Anosmia Explained

Anosmia
Synonym:Loss of smell, smell blindness, odor blindness
Types:Partial, total

Anosmia, also known as smell blindness, is the loss of the ability to detect one or more smells.[1] [2] Anosmia may be temporary or permanent.[3] It differs from hyposmia, which is a decreased sensitivity to some or all smells.[2]

Anosmia can be categorized into acquired anosmia and congenital anosmia. Acquired anosmia develops later in life due to various causes, such as upper respiratory infections, head trauma, or neurodegenerative diseases.[4] In contrast, congenital anosmia is present from birth and is typically caused by genetic factors or developmental abnormalities of the olfactory system.[5] While acquired anosmia may have potential treatments depending on the underlying cause, such as medications or surgery, congenital anosmia currently has no known cure, and management focuses on safety precautions and coping strategies.[6]

Anosmia can be due to a number of factors, including inflammation of the nasal mucosa, blockage of nasal passages, or destruction of temporal lobular tissue.[7] Anosmia stemming from sinus inflammation is due to chronic mucosal changes in the lining of the paranasal sinus and in the middle and superior turbinates.[8] [9]

When anosmia is caused by inflammatory changes in the nasal passageways, it is treated simply by reducing inflammation.[10] It can be caused by chronic meningitis and neurosyphilis that would increase intracranial pressure over a long period of time,[11] and, in some cases, by ciliopathy,[12] including ciliopathy due to primary ciliary dyskinesia.[13]

The term derives from the Neo-Latin anosmia, based on Ancient Greek ἀν- (an-) + ὀσμή (osmḗ 'smell'; another related term, hyperosmia, refers to an increased ability to smell). Some people may be anosmic for one particular odor, a condition known as "specific anosmia". The absence of the sense of smell from birth is known as congenital anosmia.[14]

In the United States, 3% of people aged over 40 are affected by anosmia.[3]

Anosmia is a common symptom of COVID-19 and can persist as long COVID.[15]

Definition

Anosmia is the inability to smell.[1] It may be partial or total, and can be specific to certain smells.[2] Reduced sensitivity to some or all smells is hyposmia.[2]

Signs and symptoms

Anosmia can have a number of harmful effects.[16] People with sudden onset anosmia may find food less appetizing, though congenital anosmics rarely complain about this, and none report a loss in weight. Loss of smell can also be dangerous because it hinders the detection of gas leaks, fire, and spoiled food. Misconceptions of anosmia as trivial can make it more difficult for a patient to receive the same types of medical aid as someone who has lost other senses, such as hearing or sight.

Many experience one sided loss of smell, often as a result of minor head trauma. This type of anosmia is normally only detected if both of the nostrils are tested separately. Using this method of testing each nostril separately will often show a reduced or even completely absent sense of smell in either one nostril or both, something which is often not revealed if both nostrils are simultaneously tested.[17]

Losing an established and sentimental smell memory (e.g. the smell of grass, of the grandparents' attic, of a particular book, of loved ones, or of oneself) has been known to cause feelings of depression.[18]

Loss of the ability to smell may lead to the loss of libido, but this usually does not apply to those with olfactory dysfunction at birth.[18] [19]

Often people who have loss of smell at birth report that they pretended to be able to smell as children because they thought that smelling was something that older/mature people could do, or did not understand the concept of smelling but did not want to appear different from others. When children get older, they often realize and report to their parents that they do not actually possess a sense of smell, often to the surprise of their parents.

Causes

A temporary loss of smell can be caused by a blocked nose or infection. In contrast, a permanent loss of smell may be caused by death of olfactory receptor neurons in the nose or by brain injury in which there is damage to the olfactory nerve or damage to brain areas that process smell (see olfactory system). The lack of the sense of smell at birth, usually due to genetic factors, is referred to as congenital anosmia. Family members of the patient with congenital anosmia are often found with similar histories; this suggests that the anosmia may follow an autosomal dominant pattern.[20] Anosmia may very occasionally be an early sign of a degenerative brain disease such as Parkinson's disease and Alzheimer's disease.

Another specific cause of permanent loss could be from damage to olfactory receptor neurons because of use of certain types of nasal spray; i.e., those that cause vasoconstriction of the nasal microcirculation. To avoid such damage and the subsequent risk of loss of smell, vasoconstricting nasal sprays should be used only when absolutely necessary and then for only a short amount of time. Non-vasoconstricting sprays, such as those used to treat allergy-related congestion, are safe to use for prescribed periods of time.[21] Anosmia can also be caused by nasal polyps. These polyps are found in people with allergies, histories of sinusitis, and family history. Individuals with cystic fibrosis often develop nasal polyps.

