Keeping Up with the News

I’ve tracked new scientific findings about the human sense of smell for a long time. Rather than just file them away for my own interest, I posted one-sentence summaries of clinically relevant findings to the Disorders of Odor Perception website at hyposmia.com. I was doing so on a more or less weekly basis until about a year ago when covid hit the fan and disrupted my routine along with everyone else’s.

Over the course of the year, “regular” publications on smell science were overwhelmed by a flood of papers on covid-related smell loss. I tried to keep up with these for while, but it was simply too much to handle and eventually I stopped updating the site.

Recently, when I decided to resume posting new material to Disorders of Odor Perception, it occurred to me that the web design was hopelessly out of date: the site looked OK on laptops, but was barely legible on phone or tablet. So I redesigned the site to make it “responsive”, i.e., it adapts to the device you view it on and is (hopefully!) much easier to read on mobile devices.

As before, new content appears in three categories: Smell Loss (hyposmia and anosmia); Smell Distortion (parosmia, phantosmia, etc.); and News & Reviews.

I also updated the format of the “new content” emails. They now contain direct links to the original source items—no need to go back to website to find them. This ought to make the emails much more user friendly.

If you are a clinician or patient or just interested in the topic of smell disorders, I encourage you to sign up for the email alerts. It’s a painless way to keep up with new work in the field.

Sommeliers Take It on the Nose

 

Robert Camuto, the Wine Spectator editor who interviewed me about his COVID-19-related smell loss, has a new piece up at the magazine. He surveys the experiences of sommeliers who have had the illness and how the olfactory disturbances have impacted their professional lives.

I thought of Camuto a few days ago when I found a paper in The Laryngoscope by a multi-European group of clinicians including Thomas Hummel and Carl Philpott. The study examined recovery from post-infectious olfactory dysfunction (PIOD) among patients who undertook olfactory training—a regimen formulated by Hummel and others which has shown promise in speeding the return of smell. The new paper, based retrospectively on 153 PIOD patients, finds that the presence of parosmia—altered smell impressions—at the initial visit is, somewhat paradoxically, a marker of better eventual recovery in odor identification and discrimination.

The study discussed here is “Parosmia is associated withrelevant olfactory recovery after olfactory training,” by David T. Liu, Maha Sabha, Michael Damm, Carl Philpott, Anna Oleszkiewicz, Antje Hähner, and Thomas Hummel, published in The Laryngoscope 131:618, 2021. The paper is available for free download at the link.

Another “New York Death”?

Hey, I’m as big a fan of Febreze® as the next guy, but I think it’s a tall order for that product to handle the smell of human decomposition. This case reported by the New York Post will ring a bell with fans of FirstNerve’s long-standing “I Smell Dead People” feature which, if memory serves, recorded instances of people attempting to hide the smell of rotting corpses with scented candles and air fresheners.

Cops believe the actor who was found dead with his mom’s body in Chelsea lived with her decomposing corpse for several days before he also passed away — and that he used Febreze to mask the odor, law-enforcement sources said Sunday.

ISDP fans will note that this is not a bona fide case of “I Smell Dead People” because the remains of the unfortunate Mr. Wedell and his mother were not discovered by smell, but via a police wellness check requested by concerned relatives. 

Enjoy the screenshot of the Post story in case a copy editor wakes up and notices the product name was misspelled in the headline.

The Road to Recovery

I was interviewed last week by Robert Camuto, an editor at Wine Spectator who lost his sense of smell after a recent bout with COVID-19. I suggested that he try smell training to assist his recovery of function. You can read about his experience here in his new column.

The SMELL CHANGE STATUS CHECK -- A Quick Way to Assess Recent Smell Loss in Suspected COVID-19

There have been numerous anecdotal reports of smell loss in people with COVID-19. It’s not surprising to find transient or even permanent smell loss associated with upper respiratory tract infections—in fact, it’s one of the leading causes of smell loss. However, in cases of flu, head cold, and sinus infection, the smell loss usually occurs at the same time, or following, the emergence of symptoms. What’s interesting here is the suggestion that the SARS-CoV-2 virus may trigger smell loss before full-blown COVID-19 disease is apparent. Thus, it might be evident in otherwise symptom-free people. If so, smell loss could be a useful marker in deciding whether to test someone for the virus, allow them back to work, etc.

