As reported by The Washington Post, November 1, 2005.

I Don't Smell a Thing

When Your Nose Doesn't Work Right, It's Hard to Tell Chocolate From Vicks VapoRub. Maybe That's Not So Bad.

By Jason Feifer

From across the apartment, my girlfriend smelled smoke. "Is something burning?" she called to me in the kitchen. No, everything's fine, I yelled back. A few minutes later, she came in to investigate. She found me washing dishes, oblivious to the smoking George Foreman grill beside me. "You're so dying in a fire," she said as she yanked the plug from the wall.

I don't know why I didn't see the smoke, but there was good reason I didn't smell it. Like an estimated 14 million Americans, I suffer from smell loss. Like a smaller number of them, I can't taste, either. I can occasionally appreciate a flower's aroma or food's flavor, but only vaguely and superficially. My imagination helps fill in the blanks; but when I'm blindfolded, I confuse mint ice cream and peanut butter ice cream. My girlfriend, who has the olfactory capabilities of a bloodhound, has run me through this test numerous times. She, like most everyone else I tell about this, simply cannot understand my experience.

I have a hard time explaining it myself. It's as if my tongue and nose can sense differences -- water tastes different from juice, say, and unscented air smells different from perfume -- but the differences are faint and forgettable, and I have no ability to identify them. Chocolate is strawberry is scrambled eggs.

I've known about this for years, but have no idea when it started. After all, I never had a basis for comparison. Unlike someone with vision problems, I couldn't simply put on glasses and see what I was missing.

In a way, I'm lucky. People who suddenly lose their sense of taste or smell after decades of trusting it can find the change so devastating that they fall into depression, lose weight or develop anorexia, according to Norman Mann, director of the Taste and Smell Center at the University of Connecticut Health Center in Farmington, Conn. I've experienced none of that. In fact, I'm untroubled by it -- except that after the smoking-grill incident, I'm determined not to die in a fire. So I signed up as a patient at Mann's center and went through a battery of tests during three appointments in September.

The center is one of a few specialized taste and smell clinics across the country, including one on MacArthur Boulevard in the District. Their task is not easy. Chemosensory disorders come in numerous forms, each with its distinctive Greek tag: absent ( anosmia for smell; ageusia for taste) , diminished ( hyposmia/hypogeusia ), distorted ( dysosmia/dysgeusia ), altered ( aliageusia ) and phantom smells and tastes ( phantosmia / phantogeusia ). And because malfunctions can be caused by a wide range of problems -- from chemical exposure to brain tumors to even seemingly unrelated things like Alzheimer's disease -- the clinics subject patients to a host of tests in search of the problem's origin.

In this multidisciplinary approach, a patient may see a dentist, neurologist and otolaryngologist (ear, nose and throat doctor), undergo a general physical examination and even receive an MRI scan. The tests run about $2,500 at UConn and are usually covered by major insurers.

Some patients are referred by doctors; others stumble across smell centers on the Internet after having had their problems shrugged off by clinicians who do not know how to treat them or do not believe they are serious.

"They don't know what to do, they don't know where to go," said Robert Henkin, director of the Taste and Smell Clinic in Washington. At UConn, Mann has had patients break down and hug him.

For some patients, though, sympathy is all they'll get. When smell and taste loss can be linked to a problem such as acid reflux or diabetes, treatment of that condition may restore the senses. However, if the loss resulted from olfactory-nerve damage caused by head trauma or a viral infection such as a cold, there is no reliable cure, said Barry Davis, director of the taste and smell program at the National Institute on Deafness and Other Communication Disorders, part of the National Institutes of Health. Sometimes the nerves will regenerate and senses will be restored, and other times they won't.

"I expect that taste and smell clinics are frustrated to a certain degree, in the sense that they see people they cannot help," Davis said. "They can't give them bypass surgery, they can't give them antibiotics, they can't give them some magic bullet. All they can do is tell them the extent of their problems and say, 'Sorry.' "

Sometimes, patients come in complaining of a loss of taste, but only suffer a loss of smell, according to Henkin. They confuse the two because taste is so dependent upon smell. Then, too, olfactory nerves do not regenerate as quickly or effectively as taste cells do, and they are more delicate and open to exposure. "You can close your mouth. You can't really close your nose," Henkin said.

When food is chewed, odors go to the back of the mouth, where a properly functioning olfactory system translates them into flavor. When the system malfunctions, taste often remains intact -- that is, the mouth can still distinguish among sweet, salty, sour and bitter. (It can also appreciate temperature and texture.) What's missing is flavor -- that sense that lets you savor a lemon drop as lemony, salsa as tangy, ice cream as not just sweet and cold but mint chocolate chip or pistachio. Many patients who complain of a loss of taste are really just experiencing a loss of flavor, and can sense the four categories of taste just fine, Henkin said.

