sweet milk. Like Wolfe, Suskind provides a disparate collection of familiar smells, allowing us to home in on the exact smell. Unlike Wolfe, though, he allows the synaesthetic to impinge on his smell-collage. The baby surely feels like warm stone as much as it smells like it, and the silk and the girl share a visual and tactile rather than an olfactory beauty.

It is clear that writers in ancient Rome, modernist France and postmodern America are tackling the same problem when writing about smell. And as you sniff your way across the centuries from Aristotle to the internet, you will notice how much continuity there is, not just in writing technique but in the smells themselves.

Catullus found hairy armpits as noisome as the Americans find them in France today. The 17th-century poet Robert Herrick found Julia’s sweat as much of a turn-on as Napoleon did Josephine’s 200 years later. (He famously sent word from the thick of battle that she should abstain from washing now that his return was nigh.) The American man longing to bottle vagina scent finds his place at the end of this trajectory of secretion-loving men. In 1952 Le Gros Clark suggested that Descartes’s cogito ergo sum should be changed to olfacio ergo cogito. Proust, perhaps, would go so far as to change it to olfacio ergo sum. Either seems a good endorsement for learning to smell. We will never again be apes or know the exquisite aromas of a pre-lapsarian paradise. This need not stop us from following Walter Hagen’s advice: “You’re only here for a short visit. Don’t hurry, don’t worry. And be sure to smell the flowers along the way.”

Evening News (Edinburgh)
January 4, 2007

This sense is not to be sniffed at
By Julia Horton

A man born with an acute sense of smell is so intoxicated by the scent of a woman who he encounters one night that he accidentally murders her.

Unable to cope with losing her captivating essence forever, he becomes obsessed with trying to recreate her elusive aroma and embarks on a killing spree as he attempts to distil the fragrance of virginal female innocence.

The idea that a smell could be powerful enough to turn a man into a serial killer is the storyline of Tom Tykwer’s latest film Perfume: The Story of a Murderer, based on German writer Patrick Süskind’s 1985 cult novel.

In real life, few people are inspired to commit such gruesome crimes simply by inhaling, but their sense of smell is far more important than many realise.

Because it is so automatic and ever present, it is often less obvious than other key senses like sight and hearing.

Yet it is crucial to people’s health and well-being, and can literally be a lifesaver in the most basic ways, as Edinburgh neurologist Dr Colin Mumford explains.

He says: “Being able to smell is an important part of your day-to-day life. If you cannot smell when there is a fire you will not detect smoke, if you are cooking food and you cannot smell that it is rancid, you risk getting food poisoning.”

Like taste, smell is known as a chemical sense, referring to the fact that smells, whether they be the natural scent of a newborn baby’s head or the artificial stink of cigarettes, are all essentially chemicals.

The mechanism for smell involves inhaling molecules through the nose where they trigger signals from the olfactory nerve to the brain via a bone called the cribiform plate.

The most common cause of loss of smell is a simple cold blocking the path of chemicals from nose to brain, but it can also be caused by head injuries, and in very rare cases, brain tumours.

Whatever the cause, loss of smell can be very distressing, even causing depression in some cases, because of the senses’ second main role, in helping people experience pleasure.

It is particularly important in eating, where it is often confused with taste, another chemical sense. Statistics suggest that some 90 per cent of what people think is taste is actually smell. Try chewing on a piece of fresh flat leaf parsley while holding your nose—the “taste” disappears.

Dr Mumford, who is based at the Western General Hospital and lectures at Edinburgh University, adds: “Without smell, the joy of anticipating food is gone, and a lot of what people think is taste is also actually smell. Losing the ability to smell can be very distressing for people.”

Permanent loss of smell is known as anosmia, and unlike loss of hearing or sight there are no aids such as glasses which can bring back the lost sense.

Generally the loss is temporary, a condition known as hyposmia, although when it returns it can create some strange experiences for people.

