I have "olfactory hallucinations" in which I smell smoke. What could be causing this?
By Ronald DeVere, MD
These perceived abnormal smells are not actually present in the physical environment. How long they last depends on the olfactory hallucination’s cause.
Dr. Ronald DeVere responds:
Olfactory hallucinations are perceived abnormal smells—usually unpleasant—that are not actually present in the physical environment. They can come from a number of different areas of the smell system. The length of time these smells last depends on the cause. If the smell of smoke occurs suddenly and continues for less than a few minutes, the site of origin is likely the smell region of the inner temporal lobe of the brain, called the uncus. The source could be an abnormal electrical discharge or "firing" in the brain (a seizure). Potential causes of this abnormality could be a brain tumor, inflammation, stroke, or an injury following head trauma. Confirming the cause requires an imaging study of the brain (MRI) and a brain-wave test (EEG). Usually, results of smell testing will be normal to minimally abnormal in a person who is experiencing this type of seizure. If a seizure disorder is suspected, antiseizure medications may be used to prevent a seizure and thus eliminate the smell.
Olfactory hallucinations lasting more than a few minutes to several hours are usually due to a disturbance of the smell system in the nose (olfactory organ or olfactory nerves) or in the olfactory bulb, which sits just inside the skull above the upper nose level. The term for this type of olfactory hallucination is dysosmia. Common causes of dysosmia are head and nose injury, viral damage to the smell system after a bad cold, chronic recurrent sinus infections and allergy, and nasal polyps and tumors. The brain is usually not the source. In these instances, sense of smell for other odors is often impaired as well, and the results of smell testing typically are abnormal.
Dysosmia usually disappears with time (three months to two years) without treatment. A thorough evaluation for the mentioned causes may include an MRI of the olfactory system and a nasal endoscopy, in which an ear, nose, and throat (ENT) physician looks inside nasal and sinus passages with a magnified scope. Dysosmia can be treated with normal saline nose drops administered with the head lowered (the top of the head should be pointing to the floor). It may also improve with some medications, such as gabapentin—a medication normally used for seizure disorders but that has also been shown to prevent unpleasant odors arising from injured smell receptors or their nerve branches. The use of gabapentin in this instance is considered off label, which means it is not approved by the FDA for this indication. This doesn't mean the medication is not effective and safe, but rather that the drug has not been officially studied and evaluated by the FDA for this condition.
Q.What can cause someone to smell something bad, like heavy cigarette smoke or old garbage, when neither is nearby? Could it be caused by a vitamin deficiency? And why does it make some foods taste funny when it happens?
A. Having an altered sense of smell is actually quite common. A survey of American adults found that two-thirds had experienced a problem with smell sometime during their lives. Smell disorders are often classified as one of the following:
- anosmia: complete loss of the ability to detect odors
- hyposmia: decreased sense of smell with some ability to detect odors
- dysosmia: distorted sense of smell.
Hyposmia commonly happens as we age. But what you describe falls under the category of dysosmia. With dysosmia, the distorted smell may be dramatically different from what you expect (known as parosmia). Or it could be an odor that isn't actually present (known as phantosmia). Your symptoms suggest you have periods of phantosmia: your brain registers an odor when none is present in the environment. But at other times, it could be parosmia, meaning you are more sensitive to a smell that doesn't bother other people. When this occurs, the odor is usually described as unpleasant.
As to what might cause dysosmia, there are several possibilities. While vitamin or mineral deficiencies can cause an altered sense of smell, this would be unlikely unless you follow a restricted diet or have an intestinal problem that impairs the absorption of nutrients. Here are some other causes of altered smell:
- COVID-19 or a cold or sinus infection
- hay fever (allergic rhinitis)
- nasal polyps
- a medication, such as the cholesterol-lowering drug atorvastatin (Lipitor), the blood pressure drug amlodipine (Norvasc), or the antibiotic erythromycin (Erythrocin)
- a side effect of general anesthesia.
Regarding food having a funny taste, our ability to fully enjoy food requires stimulation of many nerve endings in the mouth and nose. The strict definition of taste is the mouth's ability to identify what is salty, sweet, sour, or bitter. There's also a fifth, savory taste called umami (from the Japanese for delicious), which is triggered by the amino acid glutamate.
