Parosmia and Phantosmia: Managing Quality Disorders

Abstract

Purpose of review: The purpose of this review was to summarize the current knowledge on parosmia and phantosmia and introduce support and treatment algorithms for the two qualitative olfactory disorders.

Recent findings: Recent literature regarding parosmia has revealed that patients with the disorder are mainly triggered by certain substances, including thiols and pyrazines. In 2015, the existing "olfactory training" regimen was improved to more effectively treat post-infectious olfactory loss and was named "modified olfactory training" (MOT). It was also found in 2022 that MOT is also effective against COVID-19-induced parosmia.

Summary: Parosmia, the distortion of smells, is a symptom in qualitative olfactory disorders that severely affects patients' mental well-being and enjoyment of their everyday lives. The condition was first documented in 1895 and can affect up to 5% of the general population. Etiologies of parosmia include sinonasal diseases, viruses, surgeries, traumatic brain injury, neurological and psychiatric conditions, toxic chemicals, and medications. Parosmia has seen a surge in cases since the onset of the COVID-19 pandemic and is linked to changes in brain structure following an infection. The evaluation of the symptom is done using surveys, smell identification tests, fMRI, MRI, PET/CT, and gas chromatography. Treatment for parosmia can vary in duration, which makes it essential to focus not only on helping the patients regain normosmia, but also on supporting the patient through the recovery journey. Parosmia should not be confused with phantosmia, in which the distortion of smells occurs in the absence of olfactory stimuli. The etiology of phantosmia can vary from infections and traumatic brain injury to psychiatric disorders like schizophrenia. Unlike parosmia, the treatment of phantosmia is less straightforward, with an emphasis on determining the etiology and providing symptomatic relief.

Keywords: Modified olfactory training; Parosmia; Phantosmia.

Fig. 1

The support algorithm above is utilized in my clinic to support the patient throughout the entire process, both mentally and physically. Not only does the course of treatment help with the symptoms of parosmia, but the other aspects of the process also help correct the neurotransmitter imbalances in the brain

Fig. 2

An example treatment algorithm when treating patients with phantosmia