Fellow neurologist Dr Malcolm Macleod, who also lectures at Edinburgh University, says: “In the same way that after an anaesthetic, feeling returns first as pins and needles before the person can differentiate between things like different temperatures, when smell returns at first people can experience unpleasant odours before the sense becomes more sophisticated again.”

Experts believe that people learn to distinguish about 10,000 different smells which can influence mood, memory, emotions, the immune system and hormones.

At Cardiff University, biosciences lecturer Professor Tim Jacob has done extensive research into the sense of smell which he says has been shown to be present in babies as young as one day old, who give unhappy facial expressions when presented with unpleasant odours.

Alison MacColl, an Edinburgh perfume designer and aromatherapist at Ladies Love Fragrance, believes people do not realise how important their sense of smell is.

“It is one of our most powerful senses but I think it is completely underestimated. It is never switched off, it’s run through subconscious control.

“Temporary loss of smell is very common in women who use their own signature scent so often that they become so used to it their olefactory senses stop picking it up.

“That’s why women will sometimes spray on more and more perfume because they can’t smell it, while people around them are choking.”

Heaven Scent Advice on How to Tackle the Problem of Body Odour

There is probably no greater social problem made by a person’s smell—and no other treated quite so flippantly—as body odour.

Perspiring is the body’s way of relieving heat and everyone sweats to some degree. Sweat itself has no odour—it is the bacteria on our skin that feed on the protein-containing sweat which creates the odour-forming chemicals.

For some people, a quick rub with a deodorant stick isn’t enough. And with BO being a big enough problem to affect professional, social and romantic relationships, why is it some people are affected more than others?

Edinburgh GP Ian McKee says: “Body odour occurs because of the chemicals secreted by the body, which vary from person to person. It’s why some have body odour and others don’t.”

Body odour generally only starts to become a problem at puberty, when our bodies begin to produce more of the hormone testosterone. This makes the glands produce more sweat.

Excessive sweating means more bacteria, so those who are overweight, exercising, anxious, or have thyroid disease, are more likely to suffer. BO, which commonly occurs on the armpits, feet and genitals because of the concentration of sweat glands in these areas, is treatable however.

Naturally, personal hygiene is a must, and a religious routine of thorough washing at least once a day using soap is essential to remove the sweat and reduce the number of bacteria that act upon it.

Antiperspirants and deodorants are also a vital after every shower. Ask your pharmacist for advice on stronger ones—an antibacterial and antiseptic solution called chlorhexidine 0.05 per cent solution is available over the counter.

What you eat can also contribute to body odour. Some foods, such as curry, garlic and spices, contain smelly chemicals which are secreted out in sweat.

It’s also crucial to wash your clothes in a hot wash and dry them properly. If clothes are left in a damp, warm state, any bacteria left will multiply.

If the problem persists, visit your doctor to get advice on prevention measures.

Science Letter
January 16, 2007

Olfaction disorders therapy; Studies in the area of olfaction disorders therapy reported from McGill University, Montreal Neurological Institute

Researchers detail in “On the trigeminal percept of androstenone and its implications on the rate of specific anosmia,” new data in olfaction disorders. “Specific anosmia is a term that describes an inability to perceive a particular odorant in the context of an otherwise normal olfactory acuity. The most common example, for the odor of androstenone, has been ascribed a prevalence ranging from 2 to 45%,” investigators in Montreal, Canada report.

“In two experiments we sought to determine whether this wide range could be explained by the difference in steroid concentrations used, and by the degree to which the trigeminal system contributes to perception of androstenone. Experiment 1 demonstrated that high concentrations of androstenone stimulated the trigeminal system, as indicated by electrophysiological recordings. Experiment 2 demonstrated that conscious detection of androstenone is possible based solely on the trigeminal system. Interestingly, detection seems to interact with olfactory acuity in that subjects with a low olfactory sensitivity to androstenone were better able to detect its trigeminal component. The agreement between conscious experience and behavioral discrimination was not well calibrated, in that subjects demonstrated a clear overconfidence in their abilities. Altogether, the current study suggests that androstenone is an odorant that produces a concentration-dependent degree of trigeminal stimulation,” wrote J.A. Boyle and colleagues, McGill University, Montreal Neurological Institute.

