The nose is the tip of the iceberg

ENT specialists, and rhinologists in particular, treat noses. When you go to your doctor for smell loss, the doctor is understandably going to want to investigate that small piece of triangular real estate in the middle of your face. Doctors want to fix things, so they will start where the problem lies.

We see with our eyes, which are the organs of sight. We taste with our tongues, which relay messages from our taste buds to the gustatory complex in our brains. For hearing, we have an eardrum and three tiny bones that transmit information about the pressure waves of air that translate to sound. But in our nose? We have a small patch of tissue called the olfactory epithelium, and this is actually brain tissue.

I have said elsewhere in this blog that the thing that was hardest for me in managing my smell loss was that it felt like anosmia messed with my head. In other words, the problem started in my nose, but six months into smell loss I felt like my personality had changed. I felt like smell loss was not just a problem in my nose, but a problem with the way my brain was interpreting the world

Which brings us back to the ENT surgeon, or even the GP that you go to on your first visit. Their job is to make us better, and they start by the obvious origin of the problem. But what happens when the problem starts to leak out into other areas of our lives? Like me, maybe you found that parosmia robbed you not only of pleasure in food but became an actual barrier to getting food down your throat? What if losing your sense of smell made you feel indescribably isolated, like no one could understand what you were talking about? What happened when you gave up trying to remind your loved ones that you don’t care whether it’s Earl Grey or Breakfast tea? Or when you put your arms around your partner and felt that there was no more connection, nothing, like you were living in a world where all the emotion, love and poignancy had drained out of your life leaving leaving you marooned some place you didn’t want to be. All emotions, unplugged

The crisis for smell loss patients is that they keep going into surgeries to say “I can’t smell” but in reality many of us are dragging with us a whole host of attendant emotional consequences. The nose is the tip of the iceberg here. Beyond the nose, smell loss can bring other consequences that go beyond the remit of the ENT. The standard therapies of steroids and waiting for the passage of time might be proven, sound advice, but other strategies for helping the patient should be employed too: smell training (click here for more) , mindfulness, talk therapy, the use of true taste and mouthfeel, other dietary strategies and of course support groups. 

For a patient information sheet from the University of Dresden, click here