This is what we established on my first visit to the UConn clinic, where I spent two hours smelling bottles of diluted alcohol, trying to identify canned scents, and swishing dozens of liquids around in my mouth to rank them by their taste. The scents were a failure: Of all those placed before me, I could recognize only Vicks VapoRub. Now, that's depressing. Imagine if everything you smelled could only be categorized as either "Vicks" or "not Vicks."

The liquids, however, were more promising. I could generally tell the difference among them, although they tasted weak and I continually confused bitter with sour. I was later told that one of my problems is hypogeusia (pronounced hypo-GOO-zee-uh)--or diminished taste. That may explain why, in college, I put melted M&Ms in my grilled cheese sandwiches.

Open Wide

When I'm at restaurants, friends sometimes ask me why I order what I do.

After all, if I can't really taste food, why do I care? There are a few reasons. For one, I have to order something . No waiter has ever said to me, "We'll make you a tasteless meal because you can't appreciate our menu." And although my preferences may be based on habit, they are real preferences. I enjoy food on my own terms -- the texture, the modicum of flavor I can mentally expand upon -- and never really focus on how I'm experiencing it differently from the people around me.

When people say they pity me, I tend to go lowbrow: At least I can't smell farts, I joke. But in fact, my loss of smell may have helped define who I am. I became a vegetarian at 13, long before anyone else I knew had done it, and never fell victim to the cravings that undo some others' resolve. I like to think my experience taught me to follow my convictions, although now I suspect success came too easily. A steak, to me, might as well have been soy.

On my second visit to UConn, I saw dentist Joseph D'Ambrosio, who checked for signs that my problem was mouth-based. Abnormal saliva production, such as saliva that is too thick or in short supply, can trigger taste loss because saliva is needed to disperse taste stimulants to the taste buds. Inflammation or infection inside the mouth can also be to blame, reducing blood flow to the tongue and thereby damaging cell receptors. My mouth was fine, though.

D'Ambrosio said visible signs of trouble in the mouth are often linked to more aggravating chemosensory problems, such as burning mouth syndrome or distorted taste. Patients may complain of smelling or tasting metal even when they're not sniffing or eating anything. Washington's Henkin said he recently treated a woman who described her experience as like having a dead mouse in her nose.

With an oral problem ruled out, my third visit began with the nose. I saw otolaryngologist Denis Lafreniere, who checked for any abnormalities that could lead to smell problems. Common causes include tumors or inflammations in the nasal canal, which can obstruct the flow of odors. They can be treated with corticosteroids, after which smell commonly returns. Lafreniere stuck a long, fiber optic telescope up my nose -- a uniquely unpleasant sensation -- but reported nothing overly troublesome. He did find that I have a deviated septum -- meaning the cartilage dividing my nostrils is off-center -- but he said that by itself does not cause smell loss.

So it was on to the final stop: Norman Mann, the director of the clinic. He gave me a full physical exam, because he said he sometimes discovers undiagnosed problems that cause taste and smell loss. He's found diabetes in patients, and some who come to him learn their loss of senses is the first symptom of oncoming Alzheimer's or Parkinson's disease, he said. (For other elderly patients, the sensory loss is more natural. Smell and taste diminish with age.) With me, though, there was nothing noteworthy.

That leaves two possible diagnoses, he said. I have a slight loss of taste and a significant loss of smell, and that's either because of a long-gone viral infection or because I was born with a defective olfactory system. The latter is unlikely, he said, because congenital loss is usually absolute, and I still have some semblance of smell. If it was a virus, he said, there's only a minuscule chance the senses will return. Damaged olfactory nerves can regenerate, but they usually do so within a year of the smell loss. "If we see a patient who has loss of smell for two or three years, the prognosis is poor," he said.

Looking Ahead

There is some hope: "We see strange things once in a while," Mann said, including a man who regained his senses after seven years. Instead of holding out for that, he said, my best bet is to buy a gas detector and make sure the batteries in my smoke alarm are good. I may not smell things, but I still can avoid a fiery death.

As I went through this process, my friends joked about all the unfortunate outcomes that could result from a renewed sense of taste. What if I discovered I hate the foods I thought I like? Or what if I become so enamored with food that I ballooned in weight? (Mann said he's heard of the second happening, but not the first.) Instead, though, all this talk made me consider for the first time what it would be like to really smell and taste -- only to be more aware of what I'll always be missing.

But then again, it's not so bad. I can always go to a concert and not smell the sweaty people around me. I don't mind talking to someone who has bad breath. And if I still wanted to put chocolate in grilled cheese sandwiches, nothing would stop me.