The researchers concluded: “This trigeminal component explains the diversity of the reported prevalence of specific anosmia for androstenone and might have implications on future use of specific anosmia as a tool to understand odor processing.”

Boyle and colleagues published their study in the Journal of Neurobiology (On the trigeminal percept of androstenone and its implications on the rate of specific anosmia. Journal of Neurobiology, 2006;66(13):1501-10).

For additional information, contact J.A. Boyle, Montreal Neurological Institute, McGill University, Montreal, Canada.

Red Deer Express (Alberta)
February 7, 2007

The Nose that Knows
By Dr. Dave Hepburn

My grandfather’s name was Dah.

As a wee lad I would spend hours sitting on Dah’s lap, watching the oft-resurrected Wyle E. Coyote rocket through another Acme disaster, while the burning embers from ol’ Dah’s cigar would fall into his snowy white chest hair or directly onto my cornea.

Finally he would say, “David, you’re 15 years old. Get off my lap and give me back the cigar.” I loved ol’ Dah and when he passed away it was for me a cruel joke.

Thirty years after his passing I received an unexpected phone call.

“Hi, my name is Bugsy and I fought alongside your grandfather George in Italy.”

As Bugsy went on to relate some of Dah’s legendary military feats, which usually featured greased pigs, five aces or stolen jeeps, I began to notice a strange odor at my desk, stranger than normal.

I glared at the dog who glared back with a stupid yet innocent grin on his mug, but it wasn’t him.

Suddenly this strange yet familiar smell twanged the memory cells of my brain. It was Dah’s cigar.

Smelling a man dead 30 years may not be a great idea for a date, but in the part of my mind responsible for smell he was very much fresh and alive. Such is the power of the sense of smell.

“Doc, I don’t smell too good.”

“Well Bloggins, I’ve got a cold so I really didn’t notice...”

“No I mean I can’t smell anything anymore. On occasion it’s a blessing but for the most part it drives me nuts. And when I eat I can’t tell if I’m eating the pizza or the cardboard box. Worse yet, it’s really getting me down. Life seems to have lost its zest for me lately.”

At the roof of our nose, in a happy little bone called the cribriform plate, sits the olfactory bulb, an organ that is lined by kazillions of glomeruli.

These amazing specific smell files can detect, differentiate and process 10,000 different smells.

While taste buds have four basic tastes; salty, sweet, sour and Snickers, it is the sense of smell that allows us to identify exactly what it is that we have just placed in our mouth.

When an odor, nice or nasty, wafts into our nostrils, past assorted hairs, chalk and peas, the glomeruli processes the odor, packs up the information and fires it along the olfactory nerve to some place in the brain right next to the “It-Wasn’t-Me!” denial centre.

Anosmia refers to the complete loss of smell. The commonest causes of anosmia include

1. Sinus disease (either allergic or infectious)
2. Upper respiratory infections, which is why normally evil tasting beasts such as Buckley’s or Fisherman’s Friend can actually be tolerated when we have a cold.
3. Head trauma, which can disrupt the cribriform plate in the nose.

Half of those over age 60 have some olfactory dysfunction not necessarily related to any disease, unless you term aging as a disease.

As we age, our sense of smell joins the vision and hearing in a gradual decline.

Rather than young vibrant cells working hard in the olfactory center, old factory workers now go on strike.

Smoking helps to wear down the old factory workers even further. A lack of smell is associated with increased depression and a lower quality of life. Thus it can be concluded that smoking contributes to depression.

Astonishingly, loss of smell can also be an early marker for certain neurodegenerative diseases such as Parkinsons, Alzheimers and even Multiple Sclerosis.

In fact, anosmia may be the first symptom to signal the onset of these diseases.