Most people in the medical and chemosensory communities are aware of these possibilities. What has been unaddressed, thus far, is how exactly front-line medical personnel should probe for recent smell changes in potential patients.

Commercially available smell tests, such as the UPSIT and Sniffin’ Stick kits, are designed for full evaluation of smell function (although there are brief versions of each). However, they are relatively time-consuming to administer, at least in the context of evaluating people in the middle of a viral pandemic. They also require close patient contact with the test materials, which raises concerns about virus transfer and hazardous waste disposal.

My old friend and colleague Mark Greenberg, a neuropsychologist with a clinical practice in Boston, were talking about this earlier in the week and decided what was needed was a brief, verbal assessment using standardized questions, to determine if a person has experienced a recent change in smell function. We came up with three questions modified from the NHANES health survey, and added another of our own.

We call the resulting 4-item screener the SMELL CHANGE STATUS CHECK, or SCSC. We’ve made it available via a Creative Commons license. You can download it at this link. We hope healthcare professionals will find it useful. It may help in compiling data regarding how often smell loss is associated with SARS-CoV-2 infection, and when it emerges during the typical clinical course.

Annals of Anosmia 9: Awareness or Cure?

John Edwin Rhodes, M.D.

I get asked about smell loss a lot—by friends, neighbors, relatives, in-laws, and complete strangers. These conversations inevitably leave me feeling depressed. All I can do is explain the basic clinical facts and offer the glimmer of hope that their condition might improve on its own. I can’t tell them about promising new clinical research or therapies under development because there are none. And the fact that after decades of substantial research funding by NIH there are no therapies for smell loss is more than frustrating—it’s a scandal.

The lack of clinical progress goes back a long way. Consider the speech given in 1890 by John Edwin Rhodes, M.D., a graduate of the University of Chicago and Rush Medical College and a pillar of the ENT community. His topic was “Anosmia” and his published text is a succinct statement of clinical knowledge at the time. Here’s the key bit:

No treatment has been suggested that will relieve a case of true anosmia. If dependent upon local conditions, as deformity of nasal structure, excessive hypertrophy, or nasal polypi, surgical measures may result in complete, or at least partial relief.

This was the state of affairs in 1890 and it is a passable summary of where we stand today, 125 years later.

Sure, we now have more precise and rigorous tests for diagnosing olfactory dysfunction—we can grade smell loss into anosmia and various shades of hyposmia. We have precise anatomical descriptions of the pathological changes to the olfactory tissue in the nose. We know how brain areas linked to the olfactory cells of the nose shrink after an extended period of anosmia. We can confirm with EEG and fMRI and computer-controlled air-dilution olfactometry what John Edwin Rhodes observed by himself in a nineteenth century consulting room. We have filled in the details, but the big picture hasn’t changed a bit.

Individual cases of restored smell are newsworthy; most involve a peripheral cause, as in the dramatic recent case of rugby player Edward Baker. In the case of perfumer Kim Spadaro, a meningioma pressing on her olfactory nerves was resolved surgically, resulting in a happy restoration of smell.

For those whose anosmia results from head trauma or flu the prospects are bleak. Go to ClinicalTrials.gov and search for “smell loss.” You’ll get 30 results, the vast majority of which concern smell impairment as a biomarker for other diseases. There are drug trials for allergic rhinitis and polyps, but nothing for primary anosmia resulting from head injury or flu. There is no therapy in sight and we are no closer to a cure than was Dr. Rhodes.

Meanwhile, anosmia has enjoyed a recent vogue of sorts. In previous Annals of Anosmia posts I noted the rise of a new features-page genre—the “first-person anosmic” essay—and its ritualized rhetorical elements. (In the mid-aughts these included a recitation of doctors consulted and a reference to the 2004 Nobel Prize.) As night follows day, magazine pieces became book proposals. Among the results were Bonnie Blodgett’s Remembering Smell: A Memoir of Losing—and Discovering—the Primal Sense, and Molly Birnbaum’s Season to Taste: How I Lost My Sense of Smell and Found My Way.

