Ask the doctors: Sense of smell can be distorted by two olfactory disorders
Q: Over the last couple of years, whenever I put on perfume or use a different skin product, I get a burning smell in my nose. It can take days or sometimes up to a week to clear. Why does this happen, and is there anything I can do to prevent it when I want to wear perfume?
A: The details you shared point to a distortion in the sense of smell. This can occur in two different but related olfactory disorders: parosmia and phantosmia. (For fellow science nerds, the suffix -osmia comes from the ancient Greek word osme, meaning “smell” or "odor.") Each of these can cause you to perceive scents and odors in unexpected ways.
Let's begin with parosmia, the more common of the two. This is a distortion of an existing scent. For example, someone brews coffee and smells scorched rubber. Freshly mowed grass smells rotten. Or, as now happens to you, rather than the fragrance of a perfume, your nose says something is burning.
Phantosmia, by contrast, is the perception of a smell that does not exist. Think of it as an olfactory hallucination: Someone smells cigarettes, but nobody is smoking. Another common phantom smell is the scent of gasoline.
The exact causes of parosmia and phantosmia are not yet understood. They can happen in people who are recovering from viral infections such as a cold, the flu or COVID-19. The disorders have also been associated with acute sinusitis, nasal polyps, head trauma, migraine, tobacco use and as a side effect of certain medications.
There may also be a link to certain vascular conditions, such as high blood pressure and high cholesterol. And while it's logical to assume the olfactory mismatches start in the nose, the brain also plays a key role.
Our sense of smell begins when odor molecules bind to specialized nerve cells in the upper nasal cavity. Those cells then send signals to a rounded mass of tissue located at the base of the brain.
Known as the olfactory bulb, it serves as a kind of processing center for scent. The olfactory bulb transfers the signals it receives to areas of the brain involved in perception, memory and emotion. If an interruption occurs at any point in this pathway, the sense of smell can be adversely affected.
The scent distortion you described straddles both disorders. Your perfume smelling like something burning is consistent with parosmia. And the fact that the odor lingers for up to a week suggests phantosmia may be involved. Because these symptoms can arise from a range of causes, it's a good idea to check in with your healthcare provider.
Depending on your medical history and physical exam, you may be referred to an ear, nose and throat specialist. Treatment typically focuses on addressing any underlying physical conditions. If none are found, some people find success with a process known as smell retraining therapy. Although progress may be gradual, many people find their symptoms can improve over time.
• Dr. Eve Glazier is an internist and associate professor of medicine at UCLA Health. Dr. Elizabeth Ko is an internist and assistant professor of medicine at UCLA Health. Send your questions to askthedoctors@mednet.ucla.edu.
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