I Don't Smell a Thing

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Open Wide
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When I'm at restaurants, friends sometimes ask me why I order what I do.
After all, if I can't really taste food, why do I care? There are a few reasons. For one, I have to order something . No waiter has ever said to me, "We'll make you a tasteless meal because you can't appreciate our menu." And although my preferences may be based on habit, they are real preferences. I enjoy food on my own terms -- the texture, the modicum of flavor I can mentally expand upon -- and never really focus on how I'm experiencing it differently from the people around me.
When people say they pity me, I tend to go lowbrow: At least I can't smell farts, I joke. But in fact, my loss of smell may have helped define who I am. I became a vegetarian at 13, long before anyone else I knew had done it, and never fell victim to the cravings that undo some others' resolve. I like to think my experience taught me to follow my convictions, although now I suspect success came too easily. A steak, to me, might as well have been soy.
On my second visit to UConn, I saw dentist Joseph D'Ambrosio, who checked for signs that my problem was mouth-based. Abnormal saliva production, such as saliva that is too thick or in short supply, can trigger taste loss because saliva is needed to disperse taste stimulants to the taste buds. Inflammation or infection inside the mouth can also be to blame, reducing blood flow to the tongue and thereby damaging cell receptors. My mouth was fine, though.
D'Ambrosio said visible signs of trouble in the mouth are often linked to more aggravating chemosensory problems, such as burning mouth syndrome or distorted taste. Patients may complain of smelling or tasting metal even when they're not sniffing or eating anything. Washington's Henkin said he recently treated a woman who described her experience as like having a dead mouse in her nose.
With an oral problem ruled out, my third visit began with the nose. I saw otolaryngologist Denis Lafreniere, who checked for any abnormalities that could lead to smell problems. Common causes include tumors or inflammations in the nasal canal, which can obstruct the flow of odors. They can be treated with corticosteroids, after which smell commonly returns. Lafreniere stuck a long, fiber optic telescope up my nose -- a uniquely unpleasant sensation -- but reported nothing overly troublesome. He did find that I have a deviated septum -- meaning the cartilage dividing my nostrils is off-center -- but he said that by itself does not cause smell loss.
So it was on to the final stop: Norman Mann, the director of the clinic. He gave me a full physical exam, because he said he sometimes discovers undiagnosed problems that cause taste and smell loss. He's found diabetes in patients, and some who come to him learn their loss of senses is the first symptom of oncoming Alzheimer's or Parkinson's disease, he said. (For other elderly patients, the sensory loss is more natural. Smell and taste diminish with age.) With me, though, there was nothing noteworthy.
That leaves two possible diagnoses, he said. I have a slight loss of taste and a significant loss of smell, and that's either because of a long-gone viral infection or because I was born with a defective olfactory system. The latter is unlikely, he said, because congenital loss is usually absolute, and I still have some semblance of smell. If it was a virus, he said, there's only a minuscule chance the senses will return. Damaged olfactory nerves can regenerate, but they usually do so within a year of the smell loss. "If we see a patient who has loss of smell for two or three years, the prognosis is poor," he said.
Looking Ahead
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There is some hope: "We see strange things once in a while," Mann said, including a man who regained his senses after seven years. Instead of holding out for that, he said, my best bet is to buy a gas detector and make sure the batteries in my smoke alarm are good. I may not smell things, but I still can avoid a fiery death.
As I went through this process, my friends joked about all the unfortunate outcomes that could result from a renewed sense of taste. What if I discovered I hate the foods I thought I like? Or what if I become so enamored with food that I ballooned in weight? (Mann said he's heard of the second happening, but not the first.) Instead, though, all this talk made me consider for the first time what it would be like to really smell and taste -- only to be more aware of what I'll always be missing.
But then again, it's not so bad. I can always go to a concert and not smell the sweaty people around me. I don't mind talking to someone who has bad breath. And if I still wanted to put chocolate in grilled cheese sandwiches, nothing would stop me.
Jason Feifer sniffs out stories regularly as a reporter in Massachusetts. To comment on this story, e-mail health@washpost.com.