Overview of Smell and Taste Disorders
Because disorders of smell and taste are rarely life threatening, they may not receive close medical attention. Yet, these disorders can be frustrating because they can affect the ability to enjoy food and drink and to appreciate pleasant aromas. They can also interfere with the ability to notice potentially harmful chemicals and gases and thus may have serious consequences. Occasionally, impairment of smell and taste is due to a serious disorder, such as a tumor.
Smell and taste are closely linked. The taste buds of the tongue identify taste, and the nerves in the nose identify smell. Both sensations are communicated to the brain, which integrates the information so that flavors can be recognized and appreciated. Some tastes—such as salty, bitter, sweet, and sour—can be recognized without the sense of smell. However, more complex flavors (such as raspberry) require both taste and smell sensations to be recognized.
A partial loss of smell (hyposmia) and complete loss of smell (anosmia) are the most common disorders of smell and taste. Because distinguishing one flavor from another is based largely on smell, people often first notice that their ability to smell is reduced when their food seems tasteless.
How People Sense Flavors
The ability to smell can be affected by changes in the nose, in the nerves leading from the nose to the brain, or in the brain. For example, if nasal passages are stuffed up from a common cold, the ability to smell may be reduced because odors are prevented from reaching the smell receptors (specialized nerve cells in the mucous membrane lining the nose). Because the ability to smell affects taste, food often does not taste right to people with a cold. Smell receptors can be temporarily damaged by the influenza (flu) virus. Some people cannot smell or taste for several days or even weeks after a bout of the flu, and, rarely, loss of smell or taste becomes permanent. Sudden loss of smell also may be an early symptom of coronavirus disease 2019 (COVID-19), an acute respiratory illness that can be severe and is caused by a newly identified coronavirus officially named SARS-CoV2. (See Loss of Smell.)
Oversensitivity to smell (hyperosmia) is much less common than loss of smell. Pregnant women commonly become oversensitive to smell. Hyperosmia can also be psychosomatic. That is, people with psychosomatic hyperosmia have no apparent physical disorder. Psychosomatic hyperosmia is more likely to develop in people who have a histrionic personality (characterized by conspicuous seeking of attention with dramatic behavior).
Some disorders can distort the sense of smell, making innocuous odors smell disagreeable (a condition called dysosmia). These disorders include the following:
Seizures originating in the part of the brain where memories of smell are stored—the middle part of the temporal lobe—may produce a brief, false sensation of vivid, unpleasant odors (olfactory hallucinations). These odors are part of the intense feeling that a seizure is about to begin (called an aura) and do not indicate a smell disorder. Brain infections due to herpesviruses (herpes encephalitis) may also cause olfactory hallucinations.
A reduction in the ability to taste (hypogeusia) or loss of taste (ageusia) usually results from conditions that affect the tongue, usually by causing a very dry mouth. Such conditions include Sjögren’s syndrome, heavy smoking (especially pipe smoking), radiation therapy to the head and neck, dehydration, and use of drugs (including antihistamines and the antidepressant amitriptyline). Nutritional deficiencies, such as decreased zinc, copper, and nickel levels, can alter both taste and smell. Sudden loss of taste may be an early symptom of COVID-19.
In Bell palsy (a disorder in which half of the face is paralyzed), the sense of taste is often impaired on the front two thirds of one side of the tongue (the side affected by the palsy). But this loss may not be noticed because taste is normal or increased in the rest of the tongue. Burns to the tongue may temporarily destroy taste buds. Neurologic disorders, including depression and seizures, may impair taste.
A distortion of taste (dysgeusia) may be caused by inflammation of the gums (gingivitis) and by many of the same conditions that result in loss of taste or smell, including depression and seizures. Taste may be distorted by some drugs, such as the following:
Taste can be tested using substances that are sweet (sugar), sour (lemon juice), salty (salt), and bitter (aspirin, quinine, or aloes).