Life Science Weekly
February 13, 2007

Olfaction Disorders; Study findings from Weizmann Institute of Science, Department of Molecular Genetics provide new insights into olfaction disorders

Researchers detail in “Mutations in olfactory signal transduction genes are not a major cause of human congenital general anosmia,” new data in olfaction disorders. “Anosmia affects the western world population, mostly the elderly, reaching to 5% in subjects over the age of 45 years and strongly lowering their quality of life. A smaller minority (about 0.01%) is born without a sense of smell, afflicted with congenital general anosmia (CGA),” researchers in Rehovot, Israel, report.

“No causative genes for human CGA have been identified yet, except for some syndromic cases such as Kallman syndrome. In mice, however, deletion of any of the 3 main olfactory transduction components (guanidine triphosphate binding protein, adenylyl cyclase, and the cyclic adenosine monophosphate-gated channel) causes profound reduction of physiological responses to odorants. In an attempt to identify human CGA-related mutations, we performed whole-genome linkage analysis in affected families, but no significant linkage signals were observed, probably due to the small size of families analyzed. We further carried out direct mutation screening in the 3 main olfactory transduction genes in 64 unrelated anosmic individuals. No potentially causative mutations were identified, indicating that transduction gene variations underlie human CGA rarely and that mutations in other genes have to be identified,” wrote E. Feldmesser and colleagues, Weizmann Institute of Science, Department of Molecular Genetics.

The researchers concluded: “The screened genes were found to be under purifying selection, suggesting that they play a crucial functional role not only in olfaction but also potentially in additional pathways.”

Feldmesser and colleagues published their study in Chemical Senses (Mutations in olfactory signal transduction genes are not a major cause of human congenital general anosmia. Chemical Senses, 2007;32(1):21-30).

For additional information, contact E. Feldmesser, Weizmann Institute of Science, Dept. of Molecular Genetics, Rehovot, Israel.

New Straits Times (Malaysia)
April 8, 2007

Off the scent
By Dr. Kuljit Singh

At a typical Asian cuisine outlet, everyone would be enjoying the aroma of good food seeping through the doors of the kitchen. Imagine the feeling when the food is served. When the sensation of smell is lost, it is comparable to blindness and deafness. People who suffer from anosmia are unable to smell anything.

What is anosmia?

Wikipedia defines anosmia as lack of olfaction or a loss of the ability to smell. Many people may not realise they have this disorder until they encounter a situation whereby it is obvious that they had missed an odour or smell. It is distressing and could lead to depression in some. There is another condition called “hyposmia” where an individual’s ability to smell is diminished. He would be able to catch the smell only when the odour/fragrance intensity is high.

How do we smell?

The earliest research on the mechanism of smell was done in 1756 by Linnaeus, a Swedish botanist. Decades later, scientists have differentiated various molecules and described them as aromatic, fragrant, repulsive, ethereal, resinous, spicy, burned, putrid and so on. Smell must be either in gaseous or volatile liquid form for it to be perceptible.

In the roof of our nose are sensitive nerve endings and nerve cells that form the olfactory system. These can detect odours in the air. The level of sensitivity varies from person to person. Some animals have greater sensitivity to the smell of certain odours. We even have canines that can sniff out pirated CDs.

Our system of smell is unique as sensitivity would diminish upon continuous exposure to a particular smell.

An odour can also mask another, especially if one is much stronger, or the combination of the two yields no odour at all.

There are 16 chemical elements that produce odour: Hydrogen, carbon, silicon, nitrogen, phosphorus, arsenic, antimony, bismuth, oxygen, sulphur, selenium, tellurium, fluorine, chlorine, bromine and iodine. Halogen and ozone are also odorous elements.

Losing the smell sensation

It is postulated that when air flow towards the roof of the nose is blocked, the sense of smell would decrease. This occurs commonly when we suffer viral influenza which causes an inflammation within the nose.

Patients with allergic rhinitis would suffer the same fate as there would be inflammation that almost occludes the air passage. It prevents air flow carrying molecules containing substances which could stimulate the sense of smell from reaching the olfactory nerve endings. Nasal polyps, deviated septum, tumours and deformed bones within the nose could also contribute to anosmia.

