The large range of emotional and practical impacts caused by a loss of smell is elucidated in a new study from the University of East Anglia. It finds that almost every aspect of life is disrupted - from everyday concerns about personal hygiene to a loss of sexual intimacy and the break-down of personal relationships.
“Smell disorders affect around five per cent of the population and cause people to lose their sense of smell, or change the way they perceive odours. Some people perceive smells that aren’t there at all,"
said Prof Carl Philpott, from UEA’s Norwich Medical School, the author of the study.
Anosmia, also known as smell blindness, is the loss of the ability to detect one or more smells. Anosmia may be temporary or permanent. It differs from hyposmia which is a decreased sensitivity to some or all smells.
“There are many causes - from infections and injury to neurological diseases such as Alzheimer’s and as a side effect of some medications. Most patients suffer a loss of flavour perception which can affect appetite and can be made even worse if distortions in their sense of smell also co-exist. Previous research has shown that people who have lost their sense of smell also report high rates of depression, anxiety, isolation and relationship difficulties. We wanted to find out more about how a loss of smell affects people,"
The researchers worked with the Smell and Taste clinic at the James Paget University Hospital, Gorleston-On-Sea. The clinic opened in 2010 and was the UK’s first clinic dedicated to taste and smell.
The study involved 71 participants aged between 31-80 who had written to the clinic about their experiences. It was carried out in collaboration with Fifth Sense, the charity for people affected by smell and taste disorders.
The research shows that sufferers experience wide-ranging impairments to their quality of life. These included a negative emotional impact, feelings of isolation, impaired relationships and daily functioning, impacts on physical health and the difficulty and financial burden of seeking help.
“One really big problem was around hazard perception - not being able to smell food that had gone off, or not being able to smell gas or smoke. This had resulted in serious near misses for some. But smell is not just a life-saving sense - it is also life-enhancing. A large number of the participants no longer enjoyed eating, and some had lost appetite and weight. Others were eating more food with low nutritional value that was high in fat, salt and sugar - and had consequently gained weight,"
Prof Philpot explained.
Although 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, can safely treat anosmia.
Anxiety And Embarrassment
Some people in the study had lost interest in cooking food, with some reporting they were too embarrassed to serve dishes to family and friends, with a negative impact on their social lives.
“The inability to link smells to happy memories was also a problem. Bonfire night, Christmas smells, perfumes and people - all gone. Smells link us to people, places and emotional experiences. And people who have lost their sense of smell miss out on all those memories that smell can evoke. We found that personal hygiene was a big cause for anxiety and embarrassment, because the participants couldn’t smell themselves.
Parents of young children couldn’t tell when their nappies needed changing, and this led to feelings of failure. One mother found it difficult bonding with her new baby because she couldn’t smell him. Many participants described a negative impact on relationships - ranging from not enjoying eating together to an impact on sexual relationships,"
said Prof Philpot.
All of these problems led to diverse range of negative emotions including anger, anxiety, frustration, depression, isolation, loss of confidence, regret and sadness. And the problems were compounded by a lack of understanding about the disorder among clinicians.
There is a need for better support and education - both for sufferers and for health care providers. The research also highlights the need to improve our understanding of olfactory disorders.
 Erskine, SE, Philpott, CM. An unmet need: Patients with smell and taste disorders. Clin Otolaryngol. 2019; 00: 1– 7. https://doi.org/10.1111/coa.13484