In an essay posted a year and a half ago, Rebecca Steinitz pithily described the standard narrative and how it doesn’t square with her experience as an anosmic from birth.

I only discovered the word for people like me a few years ago. We are anosmic; we have anosmia: lack of the sense of smell.

Sometimes anosmia is defined as loss of the sense of smell. When people lose their sense of smell, they wax irate and nostalgic. They write articles in the New York Times about the tragedy and danger of not being able to smell burnt toast and how their friends don’t understand. They write books about traveling the world, searching for smell. They almost always regain what they have lost, because that is the nature of narratives of loss: you lose, you suffer, you recover.

Then there are those of us who never had what we’ve supposedly lost.

Over at New Scientist, anosmic Mick O’Hare took things to a new level of meta by reviewing an art installation by Eléonore de Bonneval called “Anosmia: Lives Without a Sense of Smell” which took place at the Kenzo Parfums showroom in Paris.

The biggest news on the anosmia front is the increase in advocacy. UK resident Duncan Boak, rendered anosmic by a traumatic brain injury in 2005, founded the organization Fifth Sense, whose purpose is to provide support and advice to those who suffer from smell and taste disorders (a worthy goal), and to address society’s lack of understanding about these disorders (a somewhat amorphous goal).

Among other things, Boak calls for scientists to saddle up and join the cause:

It’s time for science to come to the aid of olfaction, and we must harness it to develop our understanding of the role and function of the sense of smell, and treatment for olfactory disorders.

Newsflash for Mr. Boak: scientists are definitely aware of olfactory disorders. They have been getting NIH grant money for decades by claiming their research might eventually help people who suffer from anosmia. He might want to ask them why the millions of dollars spent to date have produced so little.

Fifth Sense also works to raise awareness of anosmia among the general public. In this they are joined by the Monell Chemical Senses Center (where I once worked long ago). Getting the word out on social media about support groups and coping strategies is certainly worthwhile. But what else can public awareness hope to accomplish in the absence of treatment options?

Monell, for its part, has tied the awareness campaign to a fundraising effort. Called “A sense of hope”, it comes with tagline (“Imagine life without a sense of smell”), celebrity spokesman (Bill Pullman) and monetary goal ($1.5 million over three years).

Monell does some great research on smell and taste. I admire my many former colleagues who work there. However, the anosmia campaign makes me uneasy. Given the long, dismal history of the field, is it wise to raise money on a promise you are unlikely to keep?

Annals of Anosmia 8: Mixed Signals from the BBC

In what’s becoming a journalistic Rite of Spring, BBC News health reporter Philippa Roxby cobbles together a story on anosmia. In “Learning to live without a sense of smell” she relates the story of Duncan Boake whose inability to smell is the result of a head injury suffered some years ago. Mr. Boake, very admirably, has set up the UK’s first charity to address issues faced by people with smell and taste disorders.

Roxby combines his story with that of a young girl born without a sense of smell. Congenital anosmia, besides having nothing to do scientifically with Mr. Boake’s condition, rather undercuts the “learning to live without” theme of the article. How can one miss what one has never experienced in the first place?

The BBC’s urban-elite bias is amusingly evident in the story: the young girl “never reacted or commented on bad smells, despite living in the country.” Oh, yes—those horrid farm smells! How far can a BBC reporter stray from England’s great tradition of sweet-smelling pastoral poetry? This far, apparently:

Hills, vales, woods, netted in a silver mist,
Farm, granges, doubled up among the hills,
And cattle grazing in the watered vales,
And cottage-chimneys smoking from the woods,
And cottage-gardens smelling everywhere,
Confused with smell of orchards.

—Elizabeth Barrett Browning

Movies & Molecular Biology

I’ve followed the molecular biology of olfaction ever since Linda Buck and Richard Axel burst upon the scene in 1991 with their discovery of the olfactory receptor genes. Along the way I’ve learned some molecular biology—it’s now about as good as my tourist French—and I like to check in on the field at the AChemS conference.

