16708 Loss Of Taste And Smell

Overview

Smell and taste are two separate senses that work closely together. Smell comes from receptors high up inside your nose, and taste comes from taste buds on your tongue, in your mouth and throat. When you chew and swallow, food releases smells that travel up the back of your throat — this is why most of what we call 'taste' is actually smell. So when your nose is blocked, or the nerves that carry smell signals are damaged, food often tastes bland or 'off'. Loss of smell is called anosmia (no smell) or hyposmia (reduced smell). Loss of taste is called ageusia. Many people who think they have lost their taste have actually lost their smell. You can usually still detect the basics — sweet, salty, sour, bitter and savoury — but the rich flavours of food disappear.

Yes, it is very common. Colds, flu, sinus infections and COVID-19 cause temporary loss of smell and taste in millions of people every year. Smell also naturally gets weaker as we get older. Since the COVID-19 pandemic, more people and doctors now recognise these symptoms and take them seriously.

Anyone can be affected, at any age. It is more common in older adults, people who smoke, people with nasal allergies, sinus problems or nasal polyps (soft growths inside the nose), people who have had a head injury, and people having certain medical treatments. Some people notice it in pregnancy, usually temporarily.

Symptoms

Common symptoms

• Food tastes bland, dull or 'cardboard-like'
• Not being able to smell cooking, flowers, perfume, soap or coffee
• Only noticing strong basics like sweet, salty or sour, but missing the full flavour
• Smells that seem weaker than they used to (reduced smell)
• A complete lack of smell (no smell at all)
• Smells that seem distorted — familiar things smell unpleasant or wrong (this is called parosmia)
• Smelling something that is not there, often an unpleasant odour (this is called phantosmia)
• A blocked or stuffy nose, often with a cold or sinus symptoms
• Losing interest in food or eating less because meals are no longer enjoyable

Symptoms in children

• Fussiness at meals or refusing foods they used to like
• Saying food is 'boring' or 'tastes funny'
• Not noticing usual smells around the house and needing reminders about safety
• Often following a cold, flu or COVID-19 infection
• Usually temporary, but children can find it upsetting and may need extra reassurance

Symptoms in older adults

• A gradual, mild decline in smell is common with ageing and is not usually a sign of illness
• Greater safety risk from gas, smoke and spoiled food, so alarms and food dates matter more
• Eating less or losing weight because food is less appealing
• Some medicines can reduce smell or taste, so a medicine review can help
• A new loss of smell should be checked, as it can occasionally be linked to other health conditions

Causes

Main causes

• Viral infections such as the common cold, flu and COVID-19 — the most common cause
• Sinus infections, ongoing (chronic) sinusitis and nasal allergies, which block the flow of air to the smell receptors
• Nasal polyps — soft, harmless growths inside the nose that block airflow
• Head injury that damages the tiny nerves carrying smell signals
• Ageing, where smell gradually weakens over the years
• Side effects of some medicines, including certain blood pressure and antibiotic medicines
• Smoking and long-term exposure to chemicals, dust or solvents
• Nutritional problems, such as low vitamin B12 or low zinc levels
• Hormonal changes, including pregnancy
• Radiation treatment to the head or neck, or some types of chemotherapy
• Long-term neurological conditions such as Parkinson's disease or Alzheimer's disease, where smell changes can appear early
• Rarely, other conditions affecting the nerves or brain

Risk factors

• Being older
• Smoking
• A history of nasal allergies, sinus problems or nasal polyps
• A recent cold, flu or COVID-19 infection
• Head injury
• Taking medicines that can affect smell or taste
• Working with chemicals, dust or strong fumes
• Low levels of certain vitamins or minerals in the diet
• A family history of smell or taste problems
• Certain long-term health conditions affecting the nerves

When to see a doctor

See a doctor urgently if:

• Any sudden loss of smell or taste with weakness, numbness, speech problems, confusion or a drooping face
• Loss of smell after a head injury
• One-sided nasal symptoms that are not improving
• Repeated nosebleeds or a nose blockage that is getting worse
• Facial swelling, breathing or swallowing problems, or vision changes

Book a routine appointment if:

• Loss of smell or taste that has lasted more than two to four weeks
• Eating less or losing weight because food no longer appeals
• Smells that seem distorted or unpleasant, or smells that are not there
• A blocked nose or sinus symptoms that keep coming back
• No obvious cause, such as a recent cold
• You are worried, or the change is affecting your mood, sleep or daily life

Diagnosis

A doctor will usually start by asking questions: when the change started, whether you had a cold or infection, what you can and cannot smell, whether you have a blocked nose, what medicines you take, and whether you have had a head injury. They will look inside your nose and check your mouth and throat. If the cause is not clear, or the problem is not improving, they may arrange simple smell or taste tests, or refer you to an ear, nose and throat (ENT) specialist.

Tests that may be done

• A physical examination of the nose, mouth and throat, sometimes with a small camera (nasal endoscopy)
• Smell tests — you sniff a set of standardised scents and identify or rank them
• Taste tests — small samples of sweet, salty, sour and bitter solutions, or taste strips
• Blood tests to check vitamin levels, thyroid function, or signs of inflammation or allergy
• Allergy testing if allergies seem likely
• A CT or MRI scan in selected cases, such as after a head injury, one-sided symptoms, or when other causes are suspected

What to expect at your appointment

These checks are usually quick and painless. Most people are diagnosed by their GP after a conversation and a simple examination. If you are referred, waiting times vary, and you may be offered smell training while you wait. Many people never need scans or complex tests.