Medications such as nasal vasoconstrictors could lead to a permanent anosmia, scientifically known as rhinitis medicamentosa. It also causes crusting and bleeding. Treatment is far from successful in these cases.

Other probable causes of anosmia would be tumours of the nose or brain, head trauma and a variety of endocrine, nutritional, Alzheimer’s dementia, and nervous disorders.

Treating anosmia

It is difficult to promise recovery and total cure for anosmia. In some cases, if the probable cause is identified, the chance of regaining the sense of smell is encouraging.

The common treatment method would be to clear the offending obstruction in the nose. Inflammation caused by allergy or infection would be cleared with the use of nasal steroids and antibiotics. Polyps may have to be removed surgically if persistent, and other bony/cartilage deformities could be corrected.

Anosmic patients with nerve defects have less chance of recovery. Viral infections damage nerves and this is irreversible.

Hypothyroidism and poor control of diabetes mellitus may also slow down recovery of the olfactory system.

Nutritional deficits may be reversed with zinc, vitamin A, thiamine or any other specific nutrient that may be lacking. The evidence of its effectiveness is yet to be proven.

Many patients suffer anosmia due to unknown causes which are not amenable to specific treatment. Use of zinc sulphate is controversial as again, it has not been proven effective.

Other remedies such as vitamins and tricyclic antidepressants have been tested on some patients. It is advisable to eliminate toxins (eg. cigarette smoke, airborne pollutants).

Conclusion

Anosmia is not a life-threatening problem but it could be dangerous as sometimes poison fumes or the smell of fire are missed. This is common in many individuals and a proper nasal examination by an ENT surgeon would be warranted.

Africa News
May 16, 2007

Rwanda; Olfactory Dysfunction; Common Problem Amongst Aged Patients

Most people recognize the values of olfactory function only after they have been lost. Olfactory function is important because it acts as a warning system which may alert individuals to poisonous fumes, leaking gases, and spoilt foods which are very dangerous to the individual’s health.

Doctor Vennant Ntabomvura, a medical specialist in nasal related problems working at the university hospital of Butare, says that loss of olfactory function is a frequent problem amongst aged; however a few incidences may occur among the youth.

He says that while olfactory loss goes undetected in everyday life, it severely alters the quality of life of its victims.

The doctor explains that nasal issues can have a significant impact on our lives for example, when the sense of smell is lost, it does not only make difficulties in differentiating odours but also another sense is lost which alerts us to dangers from fire or other dangerous substances.

Three major causes of olfactory disorders are head injury, infections of the upper respiratory tract (URI), and sino-nasal disease. Other frequent causes include congenital anosmia or exposure to toxic substances, each of which has been reported to occur in less than 5 per cent of the cases.

Most people probably think that the enjoyment of what we eat or drink is most dearly missed when the sense of smell has been lost. Many patients complain to their physicians about disturbances of smell or taste and this is often explained to the fact that the olfactory loss appears to go unnoticed even in cases where there is head trauma caused by sudden olfactory loss.

Amongst the qualitative odour dysfunction are parosmia, also called troposmia which occurs in the presence of an odour, and phantosmia which refers to an olfactory perception when no odour source is present and they may occur intermittently or constantly. Parosmia is typically associated with reduced olfactory sensitivity.

The doctor says that almost none of parosmic patients’ reports to perceive pleasant odours, the large majority, if not all patients find these sensations to be unpleasant, sometimes even faecal. Also, signs of depression have been reported to be present in approximately two thirds of patients reporting qualitative olfactory dysfunction.

The doctor says that it is also important to know how the olfactory centres of the body work. For example the perception of certain flavour results from the interplay between three sensory systems of the olfactory nerve that mediates olfactory sensations such as the pleasant odour of vanillin or the rotten smell of an egg. Also important is the gustatory system that mediates basic tastes such as sweet, salty, sour, and bitter. Nerves that innervate olfactory and taste body parts also contributes to the state of sense of olfaction for an individual.

