Headlines
As reported by The Hartford Courant, January 13, 2004.
Coming to Their Senses
By Hilary Waldman
There were moments on his Lebanon farm when James Northrop's bum nose was a blessing. But he sure missed the aroma of a roasting prime rib or the fragrant garlic in a sizzling pan of shrimp scampi. Mostly, he was frightened that his sudden loss of the ability to smell portended some horrible disease, perhaps a brain tumor or cancer invading his sinuses.
Northrop's seemingly unusual problem brought him to the smell and taste clinic at the UConn Health Center in Farmington, one of a half-dozen such centers in the country.
There, after a three-hour work-up that included inhaling and tasting a variety of nasty liquids and examinations by an internist; a dentist; an ear, nose and throat specialist; and a neurologist, Northrop came away with mixed news.
He was not dying. But there was only a slim chance that the aroma of shrimp scampi - or the odor from the wrong end of his cows - might ever be strong again.
Doctors said Northrop's problem might have been caused by a common virus that damaged the nerve receptors in his nasal canal. Colds are among the leading causes of smell and taste problems, said Dr. Norman M. Mann, director of the UConn clinic. Northrop was given nose drops and medication for acid reflux, which can also cause smell and taste disruptions.
Each year, about 200,000 people visit a doctor for help with a smell or taste disorder, according to the National Institutes of Health. But the study of such disorders is in its infancy, and often patients and doctors do not recognize the symptoms.
Frequently, patients have had a recent viral respiratory infection before the loss. Colds can damage nerve receptors in the tongue and nose. While there is no medical treatment, time can reverse some of the damage.
"This nerve blessedly regenerates," said Linda Bartoshuk, who researches taste disorders and oral pain at Yale School of Medicine. While the nerve repair can take years in some cases, it can be very rapid in others.
Other more treatable causes of smell and taste loss include mouth fungus, polyps or tumors in the nose, certain medications and depression. Head injuries, neurological conditions such as Alzheimer's and Parkinson's diseases, gland diseases such as diabetes, old age and exposure to toxic chemical also can cause problems.
While clinics cannot cure everyone, they can provide answers. "People come here; they are unhappy; food tastes like cardboard," said Lawrence Savoy, a research assistant at the UConn clinic.
Savoy is the first stop for patients entering the Farmington clinic. Sitting behind a table in his white lab coat, he opens plastic bottles containing various concentrations of butyl alcohol.
To the healthy nose, it smells something like rotten eggs. With one hand, the patient closes off one nostril. Savoy waves a bottle of plain water and another containing the weakest concentration of butyl alcohol under the patient's nose. The patient is asked to identify the alcohol. The process is repeated with each nostril, and the concentration of butyl alcohol is increased each time. The patient is given a score indicating whether the sense of smell is normal, impaired or lost.
To test taste, patients swish solutions in their mouths. The solutions taste salty, sweet, sour or bitter - the four sensations the tongue is programmed to pick up. Patients' responses are analyzed by computer to determine the extent and location of taste problems.
The trick is to determine where the problem originates - in the nose or the mouth. The two must work together to convey the subtleties of flavor.
A mouthful of smooth chocolate or morning's first sip of robust coffee would be nothing without the combination of smell and taste. Smell, taste and the sensations of pain, texture and temperature, which also are picked up by the tongue, work in concert to deliver what we recognize as flavor.
Sensations perceived by the tongue are delivered directly to the brain. Smells are interpreted by the olfactory nerves behind the eyes.
Bartoshuk believes the hard wiring of the tongue to the brain was an evolutionary adaptation necessary for animal survival. The tongue picks up life-or-death sensations: bitter, for poison; salty, to regulate sodium intake; sweet, to insure the intake of sugar for fuel; and sour, to warn against acid. The olfactory nerves contribute to the pleasure of food.
The brain also has a backup system designed to re-route taste sensations if nerves in the tongue become damaged. But if the system goes awry, it can produce phantom tastes that drive people crazy, Bartoshuk said.
"You wake up in the morning with a bad taste in your mouth, and it doesn't go away," she said.
Tests often find an area of dead nerves on the tongue, Bartoshuk said. Instead of re-routing the appropriate sensations to other nerves, the brain overcompensates by creating tastes that do not exist. The tastes, often metallic or bitter, get stronger through the day, and by evening they can make patients nauseous.
"They may seem minor, but they can destroy a patient's life," said Miriam Grushka, a Toronto dentist who specializes in treating mouth pain. She and others said a combination of low-dose anti-convulsive medications can reduce or eliminate phantom tastes.
Grushka and Mann also have had success treating burning-mouth syndrome with anti-convulsive medications. Burning mouth vexes some women after menopause. Until recently, doctors wrote it off as psychosomatic. Patients describe the pain as being similar to burning your tongue on a cup of coffee. But it grows more intense all day and never goes away, Grushka said.
Although surgery can help people whose sense of smell is stifled by blockages such as nasal polyps, and medications can be successful for phantom tastes and pain, doctors still have little to offer many patients. Mann and Bartoshuk said research is needed to find ways to prevent smell and taste losses and treat problems when they occur.
Mann said the dearth of treatment options also should not discourage patients from seeking help.
"Even if I can't fix it, I can pinpoint the source of the problem," Mann said.
That was sufficient for Northrop, who discovered his loss of smell about two years ago while visiting an animal trapper in Vermont. His trapper friend opened a jar containing a mixture of skunk gland and Crisco that he said worked wonders for luring fisher cats. Another man inside the trapper's tiny shack almost passed out from the odor. Northrop could barely smell it.
Since his visit to the UConn clinic two years ago, Northrop said his ability to smell has returned somewhat. And he does not miss the full odor of his cows.
"Once I found out that it was not cancer or something, I felt, heck, I can live with that," said Northrop, now 54. "It cleared my mind."