Treatment and Prevention of Phantosmia

How can you Treat Phantosmia?

Initially, the experience of unpleasant smells will resolve when you fall asleep. Others try to gag, use the Valsalva's maneuver, intranasal instrumentation, or force themselves to cry, to stop the sensation of unpleasant smells. With time, these strategies prove to be ineffective.

Watchful waiting: In many cases, the distorted smell perception may decrease and wane away with time, without medications or surgery.


Other ways to treat phantosmia include:

Drugs: Medications, eg. antidepressants, antiepileptic drugs or sedatives, have been prescribed, with limited relief. The dose has to be increased over time, and patients are unable to deal with the side effects. Cocaine and nasal saline drops can temporarily relieve people from undesired odors.

Surgery: Removal of the olfactory cells or epithelium, eliminates the perceived odors and retains the normal sense of smell. When the olfactory bulb is removed with bifrontal craniotomy, the perceived odors disappear but the intensity of smell perception is reduced and surgery-related risks increase.

How do you Prevent Phantosmia?

You cannot prevent phantosmia. However, once you are affected, you can identify the potential cause and resort to initial preventive strategies (eg. watchful waiting, Valsalva's maneuver, etc). If needed, surgery or medications are recommended.

References:

1. Swanson JW. Phantosmia: What causes olfactory hallucinations? Updated Apr 19, 2018; Accessed September 21, 2018; Cited September 24, 2018. - (https://www.mayoclinic.org/diseases- conditions/temporal-lobe-seizure/expert-answers/phantosmia/faq-20058131)
2. Smelling things that aren�t there (phantosmia). Updated Aug 31, 2017; Accessed September 21, 2018; Cited September 24, 2018. - (https://www.nhs.uk/conditions/phantosmia/)
3. PubMed Health Glossary. Phantosmia. Accessed September 21, 2018; Cited September 24, 2018. - (https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0028147/)
4. Smell disorders. Updated May 12, 2017; Updated Aug 31, 2017; Accessed September 21, 2018; Cited September 24, 2018. - (https://www.nidcd.nih.gov/health/smell-disorders)
5. Kong X et al. Dysphasia and Phantosmia as First Presentation of Multifocal Cerebral Anaplastic Astrocytomas: Case Report and Review of the Literatures. Schaller. B, ed. Medicine. 2015;94(20):e877. - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4602886/)
6. Sara Sj�lund et al: Phantom Smells: Prevalence and Correlates in a Population-Based Sample of Older Adults, Chemical Senses, Volume 42, Issue 4, 1 May 2017, Pages 309�318. https://doi.org/10.1093/chemse/bjx006
7. Donald Leopold; Distortion of Olfactory Perception: Diagnosis and Treatment, Chemical Senses, Volume 27, Issue 7, 1 September 2002, Pages 611�615, https://doi.org/10.1093/chemse/27.7.611
8. Leopold DA, Loehrl TA, Schwob JE. Long-term Follow-up of Surgically Treated Phantosmia. Arch Otolaryngol Head Neck Surg. 2002;128(6):642�647. - (https://jamanetwork.com/journals/jamaotolaryngology/fullarticle/482912)
9. Henkin RI, Potolicchio SJ, Levy LM. Olfactory Hallucinations without Clinical Motor Activity: A Comparison of Unirhinal with Birhinal Phantosmia. Brain Sciences. 2013;3(4):1483- 1553. - (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4061890/)
10. Landis BN, Reden J, Haehner A. Idiopathic phantosmia: Outcome and clinical significance. ORL J Otorhinolaryngol Relat Spec. 2010;72(5):252-5. - (https://www.ncbi.nlm.nih.gov/pubmed/20714205)
11. Morrissey DK et al. The role of surgery in the management of phantosmia. The Laryngoscope. 2016;126:575-578. - (http://www.sbccp.org.br/arquivos/LG2016-03/lary.25647.pdf)

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