Phantosmia: Causes, Symptoms, Treatment, Prognosis

What is Phantosmia?

The ability to smell provides valuable information about our surrounding environment. Our ability to smell can alert us from any impending dangerous situations like a gas leak or a fire. Experts state that our ability to smell also has a direct link with memory and emotions. Our ability to smell also affects our taste buds. Research suggests that around 80% of the flavors that we get come from our sense of smell[1, 2].

When this sense of smell gets distorted or impeded it affects the quality of life significantly. When we talk of what can go wrong with the sense of smell, it can happen in three ways. The first way that the sense of smell gets affected is a reduction in the intensity of the smell. This in medical term is known as hyposmia or anosmia[1].

The second type is the change in the quality of the perception of smell. The third type is a perception of smell which does not exist. This is what is called as Phantosmia. This perception of smell does not last for more than a minute or two and is generally unpleasant and foul smelling like burning of a tire or a burned toast. Their causation is either peripheral or central or sometimes a combination of the two[1].

Phantosmia can be quite distressing and have a significant impact on the quality of life of the person. It also affects the appetite and lead to unintentional weight loss in people with Phantosmia[1].

What Causes Phantosmia?

As stated, Phantosmia can be caused peripherally, centrally, or both. If the phantom smell is caused due to an abnormality in the nose then it is termed peripheral Phantosmia. If the phantom smell is caused due to an abnormality in the brain then it is termed as central phantosmia[1, 3].

For peripheral phantosmia, problem with the nose or nasal cavity is the most common cause. Some of the conditions related to the nose that can cause Phantosmia include nasal polyps, a tumor, sinus infections, and rhinitis. Coming to the central etiology for Phantosmia, epilepsy, head injury, migraines, or Parkinson Disease can all be reasons behind it[1, 3].

When Phantosmia occurs due to brain abnormality the perceived smell is more persistent and is present both in the day and night. When Phantosmia is caused due to nose issues then one nostril may have a stronger smell than the other and the smell is not constant or persistent[3].

How is Phantosmia Diagnosed?

For a diagnosis of Phantosmia, The patient will undergo a physical examination with a detailed history about when the symptoms started and whether there are any other accompanying symptoms. Tests and investigations will be done to rule out other conditions that may affect the smell of a person. A rhinoscopy or an endoscopy will be done to take a look at the nasal cavity looking for any abnormality that may be the reason behind Phantosmia[3].

Imaging studies in the form of CT scans and MRI can also be done around the nasal cavity and brain to identify any abnormality that may be causing the phantom smells. The results of all these tests will confirm the diagnosis of Phantosmia[3].

How is Phantosmia Treated?

Phantosmia is not a condition to be worried about. In most cases it resolves on its own. Treatment-wise, the underlying cause of it determines the approach for dealing with the phantom smell. People who have chronic sinusitis can speak with their physicians about the best way to treat the condition and get rid of Phantosmia[1, 2, 3].

In case, if the phantom smell persists for longer than a few days, it is best to go to ENT specialist for treatment options. Treatment first starts with using saline solutions to clear out the nasal passages by dislodging any obstruction that can be causing Phantosmia. Certain medications like an anesthetic to numb out the nerve cells, medications to narrow the blood cells in the nose, or steroid nasal sprays are also effective in treating Phantosmia. Surgery is sometimes recommended although rarely to treat phantom smells; however, there is no accurate data about the efficacy of such a treatment for Phantosmia[1, 2, 3].

What Is The Prognosis Of Phantosmia?

Since Phantosmia is a condition that in most cases resolves on its own, treatment is not always necessary. However, in some instances Phantosmia is a symptom of some other serious underlying condition and this is something that needs to be ruled out and treated. For other cases, the treatment of Phantosmia depends on the underlying cause whether it is peripheral or central[1, 2, 3].

There are also cases reported where Phantosmia lasts for a very long time. Thus, it is best to consult with a physician to identify the underlying cause and devise a treatment plan for dealing with a condition like Phantosmia[1, 2, 3].