But what we commonly refer to as taste is actually a food's flavor. Flavor is determined more by the food's aroma, which is a function of our sense of smell rather than pure taste. So it makes sense that your dysosmia also interferes with the flavor of certain foods.
For most people who experience dysosmia, it's a temporary alteration in sense of smell, often without an identifiable reason. However, if it becomes persistent, speak with your doctor. He or she will likely refer you to an ear, nose, and throat specialist.
— by Howard LeWine, M.D.
Editor in Chief, Harvard Men's Health Watch
Image: © ClarkandCompany/Getty Images
As a service to our readers, Harvard Health Publishing provides access to our library of archived content. Please note the date of last review or update on all articles. No content on this site, regardless of date, should ever be used as a substitute for direct medical advice from your doctor or other qualified clinician.Sours: https://www.health.harvard.edu/diseases-and-conditions/why-do-i-smell-certain-odors-that-arent-real
Phantom smells may be a sign of trouble
Smelling disorders, including phantom smells and a lack of smell, can be a sign of serious health problems.
In a 2009 episode of “Mad Men,” a character with some major health issues — stroke and dementia — mysteriously smelled oranges while eating chocolate ice cream. Shortly after, the man dies while standing in line at the A&P.
Was the phantom orange scent a warning sign of his impending doom?
It’s possible, says Dr. Alan Hirsch of the Smell & Taste Treatment and Research Foundation in Chicago.
“By all means, a phantom smell could mean something serious,” says the psychiatrist and nationally recognized smell and taste expert. “It absolutely needs to be evaluated. It could be a tumor – that’s on the top of your list of things to rule out — but it could also be a cyst or some infectious agent housed in the area of the brain where the smell is processed.”
Brief episodes of phantom smells or phantosmia — smelling something that’s not there — can be triggered by temporal lobe seizures, epilepsy, or head trauma. Phantosmia is also associated with Alzheimer’s and occasionally with the onset of a migraine.
But it’s not typically something sweet that’s conjured up by the brain.
“It’s usually more unpleasant stuff or odors that are hard to describe,” says Hirsch. “People will say it’s chemical-like or talk about a burning smell.”
Common olfactory hallucinations include lots of icky odors. Sufferers report smelling hydrogen sulfide (rotten eggs), bad perfume, garbage, a gas leak, wet dog, pungent body odor or spoiled fish or feces. The brain may trigger such sickening odors instead of agreeable ones because humans learned very early to avoid noxious smells for survival.
“I think a larger area of the brain is represented by bad smells than good smells,” says Hirsch. “And they also may be easier to ‘fire off.’”
Smell disorders aren’t that rare. According to a 1994 survey, 2.7 million Americans have some type of olfactory problem, including anosmia (the inability to smell); hyposmia (a decreased ability to smell); parosmia (a distorted perception, instead of flowers, you smell rotten meat), and phantosmia. Another 1.1 million people have issues with taste (smell and taste are inextricably linked) including ageusia (the inability to taste); hypogeusia (a decreased ability to taste) and dysgeusia (a distorted ability to taste).
Phantom fragrances can be produced by one or both nostrils and can waft in and out of a person’s life over the course of a few hours or a few days or a few weeks. In some cases, such as that of a 35-year-old New Zealand woman who said her nose caused everything to “smell blimmin’ awful” for 17 years, the condition can come and go for no apparent reason for decades.
In a New York Times story, a woman suffered a succession of unpleasant phantom odors, from dank earth to burnt chili. When antibiotics failed to treat the condition, she simply learned to live with it — and avoid disagreeable odors.
Even if there is no underlying tumor, epilepsy or some other infection, problems with your sense of smell can be very disabling.
“Frequently, [patients will] lose a substantial amount of weight because they can’t stand the way everything tastes,” says Hirsch.
Furthermore, doctors will often treat it like a psychiatric problem, with patients visiting an average of seven physicians before getting help, says Hirsch. The irony is, some people with phantosmia will develop psychiatric disorders, depression or suicidal behavior as a result of their condition.
“Approximately half of my patients who have sought surgery for their distortions have at one time considered suicide because of the hopelessness of living a life where all food smelled like spoiled meat or worse,” Dr. Donald Leopold of the University of Nebraska Medical Center’s otolaryngology department wrote in the 2002 edition of Chemical Senses.
