Lost or changed sense of smell
Most people only notice their sense of smell once it has gone. Food loses its flavour, because almost everything we call taste is really smell; the house, a…
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Medicines commonly prescribed for Lost or changed sense of smell
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: CHEWING GUM, 30.0 mg/medicinal chewing gumActive substance: pseudoephedrineManufacturer: Farmalider S.A.Prescription not requiredDosage form: NASAL PRODUCT, 50 microgramsActive substance: mometasoneManufacturer: Aristo Pharma GmbhPrescription requiredDosage form: MODIFIED-RELEASE TABLET, 120 mgActive substance: pseudoephedrineManufacturer: Laboratorios Cinfa S.A.Prescription not required
Most people only notice their sense of smell once it has gone. Food loses its flavour, because almost everything we call taste is really smell; the house, a perfume, the smell of your own child all stop being recognisable; meals turn to cardboard and a slice of everyday pleasure goes with them. Behind it there is usually an ordinary viral infection or a blocked nose, and the sense of smell comes back. But occasionally lost smell is the only sign of something that needs finding in good time, and there are a few combinations for which you do not wait before seeing a doctor.
What a doctor calls it
Smell problems are not all the same, and the words are worth knowing so you can describe accurately what is happening.
- Anosmia — no sense of smell at all. Neither coffee, nor petrol, nor ammonia registers.
- Hyposmia — a weakened sense of smell. Smells get through, but faintly and only close up.
- Parosmia — the smells are there, but they are the wrong ones. Coffee smells of burnt rubber, meat of rot, a favourite perfume makes you feel sick.
- Phantosmia — a smell with no source anywhere around you. Usually smoke, burning, chemicals or something putrid, lasting anywhere from seconds to hours.
One distinction matters above the rest: is the nose blocked so that smells never reach the sensitive area, or does the nose breathe freely and there are still no smells? In the first case the cause is almost always in the nose itself; in the second it is more often the nerve or its connections to the brain. That is the first thing a doctor wants to establish.
After a virus: why it drags on for months
The commonest cause of a sudden loss of smell is a viral infection: a cold, flu, COVID-19 and dozens of other viruses. In an ordinary cold, smells go because of swelling and mucus and return along with nasal breathing within days. But it can go differently: the cold clears, the nose breathes freely, and the smells are still missing. That means the virus damaged not the airway but the smell cells themselves.
The timescale matters here, otherwise waiting becomes torture. Smell cells are among the few in the body that can regenerate, but they do it slowly: recovery is measured in weeks and months, not days. Most people notice the first shifts within the first two or three months; in some the process stretches over a year or more, and improvement can carry on even beyond that. It also moves unevenly — two good days, then a step back, then another gain. That is the normal course, not a deterioration.
What does not help, and does harm, is using decongestant drops or sprays for more than a few days. They do not restore smell, and with prolonged use they leave the nose permanently blocked. If several weeks after the infection nothing has shifted, that is a reason to be seen rather than to keep waiting alone.
When smells turn revolting
Parosmia frightens people more than losing smell altogether, and almost nobody is prepared for it. Someone whose sense of smell was starting to return suddenly finds that coffee, onion, meat, toothpaste and their own body odour have become unbearable. Eating becomes impossible, the people around them do not understand, and they conclude that they have got worse.
In fact distorted smell usually means the opposite: the nerve is recovering. Smell fibres grow back and at first connect to the wrong places, so a familiar smell arrives down the wrong wire. As the connections sort themselves out, the distortion fades. It typically lasts months, sometimes more than a year, and it almost always goes gradually.
While it lasts, simple things help: drop the worst offenders for a while — fried meat, onion, garlic, coffee and chocolate are often the hardest; eat cool, plainly seasoned food, which gives off fewer volatile compounds; and stick to whatever you can tolerate, even if the diet becomes monotonous for a time. Keep an eye on your weight: noticeable weight loss because eating has become repellent is a reason to see a doctor in its own right.
Phantosmia — a smell of burning or chemicals with no source — can also be a stage of recovery. But if it comes in short, identical episodes, along with a sense of dropping out of what is going on around you, an odd feeling of having lived the moment before, twitching or loss of consciousness, then it is no longer about the nose and it is the head that needs investigating.
A blocked nose: polyps and chronic sinusitis
This is the commonest treatable cause, and the first thing looked for when smell faded slowly over months rather than disappearing overnight.
Nasal polyps are soft, painless overgrowths of the lining that develop high up in the nose, exactly where the smell area sits, and shut off the airflow to it. Suspect them if the nose is blocked constantly on both sides, if it never feels as though it breathes fully, if the voice sounds nasal, if mucus runs down the back of the throat, and if decongestant drops make almost no difference. Polyps often go together with asthma and with intolerance of painkillers from the non-steroidal anti-inflammatory group.
Chronic rhinosinusitis is long-running inflammation of the lining of the nose and sinuses that drags on for months: blockage, discharge, heaviness in the face, reduced smell. Allergy on its own also dulls smell, though usually temporarily and seasonally.
The good news is that this group of causes responds to treatment. Steroid nasal sprays — with polyps sometimes steroid drops or a short oral course — salt-water rinses made with boiled and cooled water, treatment of the allergy and, where needed, surgery can bring smell back fully or partly. All of that is prescribed after the inside of the nose has been examined: polyps are not visible from outside.
