LADY MACBETH: Here’s the smell of the blood still. All the perfumes of Arabia will not sweeten this little hand. Oh, Oh, Oh!
(Play: Macbeth Act 5, Scene 1, Page 3, Shakespere)

If it is to be taken literally, Lady Macbeth could smell the blood of Lord Duncan (who was murdered) long after his demise – for sure either she had Smelling disorder or she was delirious. Whatever be the case it gives us a first hand glimpse of Smelling Disorder or Dysosmia.

Smelling disorders

Smelling disorders or disturbances of the olfactory sense, refers commonly to disturbance in the sense of smell. It can range from the total loss of smell (anosmia) to dysosmia, a distorted sense of smell. It may seem strange but the extent of complain can be felt if one knows that a person with a normal sense of smell (normosmia) is able to distinguish 10,000 odors and any disturbance in sense of smell seriously hampers this normal capacity. Lack of smelling sense can cause anxiety, depression, and even nutritional deficiencies due to decreased enjoyment of food. Loss of smell can even be life threatening, impairing the detection of smoke in a fire or the ability to identify spoiled food.

Every year, thousands of people develop problems with their sense of smell. In fact, more than 200,000 people visit a physician each year for help with smell disorders or related problems.

Problems with smell increase as people get older, and they are more common in men than women. In one study, nearly one-quarter of men ages 60–69 had a smell disorder, while about 11 percent of women in that age range reported a problem.

Smelling disorders' Types:

The disorders of smell are classified as:

Anosmia

Inability to detect odors.

Hyposmia

Decreased ability to detect odors. It is the most common type of smell loss experienced by humans, it may occur following an influenza like illness, a blow to the head, nasal allergies or from unknown causes. A recent survey of the sense of smell determined that 15 million people in the US have had this type of smell loss. Hyposmia has been classified into two major types:

• Type 1 Hyposmia ­ represents an impairment of smell at the olfactory epithelia area. Vapors cannot be recognized but can still be detected.
• Type 2 Hyposmia ­ represents a quantitative impairment of smell. Vapors can be detected and recognized but only at higher than normal concentrations.

Hyperosmia

An increased sensitivity to smell. It can be a characteristic of someone with a neurotic or histrionic personality.

Dysosmia

Distortion or perversion of the sense of smell. A person senses non-existent unpleasant odors. It can be caused by medical and mental conditions.

Parosmia

Altered perception of smell in the presence of an odor, usually unpleasant.

Phantosmia

Perception of smell without an odor present.

Agnosia

Inability to classify or contrast odors, although able to detect odors

Odor Fatigue

Another type of smelling disorder is Odor Fatigue which is the inability to distinguish a particular odor due to desensitization of receptors in the upper nose. A different scent introduced into a person’s olfactory system is however perceived.

How does sense of smell works

Specialized sensory cells, called olfactory sensory neurons, are found in a small patch of tissue high inside the nose. These cells connect directly to the brain. Each olfactory neuron expresses one odor receptor. Microscopic molecules released by substances around us—whether it’s coffee brewing or a pine forest—stimulate these receptors. Once the neurons detect the molecules, they send messages to our brain, which identifies the smell. (Because there are more smells in the environment than there are receptors, a given molecule may stimulate a combination of receptors. This response is registered by the brain as a particular smell.)

Smells reach the olfactory sensory neurons by way of two pathways. The first pathway is through our nostrils. The second pathway is through a channel that connects the roof of the throat region to the nose. When we chew our food, aromas are released that access the olfactory sensory neurons through this channel. If the channel is blocked, such as when our noses are stuffed up from a cold or flu, odors cannot reach the sensory cells and much of our ability to enjoy a food’s flavor is lost. In this way, our senses of smell and taste work closely together. Without the olfactory sensory neurons, familiar flavors such as chocolate or oranges would be hard to distinguish. Some people who go to the doctor because they think they’ve lost their sense of taste are surprised to learn that they have a smell disorder instead.

Our sense of smell is also influenced by something called the common chemical sense. This sense involves thousands of nerve endings, especially on the moist surfaces of the eyes, nose, mouth, and throat. These nerve endings help us sense irritating substances such as the tear-inducing power of an onion or the refreshing cool of peppermint.

What causes smell disorders?

Disturbances in olfaction can result from pathologic processes at any level along the olfactory pathway. They can be thought of similarly to otologic dysfunctions as conductive or sensorineural defects.