Amiodarone is a drug used in the treatment of arrhythmias of the heart. A clinical study demonstrated that the use of this drug induced anosmia in some patients. Although rare, there was a case in which a 66-year-old male was treated with amiodarone for ventricular tachycardia. After the use of the drug he began experiencing olfactory disturbance, however after decreasing the dosage of amiodarone, the severity of the anosmia decreased accordingly, suggesting a relationship between use of amiodarone to the development of anosmia.[22]

COVID-19-related anosmia

Chemosensory disturbances, including loss of smell or taste, are the predominant neurological symptom of COVID-19.[23] [24] As many as 80% of COVID-19 patients exhibit some change in chemesthesis, including smell. Loss of smell has also been found to be more predictive of COVID-19 than all other symptoms, including fever, cough or fatigue, based on a survey of 2 million participants in the UK and US.[25] Google searches for "smell", "loss of smell", "anosmia", and other similar terms increased since the early months of the pandemic, and strongly correlated with increases in daily cases and deaths.[26] Research into the mechanisms underlying these symptoms is currently ongoing.[27] [28]

Many countries list anosmia as an official COVID-19 symptom, and some have developed "smell tests" as potential screening tools.[29] [30]

In 2020, the Global Consortium for Chemosensory Research, a collaborative research organization of international smell and taste researchers, formed to investigate loss of smell and related chemosensory symptoms.[31]

Possible causes

Diagnosis

Diagnosis begins with a detailed history, including possible related injuries, such as upper respiratory infections or head injury. The examination may involve nasal endoscopy for obstructive factors such as polyps or swelling.[7] A nervous system examination is performed to see if the cranial nerves are affected.[7] On occasion, after head traumas, there are people who have unilateral anosmia. The sense of smell should be tested individually in each nostril.[17]

Many cases of congenital anosmia remain unreported and undiagnosed. Since the disorder is present from birth the individual may have little or no understanding of the sense of smell, hence is unaware of the deficit.[32] It may also lead to reduction of appetite.[33]

Treatment

Though anosmia caused by brain damage cannot be treated, anosmia caused by inflammatory changes in the mucosa may be treated with glucocorticoids. Reduction of inflammation through the use of oral glucocorticoids such as prednisone, followed by long term topical glucocorticoid nasal spray, would easily and safely treat the anosmia. A prednisone regimen is adjusted based on the degree of the thickness of mucosa, the discharge of oedema and the presence or absence of nasal polyps.[10] However, the treatment is not permanent and may have to be repeated after a short while. Together with medication, pressure of the upper area of the nose must be mitigated through aeration and drainage.[34]

Anosmia caused by a nasal polyp may be treated by steroidal treatment or removal of the polyp.[35]

Although very early in development, gene therapy has restored a sense of smell in mice with congenital anosmia when caused by ciliopathy. In this case, a genetic condition had affected cilia in their bodies which normally enabled them to detect air-borne chemicals, and an adenovirus was used to implant a working version of the IFT88 gene into defective cells in the nose, which restored the cilia and allowed a sense of smell.[36] [37]

Epidemiology

In the United States, 3% of people aged over 40 are affected by anosmia.[3]

In 2012, smell was assessed in persons aged 40 years and older with rates of anosmia/severe hyposmia of 0.3% at age 40–49 rising to 14.1% at age 80+. Rates of hyposmia were much higher: 3.7% at age 40–49 and 25.9% at 80+.[38]

