Causes of phantom smells

Overview

Phantom smells (also called phantosmia) happen when you smell something that isn't really there. It can be a pleasant scent like flowers or an unpleasant one like burning rubber or rotten food.

Phantom smells are not extremely common, but many people experience them at least once in their life. They are more usual after a cold or sinus infection.

Anyone can have phantom smells, but they are more common in adults with sinus problems, migraines, or a history of head injury. Older adults may also experience them due to medication side effects or age-related changes in the nose.

Symptoms

Common symptoms

• Smelling an odor that no one else can smell
• The odor may be foul (like burning, rotten, or metallic) or pleasant (like flowers or perfume)
• The smell may come and go, or it may be constant
• It may occur in one nostril or both

Symptoms in children

• Children may not describe the smell clearly, but they may complain of a 'bad smell' or be fussy about eating
• They might cover their nose or say something smells weird
• Phantom smells in children are often due to sinus infections or allergies

Symptoms in older adults

• Older adults may have phantom smells due to sinus infections, medications, or age-related changes in smell receptors
• Rarely, it can be an early sign of a condition like Parkinson's disease or Alzheimer's disease
• The smell may be more bothersome and affect appetite or quality of life

Causes

Main causes

• Nasal and sinus problems: sinusitis, nasal polyps, or a deviated septum
• Upper respiratory infections: cold, flu, or COVID-19
• Migraines: some people smell phantom odors just before or during a migraine
• Head injury: damage to the smell nerves or brain areas that process smell
• Neurological conditions: such as Parkinson's disease, epilepsy, or a brain tumor (rare)
• Aging: natural changes in the smell system
• Medications: certain drugs can cause phantom smells as a side effect

Risk factors

• Chronic sinusitis or allergies
• Smoking or exposure to strong chemicals
• Previous head trauma
• Migraine history
• Age over 60

When to see a doctor

See a doctor urgently if:

• If phantom smell starts suddenly along with stroke-like symptoms (face drooping, arm weakness, speech difficulty)
• After a recent head injury or a fall
• If you also have seizures or confusion

Book a routine appointment if:

• If the phantom smell lasts more than a few days
• If it bothers you or affects your eating, sleep, or mood
• If you have a history of sinus problems and the smell is new or worse

Diagnosis

Your doctor will start by listening to your symptoms and doing a physical exam. They will look inside your nose and may ask about your medical history, including any recent illnesses, injuries, or medications.

Tests that may be done

• Nasal endoscopy: a tiny camera on a thin tube to look inside your nose and sinuses
• Smell tests: to measure how well you can identify odors
• Imaging: an MRI or CT scan of your head if your doctor suspects a problem in the brain or sinuses

What to expect at your appointment

The diagnosis is usually straightforward. Your doctor may refer you to an ear, nose, and throat specialist (ENT) if the cause isn't clear. You may need a few simple tests, but most people find the process easy and not painful.

Treatment

Treating phantom smells focuses on the underlying cause. In many cases, the smell goes away when the cause is treated, such as clearing a sinus infection or stopping a medicine that might be causing it.

Self-care at home

• Use saline nasal rinses (like a neti pot) to clear your sinuses
• Keep a diary of when the smells happen and what you were doing
• Avoid strong odors that might trigger or worsen the phantom smell
• Stay hydrated and use a humidifier if your nose feels dry

Medical treatments

Your doctor may recommend treatments for the underlying condition, such as antibiotics for a bacterial sinus infection, or migraine medications. For people with chronic sinus problems, a steroid nasal spray might be suggested. If a medicine is causing the smell, your doctor may adjust the dose or try a different one. Never change your medications without speaking to your doctor.

When is surgery considered?

Surgery is rarely needed. It may be considered if a nasal blockage like a large polyp or a tumor is found. Your ENT specialist will discuss if this is an option for you.

Living with this condition

Phantom smells can be frustrating, but most people learn to manage them. Try not to let the smells upset you too much. Distract yourself with other activities, and reduce stress, which can make symptoms worse.

Lifestyle tips

• Use a fragrance-free environment at home and work
• Consider using a fan or air purifier to keep air moving
• Avoid known triggers like cigarette smoke, paint fumes, or strong perfumes

Diet and exercise

A healthy diet rich in fruits and vegetables supports overall sinus health. Gentle exercise like walking can help reduce stress and improve your sense of well-being. There's no special diet that prevents phantom smells, but staying hydrated is important.

Mental health and emotional wellbeing

Phantom smells can cause anxiety, depression, or social withdrawal. It's normal to feel frustrated or embarrassed. If the smells are affecting your mood or daily life, talk to your doctor about ways to cope, including counseling or support groups.

Prevention

There is no guaranteed way to prevent phantom smells, but keeping your sinuses healthy and avoiding head injuries can reduce your risk. Manage allergies and sinus infections promptly.

Vaccines

Getting vaccinated against the flu and COVID-19 may lower your chances of getting smell problems after a viral infection.

Screening programmes

There is no routine screening for phantom smells. If you have a condition that increases your risk (like chronic sinusitis), your doctor will monitor you during regular checkups.

Complications

If left untreated

• Persistent phantom smells can interfere with your ability to eat and enjoy food
• They can cause anxiety, depression, or social isolation
• In rare cases, an untreated brain condition causing the smell could worsen

Long-term outlook

Most people with phantom smells improve on their own or with simple treatment. Even when the cause is a chronic condition like sinusitis or migraines, symptoms can often be managed well. The outlook is usually positive, and serious causes are very rare.

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