At this year’s meeting was a poster by Françoise Wilkin and colleagues from ChemCom S.A. in Brussels, Belgium, called “Profiling of OR gene expression in the human olfactory epithelium.” While Buck and Axel identified roughly 1,500 mammalian olfactory receptor (OR) genes, it turns out that many of these are non-functional; the exact proportion varies between species. Humans have about 450 functional receptor genes. But that doesn’t necessarily mean that every person actively expresses all 450. Wilkin et al. took olfactory neuroepithelium tissue from eight cadavers and looked for actively expressed receptors. They found 200 of them, or roughly half of the functional OR genome. Of these, 114 were expressed in all eight tissue donors; the rest were expressed in some but not all donors. This variation in expression could account for some of the variability between people in odor perception.

At the Industry Symposium, the theme of which was “Taste And Smell In Translation: Applications From Basic Research,” Joel Mainland from the Monell Chemical Senses Center gave an excellent talk. His topic was “Insights from olfactory receptor screening.” Later, at a reception, we had a chance to talk about why relatively little progress has been made converting olfactory genomics to commercial use (at least when compared to the active work being pursued on taste receptors and novel agonists and antagonists for same). Part of the problem is the sheer number of OR genes one has to deal with. But that can be handled with high throughput screening. What’s really missing is motivation, i.e., specific sensory targets linked to palpable business opportunities. Once the target-plus-application path is clear, the logjam might break.

At the same reception I met Joseph Rucker, Director of R&D at Integral Molecular in Philadelphia. His company develops technologies focused on membrane proteins and thus he is well-informed about OR receptors. (His AChemS talk was “Comprehensive mapping of functional sites for agonists and inhibitors of the bitter taste receptor TAS2R16”). We were talking about ion channels in sensory neurons when Joe reminded me of a 2011 Nature paper by Frank Zufall and others. They investigated loss of function in the SCN9A gene, which encodes a voltage-gated sodium channel. People lacking this gene have a congenital inability to experience pain. Zufall et al. discovered that patients with loss of function mutations in SCN9A are also unable to smell. Mice in which the sodium channel was experimentally deleted from nasal tissue also appeared to be anosmic.

Which brings us to the movies. [About time.—Ed.] [Bite me.] Ronald Niedermann, the giant blond goon in Stieg Larsson’s The Girl Who Played with Fire, and The Girl Who Kicked the Hornets’ Nest, was completely insensitive to pain. This led to some spectacular consequences for Lisbeth Salander, among others. Presumably Niedermann was also anosmic. Since I only watched the movies, this leads to an

Exit question: In Larsson’s novels, was the Ronald Niedermann character anosmic and, if so, how did this affect the plot?

Talking Odor Perception on Huff Post Live

I’ve been on the road and am just now getting around to posting a link to this smelly panel discussion hosted on Tuesday by Josh Zepps. It’s me, Stuart Firestein, Bonnie Blodgett, and Sissel Tolaas.

Annals of Anosmia 7: Cameo Appearances

In today’s Wall Street Journal, Ellen Byron covers a lot of familiar factoid territory on the sense of smell, some of it dubious, e.g., the previously debunked coffee bean meme. She quotes a couple of my scientific colleagues, Alan Hirsch and Richard Doty, and my former perfumery colleague Ron Winnegrad. She also briefly cites the cases of two anosmics. Not much new here but there’s lots of pictures.

Annals of Anosmia 6: The Literary Nasal Cycle

It looks like we may be in for another flurry of first-person anosmic essays in the legacy media. The last burst of activity ran from 2003 to 2008; the new cycle began in mid-2010 and continued its upswing this week.

On Monday, using Valentine’s Day as a story hook, thirty-five-year-old Stephen Adams took to the pages of the UK’s Telegraph to describe the anosmia which began after he suffered a head cold.

Eighteen months ago, my sense of smell largely deserted me. With it went some of my sense of taste, leaving me with a much reduced palate and a narrow range of alien flavours.

As per the rules of the genre, Adams offers a list of experts consulted; in his case they are Prof. Tim Jacobs at Cardiff University in Wales, and an ENT specialist. The ENT orders nasal endoscopy to look for polyps and a CT brain scan to look for a tumor. Both results are negative.