What else takes smell away
- Head injury. The fine smell fibres pass through a plate of bone above the nose and tear on impact, sometimes on a fairly modest one, with no fracture and no loss of consciousness. Smell then vanishes at once and completely; recovery is possible, but slow and not always complete.
- Smoking. Tobacco smoke dulls smell gradually and unnoticeably to the smoker. It improves after stopping, but not within a week: again the count runs in months.
- Medicines. Smell is altered by some antibiotics, some blood pressure drugs, thyroid treatments, chemotherapy and, as a separate item, overuse of decongestant drops. If you link the loss to starting a medicine, tell your doctor, but do not stop anything prescribed on your own.
- Age. From around sixty onwards smell weakens in many people, and that is part of normal ageing. Its danger is that a person stops picking up burning and spoilt food without ever noticing that they have.
- Diseases of the nervous system. In Parkinson's disease and Alzheimer's disease smell often declines years before anything else shows. On its own that proves nothing: a dulled sense of smell has far more mundane causes. What counts is the combination with other symptoms — tremor, stiffness, changes in walking and handwriting, forgetfulness that keeps growing.
- Workplace exposures — solvents, metal dust, acid fumes, and also radiotherapy to the head and neck.
Signs you do not sit on
Most lost smell is not dangerous. But some combinations need a doctor, and soon.
See a doctor without delay if:
- smell has gone on one side only, that same half of the nose is permanently blocked, and blood-stained discharge or repeated nosebleeds come from it — that is how a tumour of the nasal cavity and sinuses can show itself, and here coming early decides everything;
- the loss of smell comes with headache, changed or double vision, weakness or numbness in an arm or leg, slurred speech, seizures, a change in personality or increasing forgetfulness;
- smell disappeared immediately after a blow to the head;
- one-sided blockage and discharge last for weeks, with numbness of the cheek, pain or loosening of upper teeth, facial swelling or an eye pushed forward;
- you have diabetes or a weakened immune system and develop severe facial pain, swelling, dark crusts inside the nose and fever: that kind of sinus infection advances fast and needs immediate care.
It is also worth booking an appointment, with no urgency at all, if smell has not begun to return several weeks after an infection, if it is fading gradually with no clear cause, or if distorted smells are stopping you eating properly.
Safety at home when the nose is silent
This part is almost always forgotten and it is the most practical part of the whole subject. Someone who cannot smell will not detect a gas leak, a fire starting, or food that has gone off. Until smell returns, those things are replaced by devices and by habits.
- Fit smoke alarms and test them regularly. This is the main one: you will hear a fire rather than smell it.
- Fit a domestic gas detector if you have a gas hob or boiler. A carbon monoxide alarm is a separate necessity: that gas has no smell for anyone, and poisoning starts with headache and drowsiness.
- Go by dates, not by your nose. Write the opening date on packets, respect use-by dates, do not test doubtful food by sniffing it, and throw out anything you are unsure about. This matters most for meat, fish, dairy and cooked food kept in the fridge.
- Do not mix cleaning products, especially bleach with anything acidic, and use them with a window open: you will not notice the irritant fumes.
- Watch the hob by timer rather than by smell, and do not leave cooking unattended.
- Agree with the people you live with that they will tell you if you or the flat smell of something. People without a sense of smell often worry about body odour and become heavy-handed with perfume.
- Keep an eye on eating. Without smell food stops being enjoyable, and it is easy to drift into eating too little or salting and sweetening everything. Contrasting textures help, as do sour, spicy and bitter flavours, which the tongue picks up rather than the nose.
What a doctor can do
The doctor will ask how it started, suddenly or gradually, whether an infection or a head injury came first, whether the nose breathes, whether there is any allergy, what medicines you take and whether you smoke. Then they will look inside the nose, if necessary with a slim endoscope: that is the only way polyps and deep inflammation are seen. Smell can be measured — there are simple kits of scented cards and bottles — and the score is recorded so it can be compared later. If the loss is one-sided, if a tumour is suspected, or if there are neurological symptoms, a scan is arranged.
After that the cause is treated: a steroid nasal spray for polyps and chronic inflammation, treatment of the allergy, salt-water rinses and, where needed, sinus surgery. When the problem is nerve damage after a virus or an injury, medicines add almost nothing, but there is smell training. It is a simple method: twice a day, for a couple of minutes, you sniff four strong smells one after another — rose, lemon, clove and eucalyptus are the usual set — trying to recall what each of them smells like. It takes patience: the course runs for months and the set of smells is swapped every few weeks. It works no magic, but in many people it speeds up and improves recovery, and it carries no risk.
Online consultation
Lost smell is exactly the kind of subject where a great deal is settled by talking. An Oladoctor doctor will go through with you what actually happened: whether smells disappeared or changed, suddenly or gradually, whether the nose breathes, what came before it and how long it has been going on. They will explain whether your recovery time is within the usual range, help you tell recovery-stage parosmia apart from signs that need investigating, review your list of medicines, show you how to use a nasal spray properly and how to set up smell training, and advise on food and weight while the smells are away. If your account includes one-sided blockage with blood-stained discharge or any neurological symptoms, you will be sent straight for a face-to-face examination and the necessary tests.
This material is for information only and does not replace medical advice.
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