Why am I Smelling Things That Aren't There?

Phantosmia: Olfactory Hallucinations

Phatosmia
Smelling Things That Aren't There. Getty Images / Marc Romanelli

If you've ever smelled smoke where there's no fire you've likely experienced phantosmia, also called olfactory hallucinations. People with this condition perceive smells that aren't really there. Phantosmia can be present in only one or in both nostrils. In some individuals the perceived smell is triggered by a sneeze, a cough, or by exaggerated inhalation or exhalation, or by laughing. In other individuals the perceived smell occurs spontaneously.

It is important for your doctor to determine that you are actually suffering from phantosmia as other conditions can cause similar symptoms. Before making a diagnosis of phantosmia your physician must also determine that the smell is not actually present. It is possible, for example, that you could be smelling some type of body odor such as a dental problem which is not easily self detected. Also, olfactory disorders are often confused with taste disorders and vice verse since the two senses are related. You doctor will need to determine that you are not actually experiencing changes in your sense of taste. It is possible you are experiencing a distortion of both senses. Also, because these senses are so related, individuals who have phantosmia often complain that their food tastes like the phantom smell.

While phantosmia is a well documented health condition, (you're not going crazy), little is known about what causes it or what it means for your health.

It most commonly occurs in women ages 15 to 30. When no known cause can be found for phantosmia medical professionals call it idiopathic phantosmia. Some medical conditions, however, have been associated with non-idiopathic phantosmia, these include:

  • nasal infections
  • nasal polyps
  • migraines (particularly those accompanied by aura)
  • dental problems
  • diseases of the nervous system including Parkinson's disease, epilepsy or Alzheimers, history of a stroke, or cancers which affect the brain
  • head injuries

Additionally, individuals who are exposed to cigarette smoke, chemicals, people who have dental problems, or who are undergoing radiation treatment may be more likely to experience phantosmia. When you are having olfactory hallucinations due to one of the above listed conditions, treating that condition may cause you to stop smelling things that aren't really there. For example, if your phantosmia is caused by nasal polyps, surgery to remove the polyps may cure you from the olfactory hallucinations.

Idiopathic phantosmia may be more difficult to treat than non-idiopathic phantosmia. On a more positive note, according to at least one study, idiopathic phantosmia improved or disappeared in approximately two thirds of people within a period of 5 years. The condition became worse in less than 5 percent of the individuals involved in that particular study.

Due to the rareness of phantosmia treatment options have not been extensively studied, common treatments which may be tried include:

  • nasal saline drops or Afrin (oxymetazoline) nasal spray to induce rebound congestion and block the odor
  • the use of "off-label" medications such as gabapentin or venlafaxine
  • surgery (in extreme cases only)

Sources:

Chemical Senses. Distortion of Olfactory Perception: Diagnosis and Treatment. Accessed: September 29, 2015 from http://chemse.oxfordjournals.org/content/27/7/611.full#sec-4

NCBI. Physiologically initiated and inhibited phantosmia: cyclic unirhinal, episodic, recurrent phantosmia revealed by brain fMRI (abstract). Accessed: September 29, 2015 from http://www.ncbi.nlm.nih.gov/pubmed/10966179

NHS Choices. Phantosmia (smelling odours that aren't there). Accessed: September 29, 2015 from http://www.nhs.uk/conditions/phantosmia/Pages/Introduction.aspx

Research Gate. Idiopathic phantosmia: outcome and clinical significance (abstract). Accessed: September 29, 2015 from http://www.researchgate.net/publication/45660489_Idiopathic_phantosmia_outcome_and_clinical_significance

Taylor Francis Online. Neurocase: The Neural Basis of Cognition. Long lasting phantosmia treated with venlafaxine (abstract). Accessed: September 29, 2015 from http://www.tandfonline.com/doi/abs/10.1080/13554794.2011.568497

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