Sometimes people think the stink is coming from themselves, which can lead to a condition known as olfactory reference syndrome, says Hirsch.“They’ll wash frequently and won’t go out. It will start with phantosmia, but then they’ll develop secondary paranoia as a result.”
Medical tests such as MRIs, CT scans and EEGs can find common physiological triggers such as tumor, sinus infection and epilepsy, but some patients never understand why they’re suddenly inundated by the smell of garbage or rotting fish or burned coffee or cheese. While pinpointing the cause of phantosmia can sometimes be difficult, treatment is available, including nasal saline drops, anti-depressants, sedatives and anti-epileptic drugs.
Most patients respond to medication, however, a surgical procedure involving the olfactory bulb has also been shown to provide relief. Although normal aging brings a gradual loss of smell, phantosmia sometimes occurs with a reduced ability to smell real scents, another matter that can have serious ramifications, Hirsch says.
“AIDS can initially present with smell loss,” he says. “Or it could be anything from vitamin deficiency to Alzheimer’s to hypothyroidism to head trauma to stroke to diabetes to medication to leprosy.”
One quick way to test whether your sense of smell is diminished is to dish up a bowl of ice cream.
“Take some vanilla ice cream and some chocolate ice cream and see if you can taste the difference,” says Hirsch, who says ninety percent of taste is smell. “If you can’t smell, they both taste the same.”
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What is phantosmia?
Phantosmia is a condition that causes you to smell odors that aren’t actually present. When this happens, it’s sometimes called an olfactory hallucination.
The types of odors people smell vary from person to person. Some might notice the odor in just one nostril, while others have it in both. The odor may come and go, or it may be constant.
Keep reading to learn more about what causes phantosmia and how to treat it.
While people with phantosmia can notice a range of odors, there are a few odors that seem to be most common. These include:
- cigarette smoke
- burning rubber
- chemicals, such as ammonia
- something spoiled or rotten
While the most common smells associated with phantosmia tend to be undesirable, some people do report smelling sweet or pleasant odors.
While the symptoms of phantosmia can be alarming, they’re usually due to a problem in your mouth or nose rather than your brain. In fact, 52 to 72 percent of conditions affecting your sense of smell are related to a sinus issue.
Nose-related causes include:
Other common causes of phantosmia include:
Less common causes
There are many less common causes of phantosmia. Because these usually involve neurological disorders and other conditions that require immediate treatment, it’s important to contact your doctor as soon as possible if you think you may have any of the following:
Could it be something else?
In some cases, odors coming from unusual sources can make it seem like you have phantosmia. These include odors from:
- dirty air vents in your home or office
- new laundry detergent
- new bedding, especially a new mattress
- new cosmetics, body wash, shampoo, or other personal care products
When you smell an unusual odor, try to note any patterns. For example, if you only notice it when you wake up in the middle of the night, it could be coming from your mattress. Keeping a log can also help you explain your symptoms to your doctor.
How is it diagnosed?
Diagnosing phantosmia usually involves finding out the underlying cause. Your doctor will likely start with a physical exam that focuses on your nose, ears, head, and neck. You’ll be asked about the types of odors you smell, whether you smell them in one or both nostrils, and how long the odors tend to stick around.
If your doctor suspects a nose-related cause, they may do an endoscopy, which involves using a small camera called an endoscope to get a better look at the inside of your nasal cavity.
If these exams don’t point to a specific cause, you may need an MRI scan or CT scan to rule out any neurological conditions, such as Parkinson’s disease. Your doctor might also suggest an electroencephalogram to measure the electrical activity in your brain.
How is it treated?
Phantosmia due to a cold, sinus infection, or respiratory infection should go away on its own once the illness clears up.
Treating neurological causes of phantosmia are more complicated, and there are many options, depending on the type of condition and its location (for example, in the case of a tumor or neuroblastoma). Your doctor will help you come up with a treatment plan that works best for your condition and lifestyle.
Regardless of the underlying cause of phantosmia, there are a few things you can do for relief. These include:
- rinsing your nasal passages with a saline solution (for example, with a neti pot)
- using oxymetazoline spray to reduce nasal congestion
- using an anesthetic spray to numb your olfactory nerve cells
Purchase a neti pot or oxymetazoline spray online.
