The lost senses of smell and taste

‘Our senses of smell and taste play a vital role in helping us interact with the world around us, but they are often taken for granted. Unless you work in a profession that requires these senses, ie, you are a perfumier or a chef, you can usually carry on working and coping with the deficit. Many people just put up with loss of taste and smell and don’t mention it to their doctor. Some clinicians regard this problem as low down the priority list and don’t refer patients to specialists who can help.

However, these senses are fundamental to our quality of life and should be valued as highly as touch and sight. The fact that until 2010 there was no smell and taste clinic in the whole country speaks volumes about how little importance is attached to this issue at the moment.

Our ability to smell and taste is based on a complex process which can easily be disrupted at different stages. If any part of the chain is broken or damaged, then smell is not registered by the brain. Lots of things can interfere with these senses, but by far the most common cause of loss of taste and smell is sinus disease including chronic sinusitis, allergic fungal rhinosinusitis and other sino-nasal disorders. Around 10 per cent of the population have chronic sinusitis and live with diminished senses, sometimes without knowing because the problem develops over time. Only around one per cent of the population receives medical help for the issue, so many are never treated. Medication is the first point of call, and if this doesn’t work, a patient can undergo surgery to clear the sinuses and remove polyps. Surgery allows better delivery of nasal medicine sprays and rinses post-operatively. Antibiotics are often prescribed for people with chronic sinusitis but this is controversial since, as the exact role of bacteria is uncertain and the evidence to support their use is weak. Bacteria currently implicated may just be there as a result of the sinusitis and not actually causing the problem in the first place.

Other common causes of smell loss that present to the smell and taste clinic include, viral damage to the smell receptors, head injury and a group of patients where no obvious cause can be found (idiopathic). Loss of smell may also be a precursor to neurological diseases such as Parkinson’s Disease and Alzheimer’s Disease.

 Carl Philpott is giving the 2016 Ellison-Cliffe lecture at the Royal Society of Medicine this year on Tuesday 18th October; Smell and taste – the senses that man forgot.
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