Adams, like Lowndes, fails to mention the 2004 Nobel Prize for the discovery of olfactory receptors. Perhaps this is merely old-fashioned Anglo anti-American snobbery or perhaps the Nobel is no longer a key feature of the genre.

Meanwhile, the jury is still out on my two key literary predictions: no sign yet of I-am-a –celebrity-anosmic essays, nor of soul-searching reflections by researchers seeking more grant money. But the cycle is young and time will tell.

Annals of Anosmia 5: Paradise Lost, Book Contract Gained

There was a time earlier in the decade when features editors couldn’t commission enough “how I lost my sense of smell” pieces. From 2003 to 2008, eight such essays appeared in major publications around the world. (This doesn’t count another four written by congenital anosmics—people who never had a sense of smell in the first place.)

Analysis of the “first person anosmic” genre reveals two key narrative elements: a recitation of doctors consulted, and a reference to the 2004 Nobel Prize in medicine.

The Australian newspaper The Age just published another example of the art form, an essay by Peter Lowndes called “Losing my senses.” Lowndes was an enthusiastic epicure before contracting a heavy cold six years ago at the age of thirty-five. Afterwards he was left unable to smell and barely able to taste his food. Lowndes makes the expected bow to the rules of the genre:

In search of a remedy during those initial years I saw several allergists and an ear, nose and throat specialist, and dabbled with acupuncture, nasal sprays, changing my diet and several other suggested remedies. None of that helped.

He name checks “Dr. William Smith, a senior consultant at the clinical immunology and allergy department at Royal Adelaide Hospital,” but for some unfathomable reason fails to reference the 2004 Nobel Prize. Despite failing to score the maximum number of genre points, his description of tantalizing near-recoveries and ultimate surrender to a one-dimensional olfactory life is well written.

Today’s San Francisco Chronicle carries a story by Carolyn Jung about an anosmic local chef: “Carlo Middione can’t taste but still loves to cook.” Middione, now in his mid-seventies, was for many years the owner of Vivande Porta Via on Fillmore Street. Three years ago he lost his sense of smell in a car accident and eventually gave up his restaurant in frustration. (A pity—he’s clearly talented.)

Middione experienced disturbing episodes of parosmia in which formerly pleasurable smells became obnoxious. While he still enjoys the physical process of cooking and preparing food, he seems resigned to his shrunken sensory world. 

According to Jung, Middione is not the only chef to lose it:

Middione has some company in the professional chef world. Most notably, chef Grant Achatz of Alinea in Chicago lost his sense of taste after undergoing chemotherapy for tongue cancer. And Kirk Webber, chef-owner of Cafe Kati in San Francisco, lost his sense of taste after suffering two concussions in a mugging in 2003.

These chefs eventually regained their ability to taste, although they are considerably younger than Middione, who’s in his mid-70s.

Jung also reports that food industry executive Barb Stuckey is writing a book about smell loss that features Middione. Ms. Stuckey enters a crowded marketplace. Bonnie Blodgett’s memoir of smell loss and recovery was published a few months ago. And next year cooking school student, accident victim, and NYT anosmia essayist Molly Birnbaum will publish a book recounting her recovery from anosmia. Looks like smell loss may soon get a shelf of its own in the self-help section.

Quick Sniffs

The FDA weighs in on Zicam and smell loss.

BK brings Flame to England. We published a sneak preview here.

Oversexed robots of the future hate human BO.

Annals of Anosmia 4: What’s the Prognosis?

Smell loss is most frequently caused by upper respiratory tract infection or head trauma. Most studies find that the return of smell function is more likely in the former case than in the latter. In medical jargon the conventional wisdom is that etiology (cause) determines prognosis (outcome).

However, a study published last year in the Annals of Neurology came to the surprising conclusion that etiology does not predict outcome. Richard Doty and his colleagues reviewed 542 patients examined at the University of Pennsylvania School of Medicine’s Smell & Taste Center. The patients received a comprehensive test battery on their first visit, including a 40-item smell identification test. At intervals ranging from three months to twenty-four years they were given a brief 12-item version of the same test. The researchers measured clinical outcome based on the difference in performance between the original test and the follow-up.