Famous people with anosmia

See also

Further reading

Notes and References

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  2. Book: Jones N . https://books.google.com/books?id=arSSpm-OgjYC&pg=PA25. Practical Rhinology. 2010. CRC Press. 978-1-4441-0861-3. Jones N . 24–25. en. 2. Making sense of symptoms.
  3. Book: Li X, Lui F . Anosmia . 6 July 2020 . http://www.ncbi.nlm.nih.gov/books/NBK482152/ . StatPearls . StatPearls Publishing . 29489163 . 1 December 2020 .
  4. Anosmia - StatPearls - NCBI Bookshelf . NCBI . 2021 . 29489163 . 2024-07-06 . Li . X. . Lui . F. .
  5. Web site: Congenital Anosmia . Fifth Sense . 2024-07-06.
  6. Web site: Loss of smell (anosmia) Causes . Mayo Clinic . 2024-07-06.
  7. Huynh PP, Ishii LE, Ishii M . What Is Anosmia? . JAMA . 324 . 2 . 206 . July 2020 . 32556300 . 10.1001/jama.2020.10966 . 219916772 . free .
  8. Helliwell T . Inflammatory diseases of the nasal cavities and paranasal sinuses . Diagnostic Histopathology . 16 . 6 . 255–264 . June 2010 . 32336992 . 7172334 . 10.1016/j.mpdhp.2010.03.008 .
  9. Lin YT, Yeh TH . Studies on Clinical Features, Mechanisms, and Management of Olfactory Dysfunction Secondary to Chronic Rhinosinusitis . Frontiers in Allergy . 3 . 835151 . 2022 . 35386650 . 8974686 . 10.3389/falgy.2022.835151 . free .
  10. Knight A . Anosmia . Lancet . 2 . 8609 . 512 . August 1988 . 2900434 . 10.1016/s0140-6736(88)90160-2 . 208793859 .
  11. 1943 . Anosmia . The Lancet . 241 . 6228 . 55 . 10.1016/S0140-6736(00)89085-6. 241387103 .
  12. Uytingco CR, Green WW, Martens JR . Olfactory Loss and Dysfunction in Ciliopathies: Molecular Mechanisms and Potential Therapies . Current Medicinal Chemistry . 26 . 17 . 3103–3119 . 2019 . 29303074 . 6034980 . 10.2174/0929867325666180105102447 .
  13. Ul Hassan A, Hassan G, Khan SH, Rasool Z, Abida A . Ciliopathy with special emphasis on kartageners syndrome . International Journal of Health Sciences . 3 . 1 . 65–69 . January 2009 . 21475513 . 3068795 .
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  19. Gudziol V, Wolff-Stephan S, Aschenbrenner K, Joraschky P, Hummel T . Depression resulting from olfactory dysfunction is associated with reduced sexual appetite--a cross-sectional cohort study . The Journal of Sexual Medicine . 6 . 7 . 1924–1929 . July 2009 . 19453919 . 10.1111/j.1743-6109.2009.01266.x .
  20. Waguespack RW . 1992. Congenital Anosmia. Archives of Otolaryngology–Head & Neck Surgery. 118. 1. 10. 10.1001/archotol.1992.01880010012002.
  21. https://web.archive.org/web/20060101000005/http://www.coldcure.com/anosmia/anosmia.html Preventing Anosmia from Intranasal Zinc Administration
  22. Maruyama T, Yasuda S, Odashiro K, Kaji Y, Harada M . Anosmia induced by amiodarone . The American Journal of Medicine . 120 . 11 . e9 . November 2007 . 17976411 . 10.1016/j.amjmed.2006.08.029 . free .
  23. Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, Dequanter D, Blecic S, El Afia F, Distinguin L, Chekkoury-Idrissi Y, Hans S, Delgado IL, Calvo-Henriquez C, Lavigne P, Falanga C, Barillari MR, Cammaroto G, Khalife M, Leich P, Souchay C, Rossi C, Journe F, Hsieh J, Edjlali M, Carlier R, Ris L, Lovato A, De Filippis C, Coppee F, Fakhry N, Ayad T, Saussez S . 3 . Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study . European Archives of Oto-Rhino-Laryngology . 277 . 8 . 2251–2261 . August 2020 . 32253535 . 7134551 . 10.1007/s00405-020-05965-1 . free .
  24. Xydakis MS, Dehgani-Mobaraki P, Holbrook EH, Geisthoff UW, Bauer C, Hautefort C, Herman P, Manley GT, Lyon DM, Hopkins C . 3 . Smell and taste dysfunction in patients with COVID-19 . The Lancet. Infectious Diseases . 20 . 9 . 1015–1016 . September 2020 . 32304629 . 7159875 . 10.1016/S1473-3099(20)30293-0 . free .