In conductive (ie, transport) defects, transmission of an odorant stimulus to the olfactory neuroepithelium is disrupted. Sensorineural defects involve the more central neural structures. Overall, the most common causes of primary olfactory deficits are nasal and/or sinus disease, prior viral upper respiratory infections (URIs), and head trauma.

• Conductive defects.

  • Inflammatory processes cause a large portion of olfactory defects. These may include rhinitis of various types, including allergic, acute, or toxic (eg, cocaine use). Chronic rhinosinusitis causes progressive mucosal disease and often leads to decreased olfactory function despite aggressive allergic, medical, and surgical intervention.
  • Masses may block the nasal cavity, preventing the flow of odorants to the olfactory epithelium. These include nasal polyps (most common), inverting papilloma, and any malignancy.
  • Developmental abnormalities (eg, encephaloceles, dermoid cysts) also may cause obstruction.
  • Patients with laryngectomies or tracheotomies experience hyposmia because of a reduced or absent nasal airflow. Children with tracheotomies who are cannulated very young and for a long period may have a continued problem with olfaction even after decannulation because of a lack of early stimulation of the olfactory system.

• Central/sensorineural defects

  • 'Infectious and Inflammatory processes contribute to central defects in olfaction and in transmission. These include viral infections (which may damage the neuroepithelium), sarcoidosis (affecting neural structures), Wegener granulomatosis, and multiple sclerosis..
  • Congenital causes may be associated with neural losses. Kallman syndrome is one type of congenital smell loss and is due to failed olfactory structure ontogenesis and hypogonadotropic hypogonadism. One study found the VNO to be absent in patients with Kallman syndrome.
  • Endocrine disturbances (eg, hypothyroidism, hypoadrenalism, diabetes mellitus) may affect olfactory function.
  • Head trauma, brain surgery, or subarachnoid hemorrhage may stretch, damage, or transect the delicate fila olfactoria or damage brain parenchyma and result in anosmia.
  • Toxicity of systemic or inhaled drugs (eg, aminoglycosides, formaldehyde) amphetamines, estrogen, naphazoline, phenothiazines, and resperine prolonged use of medications such as antihistamines and decongestants, drugs like amphetamines, estrogen, naphazoline, phenothiazines, and resperine can contribute to olfactory dysfunction. Many other medications and compounds may alter smell sensitivity, including alcohol, nicotine, organic solvents, and direct application of zinc salts.
  • Over-the-counter zinc nasal sprays have been implicated in the cause of smell loss.
  • The number of fibers in the olfactory bulb decreases throughout one's lifetime. In one study the average loss in human mitral cells was 520 cells per year with a reduction in bulb volume of 0.19 mm3. These olfactory bulb losses may be secondary to sensory cell loss in the olfactory mucosa and/or general decline in the regenerative process from stem cells in the subventricular zone.
  • Degenerative processes of the central nervous system (eg, Parkinson disease, Alzheimer disease, normal aging) have been found to cause hyposmia. In the case of Alzheimer disease, olfactory loss can be the first symptom of the disease process. The sense of smell, more than taste, is impaired with aging, with a noticeable average decline in function during the seventh decade of life.

Once thought to be mostly a conductive defect through mucosal edema and polyp formation, chronic rhinosinusitis also appears to disrupt the neuroepithelium with irreversible loss of olfactory receptors through upregulated apoptosis. In common words, smelling disorders are caused by: Sinus and other upper respiratory infections, Polyps in the nasal cavities, Frontal head injuries, Dental problems, Hormonal disturbances, Radiation associated with the treatment of head and neck cancers, Ageing and Other health issues that affect the nervous system, such as Parkinson’s disease or Alzheimer’s disease

Diagnosis

If a smelling disorder is a symptom of a mental condition such as schizophrenia, diagnosis should be part of treatment for that condition.

When the condition is caused by a medical condition such as allergies or a viral infection, symptoms will end with the end of allergy or infection.

In other cases a careful inspection of the nose, nasopharynx, and upper respiratory tract can suggest probable cause. The examination could include sinus transillumination, skull Xrays, CT scan, Olfactory nerve testing, Nasal cytology, which involves the study of mucus under a microscope. In some cases a test to determine scope of smelling disorder is done. The test involves the patient trying to identify each one of a group of different odors. A variation of this is a scratch-and-sniff test. The patient may be asked to differentiate among concentrations of one odor. The alcohol sniff test that involves use of a material soaked in isopropyl alcohol. Patients close their eyes and the doctor moves around. Patients tell the doctor when they smell the alcohol.

