November 11, 2019

What’s That Smell? What You Need to Know About Hyperosmia

From causes to diagnosis + when you need treatment

Illustration of a clothespin on a woman's nose

Whether it’s the smell of cookies baking or Fido’s … ahem … gas, smells have a way of seizing our attention. But when subtle odors interfere with daily living, you may have a condition called hyperosmia.

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“Hyperosmia is a heightened or increased sense of smell,” explains ENT (ear, nose and throat) specialist and rhinologist Raj Sindwani, MD. People can experience it all the time or occasionally. And while hyperosmia doesn’t always require treatment, it can signal an underlying health issue that does. Dr. Sindwani shares what you need to know about this unique and uncommon smell disorder.

What causes hyperosmia?

Hyperosmia is relatively rare, and doctors usually don’t know why someone develops it. But there’s a seemingly endless list of things that may be to blame, including:

“Other factors can also disturb our sense of smell, including exposure to toxins, such as lead or mercury. Allergies, polyps and tumors can also affect smell. So can things like diabetes and nutritional deficiencies. It’s all over the map when it comes to smell disturbances,” notes Dr. Sindwani.

While smell disorders don’t run in families, an underlying cause might. “We don’t know what causes smell disorders — so there’s no real genetic link that we’re aware of. For example, cystic fibrosis can run in families and affect smell. But smell disorders on their own generally do not.”

Sensitive to smells? How to know if it’s hyperosmia

It’s complicated. Because so many things may cause hyperosmia, symptoms can include anything and everything. But Dr. Sindwani recommends seeing a doctor if:

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  • The hypersensitivity to smells is persistent.
  • You feel like there’s a change in how you perceive odors.

How is hyperosmia diagnosed?

“A doctor can rule out a treatable causes for your sensitivity to smell by reviewing your health history and doing a physical exam,” says Dr. Sindwani. “A nasal endoscopy is the gold standard test to rule out anything physical going on in your nose like a mass, polyps or infection.”

During this minor procedure (which is performed with you awake and sitting in an exam chair – don’t worry it doesn’t hurt!), your doctor:

  1. Places a camera onto the end of a tiny rigid or flexible telescope.
  2. Guides the scope gently into your nose to look around, while the camera transmits images to a TV screen.
  3. Examines the images to see if there are any physical issues that would affect your ability to smell.

“With this type of endoscopy, we can actually see the area where the smell receptors live high up in the nasal cavity,” explains Dr. Sindwani.

If your nose gets the “all clear,” your doctor may do a “scratch and sniff” smell test. If that points to an increased sense of smell, hyperosmia is usually the diagnosis.

Smell and taste are also closely linked. (Ever smell something so strong you could taste it?) For that reason, a smell disorder can initially seem like a taste problem. “Often, people come in and say, ‘Things don’t taste right to me,’ when over time, we learn it’s a smell problem. You can have one, the other or both of those things in play.”

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How to turn the dial down on your nose

If you suspect you have hyperosmia or another smelling issue, Dr. Sindwani says a good first step is to see an ENT specialist. The specialist can rule out any physical causes for smell problems, such as tumors, polyps or infection. Sometimes imaging tests (like a CT or MRI scan) can also be helpful in looking for underlying issues.

“Beyond that, hyperosmia should be managed depending on what the underlying issue is. Migraines might be treated by your internist or neurologist, for example. If you have a brain issue, such as epilepsy, multiple sclerosis, Alzheimer’s disease or Parkinson’s disease, that might be treated by a neurologist or other type of doctor as well.”

But determining a treatment plan can be challenging since causes are hard to pinpoint. In those cases,doctors can recommend supportive treatment measures, such as:

  • Saline washes or sprays to keep the nose healthy and moist.
  • Medications to help with any nausea or vomiting induced by your extreme sensitivity to smells.
  • Masks to block strong odors.
  • Gum or candy to disguise cringe-worthy smells.

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