Anosmia, the loss of smell: causes and how to recover it

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Anosmia is one of the symptoms of COVID-19, but other conditions can also cause complete loss of smell. An expert in olfactory disorders reveals why we stop smelling and how to recover our sense of smell.

Anosmia, the loss of smell: causes and how to recover it

Of the five classic senses – hearing, taste, smell, touch and sight – we have probably never placed more importance on the ability to smell than when many of us lost it due to the SARS-CoV-2 coronavirus infection. And it is that anosmia or loss of smell was one of the signs that alerted many people who did not present any other symptoms of COVID-19 to a possible contagion. In fact, many of those affected by persistent COVID have not managed to recover their sense of smell months after passing the infection. Precisely, this February 27th is World Anosmia Day, and we take the opportunity to analyze what it consists of, its causes and consequences and what solutions exist to recover our sense of smell.

what is anosmia

“Anosmia is the term that defines the total loss of the sense of smell, when the patient smells absolutely nothing, since if it is a partial loss it is known as hyposmia”, explains Dr. Adriana Izquierdo, a member of the rhinology commission of the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) and coordinator of the Smell Unit at the Hospital de Terrassa.

Other olfactory alterations from which it should be differentiated are cacosmia, in which an unpleasant odor is perceived due to stimuli that are triggered in the body without the presence of odorous molecules in the environment, parosmia, which is characterized by an olfactory distortion that it turns normal odors into pestilential ones, and the phantomy or perception of an unpleasant odor that is not real (hence its name due to its association with phantom odors).

Sick with covid-19 trying to smell an orange

Causes of anosmia or loss of smell

There are multiple causes that can cause a total loss of smell, says Dr. Izquierdo, who is also a specialist in allergology. “The most frequent are post-viral -as we have learned with the COVID-19 pandemic-, inflammations in the nasal passages, such as nasal polyposis or allergic rhinitis, head injuries and neurodegenerative diseases, such as Alzheimer’s, Parkinson’s, certain dementias. … This encompasses approximately 70-80% of causes of anosmia, and another percentage that would be around 20% would be congenital – being born without certain olfactory structures –, due to exposure to certain drugs or toxins, or brain tumors”.

The main causes of anosmia or reasons why we lose our sense of smell are:

  • Respiratory tract infections, such as colds, flu or COVID-19 can cause a temporary loss of sense of smell.
  • Aging: 20-30% of those over 65 years of age have olfactory dysfunction, which can affect 75% of those over 80 years of age, according to the SEORL-CCC.
  • Acute sinusitis.

  • smoking. Some components of tobacco, such as nicotine and tar, can damage the cells of the olfactory receptors.
  • Brain injuries.
  • Medications (antihistamines, antibiotics, estrogens…).
  • Nasal surgeries.
  • Nasal polyps or deviations of the nasal septum.
  • Neurodegenerative diseases: dementia, Alzheimer’s, Parkinson’s…
  • Exposure to air pollution
  • Inhalation of toxic chemicals, such as benzene, paint thinners, or insecticides, among others.
  • Drug use, such as cocaine.

Consequences of loss of smell

Before the pandemic, smell was hardly talked about, unlike hearing or vision, says Dr. Izquierdo, who affirms that “it is a sense that greatly influences the quality of life and interpersonal relationships, since patients with anosmia may experience insecurity because they don’t know if they smell good or bad, or how their child or partner smells…”.

Woman eating bad sushi

The lack of smell also prevents us from identifying threats (open gas, fires…) and, for example, we can suffer food poisoning from eating food in poor condition by not being able to perceive the bad smell they give off, or not wanting to eat for not appreciating the taste of food, which can lead to malnutrition and unwanted weight loss. “There are already studies that demonstrate the appearance of nutritional deficiency states due to impaired smell; patients who lose their appetite or stop eating because they do not enjoy food.

In this regard, the specialist explains that there are three terms that are often confused: taste, flavor and smell. “Taste depends a lot on smell and if the patient has impaired smell, they will notice a different taste or they will appreciate the taste of food less, but this is confused with taste, which is what the taste buds capture: sweet, salty, sour, bitter and umami. Taste is the combination of taste with smell and when we have an altered sense of smell we normally have an altered taste, but the taste goes through other channels”.

How anosmia is treated: olfactory rehabilitation

Anosmia can be reversed in many cases and its treatment depends on the cause of the loss of smell. “If the cause is inflammation, for example, due to nasal polyposis or allergic rhinitis, there are anti-inflammatory drugs to reduce inflammation of the nasal mucosa and for the patient to recover the stimulus of odorants. If the cause is a virus, apart from obviously treating the viral infection, olfactory training is indicated: training smell to regain olfactory memory and recover smell”.

Therapist making a girl smell a fruit

This is the case of people who partially or totally lost their sense of smell due to coronavirus infection, or of those who have not recovered it because they suffer from persistent COVID. The treatment with the best results in these patients has been olfactory rehabilitation for between six and 12 months, according to the SEORL-CCC, which adds that it is a non-invasive therapy and is especially recommended for the recovery of smell after a viral infection.

From this society, they explain that otolaryngologists follow standard guidelines for the rehabilitation of smell, which consists of performing two exercises every day, exposing them to four odorants: fruity, mentholated, aromatic and floral, and that other varieties of scents have been added to these. odors and concentrations. The aromas most used in case of anosmia are usually lemon, cloves, mint and rose.

Parosmia associated with COVID-19 has also been able to be corrected with smell rehabilitation. This problem, says Dr. Izquierdo, “is very confusing because the odors reach you completely distorted and are usually unpleasant. The descriptions that we have heard the most in consultations are smells of rancid butter, mixed with smoke, with sewage, with rotten… This is nauseating and patients vomit, lose weight, refuse to eat… There have even been cases in adolescents that mothers They believed that they were starting with bulimia and anorexia disorders and it was parosmia associated with coronavirus infection ”.

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