Treatment

Treatment depends entirely on the cause. If the cause is a virus, there is no specific cure — the nerves usually heal over time and the main job is to support recovery. If the cause is a blocked nose, polyps, allergies or a sinus infection, treating that problem often improves smell. If a medicine is suspected, your doctor may review it with you. Recovery is often gradual, measured over weeks and months rather than days, and improvement can happen in stages.

Self-care at home

• Smell training: choose four familiar scents (for example lemon, rose, clove and coffee or eucalyptus), sniff each one slowly for about 20 seconds, twice a day, and focus on what you remember about it. Keep going for at least three months — progress can be slow but is often noticeable in hindsight
• Keep your nose clear — salt water (saline) rinses or sprays from a pharmacy can help if your nose is blocked or crusty
• Stay well hydrated and eat a balanced diet, since dryness and poor nutrition can make things worse
• Follow good food safety: check use-by dates carefully, reheat food properly and be cautious with leftovers, since you may not smell spoilage
• Make sure smoke and gas alarms work, and ask someone to check gas appliances regularly
• If you cook, use timers and keep an eye on pans rather than relying on smell
• Avoid smoking and strong chemical fumes, which can slow recovery
• Be patient with yourself — recovery often happens slowly and in small steps

Medical treatments

Your doctor may offer treatment aimed at the underlying cause — for example a nasal spray to reduce swelling and treat inflammation or polyps, a short course of antibiotics if there is a bacterial sinus infection, treatment for allergies, or a review of any medicine that could be contributing. Sometimes a short course of a tablet medicine is prescribed by a specialist to try to improve smell. If a vitamin or mineral deficiency is found, that will be corrected. Your doctor will explain the options, their benefits and possible side effects, and will only suggest medicines that are right for you. Never stop or change a prescribed medicine on your own — ask your doctor or pharmacist first.

When is surgery considered?

Surgery is only considered in specific situations, such as nasal polyps or a structural blockage that has not improved with other treatment, or persistent sinus problems. It is not a treatment for smell loss caused by a virus or a head injury. An ENT specialist would discuss the possible benefits and risks with you.

Living with this condition

Losing smell and taste affects ordinary life more than people expect — meals, cooking, personal care, and even noticing danger like smoke or gas. Plan around it: use timers when cooking, check dates on food, rely on alarms, and mention it to people close to you so they can help. Try new textures, colours and stronger flavours, and focus on the basics your tongue can still detect — sweet, salty, sour and bitter. Many people find that smell training gives them a sense of doing something active while they wait for recovery.

Lifestyle tips

• Do smell training twice a day and keep a short diary so you can spot small improvements
• Cut down or stop smoking, and avoid smoky or chemically strong environments
• Use a humidifier or steam from a bowl of hot water if your nose feels dry or crusty
• Keep your nose clear with saline rinses from the pharmacy if recommended
• Tell family, friends and colleagues so they can help with safety and food choices
• Keep up social meals and routines even if food is less enjoyable — the social side matters too

Diet and exercise

Eat regular, balanced meals with plenty of vegetables, fruit, protein and wholegrains, even when food is less appealing — set meal times rather than waiting to feel hungry. Try stronger flavours and seasonings, different textures and temperatures, and dishes with more colour. Keep an eye on your weight; if you are losing weight without trying, tell your doctor. If spicy or strong-smelling foods trigger unpleasant distorted smells, keep a note of which foods bother you and avoid them for a while — this often improves over time. Regular exercise and good sleep support general recovery and mood. Ask your doctor or a dietitian if eating becomes difficult.

Mental health and emotional wellbeing

It is very common to feel low, anxious or isolated when you cannot smell or taste. Food is tied to comfort, culture, family and pleasure, so losing it can feel like a real loss, and it can be frightening not to notice smoke or gas. Some people worry about hygiene or feel self-conscious. These feelings are understandable and worth talking about — tell your doctor how you are coping, especially if you feel persistently low or hopeless. If you ever have thoughts of harming yourself, contact your local crisis support service or emergency services straight away. You do not have to manage this alone.

Prevention

Not all causes can be prevented, but you can lower the risk from common ones. Good handwashing and avoiding close contact with people who are unwell reduce the chance of catching viral infections. Not smoking, keeping allergies and sinus problems well controlled, and protecting your head with a helmet when cycling or doing contact sports all help. If you work with chemicals or strong fumes, follow workplace safety guidance and use protective equipment. If a medicine seems to be affecting your smell or taste, do not stop it — ask your doctor or pharmacist about alternatives.

Vaccines

Staying up to date with recommended vaccinations, including flu and COVID-19 vaccines where offered, can reduce the chance of infections that cause loss of smell and taste. Ask your doctor or pharmacist what you are eligible for.

Screening programmes

There is no routine screening test for loss of smell or taste. Because a change in smell can occasionally be an early sign of a nerve-related condition, a new loss that has no clear cause is worth mentioning to your doctor — especially if it is one-sided, getting worse, or comes with other symptoms.

Complications

If left untreated

• Eating less and losing weight, or not getting enough important nutrients
• In older adults, a higher chance of malnutrition and frailty
• Safety risks — not smelling smoke, gas leaks, spoiled food or chemicals
• Low mood, anxiety and social withdrawal, especially when eating with others feels pointless
• Distorted or phantom smells that are unpleasant and hard to ignore
• Missing early warning signs of another health condition that needs attention
• In some people, sleep and quality of life can be affected for a long time

Long-term outlook

The outlook is good for most people. After a viral infection, most people notice improvement within a few weeks and many recover fully within a few months, though it can be slow and uneven. Smell training is the most helpful self-directed approach and works best when done regularly and patiently. Some people recover only partly, and a small number have long-lasting changes — but even then, most learn practical ways to adapt, and distorted smells often settle with time. If you are not improving or are struggling emotionally, tell your doctor so you can get the right support.

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