Living with phantosmia
While phantosmia is often due to sinus problems, it can also be a symptom of a more serious neurological condition. If you notice symptoms for more than a day or two, contact your doctor to rule out any underlying causes that need treatment. They can also suggest ways to minimize your symptoms so that phantosmia doesn’t get in the way of your everyday life.
Smoke symptom smell
Why You Smell Phantom Cigarette Smoke When Nobody’s Smoking
Nobody around is smoking, so why do you smell cigarette smoke?
Is this crazy or what? There are some explanations for this phenomenon.
“There are many reasons that cause people to have phantom smells and/or bad smells (known as parosmia),” explains Jordan S. Josephson, MD, FACS, ear, nose and throat specialist; director of the New York Nasal and Sinus Center, and author of “Sinus Relief Now.”
Unfortunately, some causes of smelling cigarette smoke when nobody is smoking are very serious.
“These phantom smells can be caused by damage to the olfactory nerve by chemicals, or infection with a virus or bacteria, or trauma.
“A tumor of the brain or the olfactory nerve can also cause phantom smells. Or it can be caused by the infection itself.
“And the resulting sensation is then confused in the brain with the smell of cigarette smoke.”
More About Parasomia
Dr. Josephson notes, “The bottom line is that many people may get this sensation at one time or another. If it comes and goes, then again, there is probably nothing to worry about.
“However, there are a few conditions that can cause parosmia, and this lasts longer than a fleeting moment, or recurs more frequently, and this is something that needs to be looked at carefully.”
Why is cigarette smoke usually the phantom smell?
“The parosmia is often described like the smell of smoke or cigarette smoke or like something that is burning,” says Dr. Josephson.
“Overall this symptom is poorly understood and we don’t know why people relate this to cigarette smoke.
“It may be that the neurologic signals sent to the brain by the damage is closest to what we have learned is the smell of cigarette smoke or something burning.”
If one has parosmia, when should he seek medical attention?
“If the parosmia lingers, worsens and does not get better or it occurs with increasing frequency, you should probably see a board certified otolaryngologist and a neurologist and get studies to evaluate the cause of this problem.
“The good news is there most likely is a solution for most of these sufferers.”
What is it about phantom cigarette smoke and being alone in a car and nobody’s been puffing tobacco?
“Many people report that this sensation of parosmia is brought on by dry heated air.
“That is probably why many people report this to occur in the car because of the heating system in the car blowing dry air.
“Boiling water and forced hot air from a furnace have also been reported by many patients to induce this sensation as well.
“It is probably that there was damage to the nerve, and the heat causes the nerve to fire and cause this sensation of parosmia. However, this is not well understood.”
Other causes of smelling cigarette smoke are infections that can invade the sinuses or throat. These can harm the nerves that pick up scents.
Dr. Josephson explains, “This is usually following a sinus infection or an upper respiratory tract infection.”
He continues, “If it is a bacterial sinusitis it needs to be treated with antibiotics, irrigation with saline and topical steroid sprays.
“Furthermore, viruses that attack the olfactory nerve or taste nerve can lead to this sense of something burning.
“Migraines can also be related to an aura that brings on the sensation of something burning or a smell described like there is cigarette smoke when there is none.”
If you continue to smell cigarette smoke, Dr. Josephson urges a comprehensive workup which includes a smell test and CAT scan.
“Then appropriate treatment has to be instituted.
“And the cause may be multifactorial and therefore the treatment may need to be multifaceted.”
Unfortunately, another cause could be neurological conditions including stroke.
Dr. Josephsonhas taught hundreds of physicians the technique of functional endoscopic sinus and nasal surgery, and was an instructor on the faculty at the Johns Hopkins Medical Center.
Lorra Garrick has been covering medical, fitness and cybersecurity topics for many years, having written thousands of articles for print magazines and websites, including as a ghostwriter. She’s also a former ACE-certified personal trainer.
What to know about phantom smells (phantosmia)
Phantosmia is the medical word used by doctors when a person smells something that is not actually there.
Phantosmia is also called a phantom smell or an olfactory hallucination. The smells vary from person to person but are usually unpleasant, such as burnt toast, metallic, or chemical smells.
Problems with the nose, such as sinusitis, or conditions of the nervous system or brain, including migraine, stroke, or schizophrenia can cause phantosmia.
In this article, we look at the causes and symptoms of phantosmia, when to see a doctor, and how to differentiate phantosmia from related conditions, such as parosmia.