“Major determinants of olfactory sensitivity are gender and age. It is well known that women outperform men in almost all aspects of olfactory sensitivity. Although the exact reason for this difference remains unclear, social, hormonal, and genetic factors are thought to be involved, other determinants of olfactory sensitivity include smoking which leads to a mild but significant decrease of olfactory function. This decrease has been shown to be related to the number of cigarettes smoked, but can be reversed after cigarette smoking has terminated.”

It seems reasonable to assume that acute loss of olfactory function following trauma or viral infection is perceived as more severe compared to the gradual loss of olfactory function for example in sino- nasal disease.

In fact, signs of higher degree of depression or global psychological distress have been reported in patients with a more recent and sudden onset of anosmia. In fact, in patients with post-traumatic olfactory loss it is a characteristic that this deficit is only noted weeks or even months following the actual incident.

The doctor again explains that the epidemiological research in this area seems to be particularly difficult considering that, within the general population difficulties to adequately judge olfactory dysfunction are frequently found and consequently many patients would not seek professional advice, even if olfactory function was seriously compromised.

The possible treatment of olfactory dysfunction involves various therapeutic possibilities. Therapy has been proven to be effective only for olfactory dysfunction due to Sino nasal disease. Surgical therapy such as polypectomy, sinusotomy, and ethmoidectomy and systemic administration of corticosteroids are more helpful to the patient.

Dr. Ntabomvura advises that during evaluation steps, doctors have to consider the historical aspects of the patient such as demographics, eating, drinking and smoking habits. This helps the doctor to list major illnesses and injuries, medications taken in relation to symptom onset, history of present illness, endocrine information including questions regarding menstrual status or thyroid function is important.

Radiological evaluation may also be helpful to rule out the presence of olfactory meningeomas, pituitary tumours, frontal lobe gliomas, large aneurysmas and other cerebral tumours.

The New York Times
May 18, 2005

Failing the Sniff Test: The Nose, Ruined
By Paul Lukas

ROBERT WEINSTOCK doesn’t remember the accident.

“It was Oct. 7, 2003, and I was going to get a prescription from my doctor,” he recalled recently. “It was just two blocks away, but I was running late, so I took my bicycle. I’d only been biking for about five seconds when I turned a corner. The next thing I remember is waking up in the hospital.”

Mr. Weinstock, a 37-year-old illustrator and children’s book author who lives in Greenwich Village, soon learned that he had been hit by a truck, resulting in a broken arm, hearing loss in one ear, spinal fluid leakage and a fractured skull. He spent two weeks in the hospital, where he underwent two spinal taps and skull surgery.

Given the gravity of his injuries, Mr. Weinstock didn’t worry too much about how his food was tasting. “My mother was bringing me soup from some fancy market,” he said, “and I realized at some point that it all tasted like chicken fat, schmaltz. I didn’t say anything, because I figured there was just something off with the food.”

But after he left the hospital, he realized the problem was wide-ranging.

“Coffee smelled a bit rank, anything with garlic tasted horrible – and I always loved garlic!” he said. “Then I had mint chocolate chip ice cream, one of my favorite foods, and it tasted really chemical-y.”

Mr. Weinstock was experiencing a loss of smell, or anosmia. Because smell and taste are so closely related, anosmia patients usually complain first about food that doesn’t taste right. They find themselves in a world where they can no longer take for granted that chocolate will taste like chocolate, longtime favorites are suddenly unpleasant, and the parameters of good and bad flavor, or ripe and spoiled, become a guessing game. A lifetime’s worth of learned assumptions and preferences are sent back to square one.

“The taste buds can only detect sweet, sour, salty and bitter – the full symphony of flavor comes from the nose,” said Dr. Charles P. Kimmelman, a Manhattan anosmia specialist. “But when your brain is hit really hard, it wiggles like Jell-O, and the little fibers going from the smell nerve endings up to the brain are stretched taut. Some of them get torn, injured or bruised.”

Can the damaged fibers regenerate? “To a certain extent,” Dr. Kimmelman said. “But not necessarily along the same pathways they had before. It’s like a crossed circuit. And there’s usually a phantom sensation, like when a person loses a foot but still feels like his toe is hurting. The brain is trying to make sense of what little information it has coming in.”

