How do you Diagnose Phantosmia?

If you experience symptoms of phantosmia, your family physician will first try to understand the symptoms and confirm if the problem is with your smell and not your taste. The physician will also check for irregularities in body functions that may cause the unpleasant odors. It is vital that the physician shows empathy to those who experience phantosmia since they may feel insecure with ineffective medications, references to mental conditions, and unempathetic remarks, such as “It will go away on its own.” The mental health and the general behavior of the patient should be checked.

The doctor should examine the nasal passage with mucus layers, the middle ear, and the tongue. An endoscopy of the nose and blocking either the left or the right or both nasal passages, will serve to inform which side of the nose is affected by the perceived smell.

The following imaging techniques help to scan the nasal cavity and the brain:

  • PET: Positron emission tomography
  • EEG: Electroencephalography-associated abnormalities
  • MRI: Magnetic resonance imaging of the brain
  • Contrast-enhanced coronal or axial CT scans: computed tomography

Metabolic testing of any functioning disorder within the body, such as the liver, will help identify if it is causing phantosmia.

References:

  1. Swanson JW. Phantosmia: What causes olfactory hallucinations? Updated Apr 19, 2018; Accessed September 21, 2018; Cited September 24, 2018. - (https://www.mayoclinic.org/diseases- conditions/temporal-lobe-seizure/expert-answers/phantosmia/faq-20058131)
  2. Smelling things that aren’t there (phantosmia). Updated Aug 31, 2017; Accessed September 21, 2018; Cited September 24, 2018. - (https://www.nhs.uk/conditions/phantosmia/)
  3. PubMed Health Glossary. Phantosmia. Accessed September 21, 2018; Cited September 24, 2018. - (https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0028147/)
  4. Smell disorders. Updated May 12, 2017; Updated Aug 31, 2017; Accessed September 21, 2018; Cited September 24, 2018. - (https://www.nidcd.nih.gov/health/smell-disorders)
  5. Kong X et al. Dysphasia and Phantosmia as First Presentation of Multifocal Cerebral Anaplastic Astrocytomas: Case Report and Review of the Literatures. Schaller. B, ed. Medicine. 2015;94(20):e877. - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602886/)
  6. Sara Sjölund et al: Phantom Smells: Prevalence and Correlates in a Population-Based Sample of Older Adults, Chemical Senses, Volume 42, Issue 4, 1 May 2017, Pages 309–318. https://doi.org/10.1093/chemse/bjx006
  7. Donald Leopold; Distortion of Olfactory Perception: Diagnosis and Treatment, Chemical Senses, Volume 27, Issue 7, 1 September 2002, Pages 611–615, https://doi.org/10.1093/chemse/27.7.611
  8. Leopold DA, Loehrl TA, Schwob JE. Long-term Follow-up of Surgically Treated Phantosmia. Arch Otolaryngol Head Neck Surg. 2002;128(6):642–647. - (https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/482912)
  9. Henkin RI, Potolicchio SJ, Levy LM. Olfactory Hallucinations without Clinical Motor Activity: A Comparison of Unirhinal with Birhinal Phantosmia. Brain Sciences. 2013;3(4):1483- 1553. - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061890/)
  10. Landis BN, Reden J, Haehner A. Idiopathic phantosmia: Outcome and clinical significance. ORL J Otorhinolaryngol Relat Spec. 2010;72(5):252-5. - (https://www.ncbi.nlm.nih.gov/pubmed/20714205)
  11. Morrissey DK et al. The role of surgery in the management of phantosmia. The Laryngoscope. 2016;126:575-578. - (http://www.sbccp.org.br/arquivos/LG2016-03/lary.25647.pdf)

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