Treatment

Treating a condition that causes a smelling disorder can sometimes restore the olfactory sense. Treatments for smelling disorders are as varied as the olfactory dysfunctions. Treatment for smelling disorders ranges from lifestyle changes to surgery. Treatment of mental conditions could affect the smelling disorder. In some cases, the disorder can't be treated, and the person must adjust to the loss of the sense of smell. Anosmia associated with aging is not treatable.

1. The sense of smell should return after a condition like a cold or the flu or after treatment of allergic or bacterial rhinitis and sinusitis. If allergies cause anosmia, adjustments should be made to avoid allergens. If dust causes allergies, care should be taken to clean areas such as the bedroom.
2. If anosmia is related to excessive use of nasal decongestants, a person should discontinue use of those medications.
3. Since head trauma injuries can lead to smelling disorders, people should wear protective helmets when bicycling or participating in sports like football or hockey.
4. Saline sprays can be used to clean the interior of the nose.
5. If smoking causes anosmia, a person should quit smoking.

Surgical treatment is needed in cases where nasal passage is being obstructed such as large nasal polyps and benign tumors.

• septoplasty is done to straighten the nasal passage,
• rhinoplasty to straighten the structure of the nose, and
• sinus surgery to open sinus drainage channels.

Surgical treatment may not be effective in conditions that result in the destruction of the olfactory nerve or its central passages. However, regeneration of those tissues may cause the sense to return.

Living with Anosmia

Anosmia associated with ageing is not treatable. In cases where smelling disorders are treatable, the outcome is positive because the olfactory sense is restored. In those cases where the sense of smell is lost, the person must make adjustments to adapt to life without that sense. Those adjustments include using spices like pepper to stimulate tastebuds.

Since a person with anosmia can no longer smell food to determine whether it is safe to eat, care should be taken. The person who lives with other people can ask them if food smells fresh. People who live alone should discard food if there is a chance that it has spoiled. Other home safety measures include installing smoke alarms and gas detectors. Cooking on an electric stove is preferable to a gas stove.

Furthermore, people with smelling disorders can find support groups. These are often associated with smell and taste clinics. In addition, there are on-line bulletin board where people can share experiences. One site contains descriptions of how things smell. Those words provide a connection to a missing sense in the same way that sign language allows the hearing-impaired to understand the spoken word.

Dysosmia and Homeopathy

Homoeopathy has immense scope in management of cases of Nose complaints and disorders, if we do timely intervention with our medicines. The ailment may be as simple as cold, coryza, or case of nasal polyp or deviated nasal septum. Homeopathy has remedy for all these ailments and also for many more. If we do apply the principles properly not only we can treat the patient of his ailments but we can

• Prevent unnecessary operative interventions.
• Stop disease progress at preliminary stages.
• Prevent disease re-occurrence.
• Help the person as a whole to heal.

Today even in the conventional system of medicine people do believe that wherever possible conservative management is best way to treat a patient and surgical intervention should be resorted only when other measures have failed to yield any positive results or in cases where patient’s life is at risk and surgery is inevitable intervention. So it is our foremost duty to act judiciously considering the scope and limitations of Homeopathy bringing relief to the patient and also considering the prognosis of the case in hand. Here the thing to highlight BOLD RED is to CONSIDER THE SCOPE AND LIMITATIONS of the case because if at all we mis-interpret Disease aggravation for Homeopathic aggravation and continue medicating the case will worsen or rather if we intentionally or unintentionally prescribe medicines to a surgical case instead of referring it the result is not at all favorable. So it is better to discuss and prescribe than to prescribe and be “discussed”

In case of Smelling Disorders or Dysosmia, the conventional school is moreover concerned about treating Anosmia or certain specific cases of Dysosmia i.e. where there is disturbed smelling sense due to polyp, sinusitis or developmental abnormalities but for other cases like Hyperosmia or Imagined smell the answer is only Homeopathy. Homeopathy reoves this false perception and brings the patient to his normal self.

Miasmatic Background

Now dysosmia is a mixed miasmatic disease. If we consider the cause of the ailment it can range from Psora as in Sinusitis to Sycosis as in nasal polyp to Syphilis as in Neural losses to Tubercular as in allergic rhinitis. As per Roberts’ theory Acute sense or exhalted sense of smell always points to Psora. While diminished sense of smell is Syphillis.