What is phantosmia?
Phantosmia is a disorder linked to a person’s sense of smell. It happens when a person can smell something that is not there.
The smell may only appear on one side of the nose, or it may affect both nostrils.
Phantosmia is relatively uncommon. It makes up around 10 to 20 percent of disorders related to the sense of smell. In most cases, phantosmia is not a cause for concern and will go away on its own.
However, phantosmia can be a sign of a serious underlying condition, so people should always discuss this symptom with their doctor.
Some phantom smells are pleasant, but people with phantosmia more often describe unpleasant, foul, or disgusting odors. These may include:
- burnt toast
- burning rubber
- cigarette smoke
- a chemical or metallic smell
- a spoiled or rotting smell
- a stale or moldy smell
People are often unable to identify the specific smell, or it may be a smell that they have never encountered before.
Phantosmia can feel distressing and may get in the way of daily life. It can influence a person’s sense of taste, leading to a reduced appetite and weight loss.
Causes of phantosmia
People may experience phantom smells for many reasons. They may be related to the nose, when the condition is known as peripheral phantosmia, or to the brain, which is called central phantosmia.
Problems with the nose or nasal cavity are the causes of smell-related disorders such as phantosmia. These include:
Otherwise, phantom smells can arise because of problems with how the brain understands smells. These include:
When phantosmia is related to nose problems, people may notice a stronger smell in one nostril than the other. Saline rinses and anesthetic pads can often help reduce the smell.
When phantosmia is related to the brain or central nervous system, the smells are often more persistent. They can be noticeable during the day and night, and both nostrils rather than only one experience the same smell.
Is it really a phantom smell?
In some cases, people may believe they are noticing a phantom smell, when they may instead be noticing a real but unexpected smell.
Possible sources of unexpected smells include:
- recent changes in deodorant or other hygiene products
- new materials, products, or packaging
- a new air-conditioning unit, heater, or air filter, which may still contain chemicals from the factory
Phantosmia vs. parosmia
Phantosmia is often confused with parosmia, which is a distorted sense of smell.
People with parosmia are smelling real-life smells, but they are distorted. For instance, the smell of flowers could trigger a smell of chemicals instead. Many people with parosmia also describe the distorted smells as unpleasant.
According to a , phantosmia and parosmia often happen at the same time, and parosmia is more common than phantosmia.
Parosmia can be disturbing, and symptoms can range from mild to severe. Severe parosmia may be debilitating. People with severe parosmia may struggle to deal with their symptoms, even temporarily.
To diagnose phantosmia, a doctor will first perform a physical exam of the person’s head and neck. They may ask about any other symptoms and perform tests to check the individual’s other senses.
A doctor may order an endoscopy or rhinoscopy to look into the nasal cavity and check for issues that could cause phantosmia. They may also request specific and comprehensive tests or refer people to a specialist.
Imaging tests, including CT scans, MRI scans, and EEG scans are sometimes used to check for abnormalities in the nasal cavity, brain, or nervous system.
Treatment for phantosmia varies based on the underlying cause of the phantom smell.
People with chronic sinusitis or other long-lasting nasal inflammation can talk to a doctor about the best treatment options. Treating the underlying conditions should also address the phantom smell.
If symptoms persist for more than a few days, doctors may first recommend simple treatments, such as using a saline solution to rinse out the nasal passages. This may help dislodge anything that is trapped in the nasal passages and relieve the symptoms.
Certain drugs may help people with long-lasting phantosmia control their symptoms:
- anesthetic to numb the nerve cells
- drugs to narrow blood vessels in the nose
- steroid creams or sprays
In some cases, doctors may turn to oral drugs or even surgery to treat phantosmia. They do not always recommend surgery, as it may only work in specific cases, and surgery carries its own set of risks.
Phantosmia is not usually a cause for concern, and it often clears up by itself.
It can also be a symptom of a more serious condition, so people experiencing phantom smells should see their doctor to check for underlying conditions or complications.
The best treatment will depend on the cause of phantosmia. In some instances, the symptoms clear up on their own with time or when the sinus or nasal sickness that caused them goes away. In other cases, phantosmia may be chronic or long-lasting.
Doctors will help a person identify the treatment that works best for them and may suggest other ways to minimize symptoms if possible.
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