  25. Menni C, Valdes AM, Freidin MB, Sudre CH, Nguyen LH, Drew DA, Ganesh S, Varsavsky T, Cardoso MJ, El-Sayed Moustafa JS, Visconti A, Hysi P, Bowyer RC, Mangino M, Falchi M, Wolf J, Ourselin S, Chan AT, Steves CJ, Spector TD . 3 . Real-time tracking of self-reported symptoms to predict potential COVID-19 . Nature Medicine . 26 . 7 . 1037–1040 . July 2020 . 32393804 . 7751267 . 10.1038/s41591-020-0916-2 . free .
  26. Walker A, Hopkins C, Surda P . Use of Google Trends to investigate loss-of-smell-related searches during the COVID-19 outbreak . International Forum of Allergy & Rhinology . 10 . 7 . 839–847 . July 2020 . 32279437 . 7262261 . 10.1002/alr.22580 . free .
  27. Shelton, J. F., Shastri, A. J., Fletez-Brant, K., Aslibekyan, S., & Auton, A. (2022). The UGT2A1/UGT2A2 locus is associated with COVID-19-related loss of smell or taste. Nature Genetics, 54(2), 121-124.
  28. Cooper KW, Brann DH, Farruggia MC, Bhutani S, Pellegrino R, Tsukahara T, Weinreb C, Joseph PV, Larson ED, Parma V, Albers MW, Barlow LA, Datta SR, Di Pizio A . 6 . COVID-19 and the Chemical Senses: Supporting Players Take Center Stage . Neuron . 107 . 2 . 219–233 . July 2020 . 32640192 . 7328585 . 10.1016/j.neuron.2020.06.032 . free .
  29. Iravani B, Arshamian A, Ravia A, Mishor E, Snitz K, Shushan S, Roth Y, Perl O, Honigstein D, Weissgross R, Karagach S . 6 . 11 May 2020 . Relationship between odor intensity estimates and COVID-19 population prediction in a Swedish sample . 10.1101/2020.05.07.20094516.
  30. Rodriguez S, Cao L, Rickenbacher GT, Benz EG, Magdamo C, Ramirez Gomez LA, Holbrook E, Dhilla Albers A, Gallagher R, Westover MB, Evans KE, Tatar D, Mukerji S, Zafonte R, Boyer EW, Yu CR, Albers MW . 6 . Innate immune signaling in the olfactory epithelium reduces odorant receptor levels: modeling transient smell loss in COVID-19 patients . June 2020 . 10.1101/2020.06.14.20131128.
  31. Web site: Global Consortium for Chemosensory Research. 10 July 2020. Global Consortium for Chemosensory Research (GCCR). en.
  32. Vowles RH, Bleach NR, Rowe-Jones JM . Congenital anosmia . International Journal of Pediatric Otorhinolaryngology . 41 . 2 . 207–214 . August 1997 . 9306177 . 10.1016/S0165-5876(97)00075-X .
  33. Sumner D . 1971 . Appetite and Anosmia . The Lancet . 297 . 7706 . 970 . 10.1016/S0140-6736(71)91470-X.
  34. Turnley WH . Anosmia . The Laryngoscope . 73 . 4 . 468–473 . April 1963 . 13994924 . 10.1288/00005537-196304000-00012 . 221921289 .
  35. Nasal Polyps Treatment & Management. McClay JE . May 1, 2014 . Medscape.
  36. McIntyre JC, Davis EE, Joiner A, Williams CL, Tsai IC, Jenkins PM, McEwen DP, Zhang L, Escobado J, Thomas S, Szymanska K, Johnson CA, Beales PL, Green ED, Mullikin JC, Sabo A, Muzny DM, Gibbs RA, Attié-Bitach T, Yoder BK, Reed RR, Katsanis N, Martens JR . 6 . Gene therapy rescues cilia defects and restores olfactory function in a mammalian ciliopathy model . Nature Medicine . 18 . 9 . 1423–1428 . September 2012 . 22941275 . 3645984 . 10.1038/nm.2860 .
  37. Web site: Gene therapy restores sense of smell in mice . Gallagher J . September 3, 2012 . BBC News.
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  39. News: Olivia . Parker . 'My partner does "armpit duty"': What it's like to live with no sense of smell . The Telegraph . 11 April 2016 . 8 December 2018 .
  40. Web site: The Neglected Sense . BBC Radio 4 . 8 December 2018 .
  41. Web site: DeGregory . Lane . 30 November 2023 . For decades, a Florida woman had no sense of smell. Can she get it back? . 2023-12-05 . Tampa Bay Times . en.
  42. Web site: Sullivan . Justin . Ben & Jerry's' Ben Cohen Interview . Delish . 8 Apr 2021 . 6 Jan 2024.
  43. News: Izundu . Chi Chi . 7 October 2013 . Little Mix's Perrie Edwards: I have no sense of smell - BBC Newsbeat . BBC News . live . 11 May 2020 . https://web.archive.org/web/20201108003511/http://www.bbc.co.uk/newsbeat/article/23254182/little-mixs-perrie-edwards-i-have-no-sense-of-smell . 8 November 2020.
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