Homeopathic medicines most commonly indicated in Dysosmia:

NOSE - SMELL - acute

ACON. adam. Agar. alum. alum-sil. am-c. ambr. Anac. ant-c. aran. aran-ix. arizon-l. arn. Ars. ars-s-f. asar. AUR. aur-ar. aur-s. bamb-a. Bar-c. bar-s. BELL. bry. Calc. calc-sil. canth. caps. carb-ac. Carbn-s. Cham. CHIN. choc. cina Cocc. COFF. Colch. Con. cupr. cycl. der. dig. dream-p. ephe-si. falco-pe. galla-q-r. granit-m. GRAPH. haliae-lc. ham. Hep. hippoc-k. hydrog. hyos. Hyper. IGN. ip. kali-ar. kali-bi. kali-c. kali-p. kali-s. kali-sil. Kalm. ketogl-ac. kola lac-ac. lac-cp. lach. lavand-a. limen-b-c. LYC. Lyss. m-arct. mag-c. marb-w. merc. mez. mur-ac. musca-d. nat-ar. nat-c. nat-p. nat-sil. neon Nux-m. NUX-V. Olib-sac. OP. oxal-a. ozone par. petr. ph-ac. PHOS. pieri-b. Plat. Plb. plumbg. plut-n. podo. positr. psor. puls. sabad. sang. sel. senec. SEP. sil. spig. spira. stann. staph. succ-ac. sul-i. Sulph. tab. thuj. valer. viol-o. zinc. zinc-p.

NOSE - SMELL - wanting

ail. Alum. alum-p. alum-sil. Am-m. amyg-p. Anac. Ant-c. ant-s-aur. Ant-t. arg-n. Ars. Ars-i. ars-s-f. arund. asaf. aspar. Aur. aur-ar. aur-i. aur-s. BELL. Bry. bufo CALC. calc-i. CALC-S. calc-sil. camph. Caps. carb-an. Carbn-s. card-m. Caust. Cham. chel. chlor. cocc. cod. con. Cupr. cycl. Elaps Graph. HEP. Hyos. Ign. Iod. Ip. Kali-bi. Kali-c. Kali-i. kali-n. kali-p. Kali-s. kali-sil. lach. laur. lem-m. Lyc. m-ambo. m-arct. Mag-m. mag-p. mang. med. MERC. Mez. morg-p. Nat-ar. Nat-c. NAT-M. nit-ac. Nux-m. Nux-v. olnd. Op. phel. PHOS. PLB. positr. Psor. PULS. rhod. Rhus-t. ruta Sang. Sarr. sec. SEP. SIL. spig. stram. Sul-ac. sul-i. Sulph. syc. Syph. Teucr. tub-a. verat. Zinc.

NOSE - ODORS; imaginary and real

agn. alum. am-m. ambr. anac. ars. Aur. bell. benz-ac. calc. canth. chin. cina con. corv-cor. dig. Graph. hep. kali-bi. kreos. laur. lyc. M-ambo. M-arct. manc. Meny. merc. mez. mosch. Nit-ac. Nux-v. par. ph-ac. phos. plb. Puls. Seneg. sep. sil. sulph. valer. Verat.

Agnus castus: Complaints of imaginary odor before the nose, as of herring or musk.

Anac. [exalted sense of smell; imaginary odours];

Belladona: Wildly delirious, but quite fantastic, almost hysterical, laughing wildly and crying, and not at all conscious; pupils widely dilated; he evidently saw visions, as in delirium tremens, for he was constantly grasping and picking at imaginary objects, ; the odor of Belladonna was strong from his hands and feet; quite blind, and stared vacantly. Imaginary odours; odour of tobacco intolerable.

Phosphorus: Foul imaginary odors. [Aur.]

Paris quadrifolia: Great sensitiveness to offensive odors, imaginary foul smells. Stopped up nose, stuffed condition and fullness at root of nose. Flows greenish mucous from nose.

- Great sensitiveness to offensive odors; imaginary foul smells; milk and bread smell like putrid meat.

Sulphur: Peculiar feature is an undue sensitivity to any nasty odour, though possibly quite unaware of his personal aroma. Aberrations of smell may occur, with awareness of imaginary odours. He is always imagining and hunting for offensive odors.