So some things may be perceived differently than they were before the injury, and others may not be perceived at all. Dr. Kimmelman said that most anosmia patients recover only 20 to 30 percent of their sensory function, and that there is little doctors can do about it.

Anosmia may be caused not only by head trauma but also by upper respiratory infection, nasal or sinus disease and exposure to toxins. Some people are born with the condition. People from all these camps usually find their way to a Yahoo anosmia message board (health.groups.yahoo.com/group/anosmia) that has emerged as a popular support group.

Many anosmic people say the biggest challenge is in the kitchen. “I wasn’t a great cook to begin with, but with anosmia you can’t tell when something’s burning,” said Lori Mesnik, a computer consultant from Edison, N.J., who suffered a head injury in December. “One time I steamed some broccoli, and it wasn’t until I cleaned up later that evening that I realized the water had boiled out and burned the Teflon from the inside of the pot.”

Another common complaint: dealing with the frequent perception that compared with other disabilities, anosmia is no big deal.

“Most people treat me like a circus oddity,” said Maria Topper, a school science coordinator from Oceanside, Calif., who became anosmic about two years ago, apparently because of allergies. “They do not realize how much of a life-changing experience it is to lose these senses.”

Mr. Weinstock initially played down his condition.

“At first my attitude was that I was grateful not to be a vegetable,” he said. “I thought, ‘If this is the worst I have to deal with, that’s fine.’ But it did take a lot of the joy out of eating. It was deflating to bite into something and have it taste bad.” Because eating is such a social activity, he sometimes felt left out at dinner gatherings. Restaurant outings became crapshoots at best, pointless extravagances at worst.

But the problems of this condition go beyond culinary inconvenience. Anosmic patients may not be able to smell a gas leak or a fire, and they can unwittingly eat spoiled food. Mr. Weinstock once handed a milk carton to his girlfriend, Dana Stevens, who poured milk in her coffee and discovered it had turned sour. Mr. Weinstock, completely oblivious, had already finished his cereal.

Mr. Weinstock was eventually referred to Dr. Kimmelman, who gave him the University of Pennsylvania Smell Identification Test, considered the gold standard for assessing olfactory function (available from smelltest.com for $26.95; minimum order seven tests). Mr. Weinstock initially thought he’d done “fairly well” on the test but was disappointed to hear that his score placed him among the bottom 5 percent of the population. “That’s when it began seeming more real,” he said. “I realized this was going to be a problem.”

Undaunted, Mr. Weinstock slowly began orienting himself to his reconfigured palate. “Thai, Japanese and fruit were O.K., but almost anything else tasted off,” he said. “Anything with a sauce or a melding of flavors tasted muddy and schmaltzy. Processed foods like candy, soda and toothpaste were very chemical-y, almost astringent.”

Ms. Stevens, a freelance journalist who occasionally writes film reviews for The New York Times, helped out by setting up blind taste tests for Mr. Weinstock. She primarily used ice creams and sorbets, since they all had similar, neutral textures. Slowly but steadily, Mr. Weinstock showed progress: At first he couldn’t tell chocolate ice cream from vanilla, but later on he successfully distinguished between the relatively similar coffee and dulce de leche. Both he and Ms. Stevens remember that as a milestone.

“My theory was that immersion therapy would help – lots of stimulus, lots of flavors,” Ms. Stevens said. “Besides, the alternative seemed so grim. At one point I found this anosmia web site where people posted messages like, ‘There’s more to food than flavor – there’s still texture and color and temperature!’ And that just seemed depressing, like, ‘Ah, here’s a red cube, and it’s tepid, oh boy!’ The taste tests made me feel like we were working on something, making progress.”

Whatever the impetus, Mr. Weinstock’s taste sense appears to have improved. “I’ve definitely gotten better at eating things with garlic, especially cooked garlic,” he said. “In general, there are more things that taste good. And I’m better at understanding what tastes good and what doesn’t.”

At a Brooklyn cafe recently,