Can you ever get back a lost sense of smell?
SIX years ago, my wife developed a persistent cough and was given various inhalers. Over time she lost her sense of taste and smell. She tried a steam inhaler for months to no avail. An ENT specialist could find nothing wrong. She’s been given various inhalers but she doesn’t use them as she thinks they caused the problem. She is 75 and in good general health. She likes cooking, but cannot enjoy the fruits of her labour. We’re told it could be permanent and would appreciate any advice.
THE loss of the senses of taste and smell can be very disabling, reducing quality of life and affecting health. Without a sense of taste, patients may no longer look forward to eating, which can lead to weight loss. And as well as providing us with pleasure, smell is vital to identify dangers in our environment, for instance detecting smoke, rotten food and leaking gas.
Yet those affected often receive little attention as these problems are not life-threatening and can all too easily be seen as unimportant.
our taste buds can become damaged by a number of factors, including viral infections, some medicines and inflammatory conditions in the mouth, such as severe acid reflux. Loss of taste can also occur as we age.
our sense of taste is very dependent on our sense of smell — the aroma of food or drink — and this is where I suggest the root of your wife’s problems lies.
When the smell ‘ receptors’, nerve cells in the nose, detect odour molecules, they fire messages via the nerves to the brain, where the smell is perceived. Loss of smell, also called anosmia, can be caused by an injury to the head, as this can sever the nerves where they pass into the brain ( although the nerves can sometimes regenerate).
RECEPtoRs
are also directly exposed to many environmental hazards, including bacteria, viruses and chemicals in the air we breathe.
In 40 per cent of cases, anosmia is due to nasal and sinus disease, including allergy and nasal polyps (swellings of the nasal lining) — these conditions interfere with smell sensation by both direct obstruction and also by inflaming the nasal lining.
the receptors can also be damaged by infections of the upper respiratory tract, such as your wife had, and this seems to be the likely cause; given that the problem began with a cough, it seems head trauma was not the cause, while the ENt specialist did not find any nasal polyps.
(some degenerative disorders such as Alzheimer’s disease, Parkinson’s, and other forms of dementia are also associated with loss of sense of smell due to nerve damage, although this is not relevant in this case.)
If there are no polyps or other obstructions in the nasal airway, patients are typically prescribed glucocorticoids, either as drops or a spray delivered into the nose. the aim is to reduce any swelling of the nasal lining and allow odour molecules to reach the smell receptors.
I suspect your wife was prescribed at least one steroid spray — perhaps beclometha-sone — but it would be rare for the medication itself to damage the nerve cells.
Around 80 per cent of patients will have recovered within a year but given that your wife’s symptoms began six years ago, I suspect she is one of the unfortunate ones. We do know that sense of smell decreases with ageing, and this may be an additional factor.
the conclusion, therefore, is that the prime cause was a viral infection that damaged the nerve cells irretrievably and after six years it seems that the prognosis for your wife must be pessimistic. I am sorry to be the bearer of these tidings. A LUMP at the back of my knee has been diagnosed as a popliteal cyst, also known as a Baker’s cyst. Although I have seen my GP about this, the knee is defined as a ‘specialist’ area and I’ve been told I will need to discuss my problem further at the local hospital. Meanwhile, I go to the gym twice a week and had also booked a European holiday which will involve a three-hour flight. Is there any advice you can give me before with regard to exercise and travel?
Terry Monk, by email. PoPLItEAL synovial cysts were first described by the surgeon William Baker in Victorian times.
A Baker’s cyst is a painless lump behind the knee, which is seen more prominently when standing with the leg fully straightened; the swelling softens or disappears when the knee is flexed. they are usually found by chance as they mostly cause no symptoms.
In a third of cases the cause is an injury such as a blow to the knee, but in the majority of patients, it’s linked to a problem within the joint, such as osteo-arthritis, a cartilage tear or gout.
the cyst is filled with synovial fluid, a lubricant normally found inside the knee joint. Arthritis, injury or cartilage damage may allow this fluid to leak out so that it passes to the back of the knee and enlarges into a pouch.
the cyst can get bigger or rupture, which results in pain, and a sensation of warmth and discomfort as the released fluid moves downwards.
AttIMEs this is wrongly diagnosed as a deep vein thrombosis (a blood clot in a vein), and only an ultrasound scan can detect the difference.
the decision about what should be done rests upon the nature of the underlying joint disorder, which will require either X-rays or an MRI scan to be identified.
I am assuming the diagnosis by your GP was made using an ultra-sound scan. Although this is perfect for detecting a Baker’s cyst, it gives no information about the state of the internal struc-tures of the knee, cartilages and ligaments. sometimes the cyst may need surgery to drain it.
Most popliteal cysts cause no symptoms or complications.
If your knee is otherwise trouble free, continue to exercise normally at the gym and go away on holiday without concern. You are at no particular risk.
WRITE TO DR SCURR
TO CONTACT Dr Scurr with a health query, write to him at Good Health Daily Mail, 2 Derry Street, London W8 5TT or email drmartin@dailymail.co.uk — including contact details. Dr Scurr cannot enter into personal correspondence. His replies cannot apply to individual cases and should be taken in a general context. Always consult your own GP with any health worries.