What determines who recovers and who doesn’t? Statistical analysis turned up several factors. One was the initial degree of dysfunction: the likelihood of recovery was better when the initial smell loss was mild, and worse when it was severe. Another factor was age: the older the patient was when the smell loss occurred, the less likely he was to recover. In particular, the odds of improvement drop substantially after the age of seventy-four.

Surprisingly, the cause of the smell loss did not predict whether patients recovered from it. Doty’s team concludes that

head trauma patients with mild or severe initial smell loss have the same likelihood for functional recovery as patients with mild or severe smell loss due to other causes.

In other words, it’s the extent of the initial smell loss that matters, not what caused it.

On the bright side, the study found that

some improvement occurs over time in one-third to one-half of patients with olfactory dysfunction.

Improvement, however, doesn’t mean the patient regains full function. Far from it: even in patients whose initial loss was mild, only 18% regained absolutely normal smell function, and 23% regained function that was normal for age.

This study is not the last word on the topic—different patient populations, different smell tests, and different patient enrollment protocols might alter the exact nature of the results. Still, the study does put a big dent in the conventional wisdom about smell loss and recovery.

Annals of Anosmia 3: The Slow Fade

The media’s enthusiasm for first-person essays on anosmia is driven by the drama of sudden-onset smell loss and the medical mystery of in-born absence of odor perception. What these stories overlook is a far more common experience: the age-related decline in smell ability known as presbyosmia.

The demographics are well-known—on average, smell sensitivity and odor-naming skill decline gradually with age; men are affected more heavily than women. Declines in performance can be detected as early as the fifth decade under laboratory conditions, but in everyday life a person might not notice anything until much later. I emphasize that these trends are group averages and that variation within an age group is large. A given 68-year old may be more sensitive than a given 28-year old. An element of use it or lose it may be in play; for example, many of the great perfumers work successfully into old age.

What causes presbyosmia? Scientific speculation points to cumulative wear and tear on the olfactory system: a lifetime of colds, flu, and sinus infections, along with the incremental impact of minor bumps on the head.

The slow fade of smell with age, although exceedingly common, has not inspired its own genre of first-person essays. This insight hit me the other day when I received an email from a reader. C. Rodney James wrote such a compelling account of his personal experience that I asked him to let me share it here on First Nerve.

Dear Mr. Gilbert:

Finished What The Nose Knows with great interest and more than a bit of sadness as it reminded me of what I have lost. As a teen I had a terrific sense of smell. At seventy it’s virtually gone. The fading, as I would describe it, began about ten years ago, perhaps a bit more. A few odors seem to come and go. I can (reliably) smell cat shit, hot paint when the furnace overheats as it did this A.M. and the odd whiff of the priming mixture used in English and some Mexican .22 rimfire ammunition. It has a distinctive tutti-frutti odor like old-time, public rest-room deodorant—unique in the olfactory arena of ammunition. Bad writers (who have never smelled it) include the odor of Cordite, which smells like many other types of nitrocellulose powders. Burning leaves, if the intensity is great enough is detectable, but little more. That’s about it . . .

University education in the speech and hearing field taught me the dangers of exposure to loud and prolonged noise, and I had the wit to avoid exposure to same. As a result my hearing is still quite good. How unfortunate there seems nothing we can do to protect or conserve the sense of smell. There are no exercises or other regimens we could follow. If there are, or better yet some means of restoring this sense, I am ready to join the line. A similar loss happened to my mother so there is likely a genetic link of some sort.

At times I get what I think you described as a false-smell experience, as when I could clearly detect/re-experience the scent of fresh hay the other day—indoors in frigid weather. Very strange.

If anyone ever comes up with some genuine aroma therapy I hope you will get the word out.

Sincerely,
C. Rodney James

Mr. James’s observations on the smell of primers and gunpowder are those of an expert. He has written about firearms and ammunition as well as motion pictures.

The evocative power of smell anchors us in time; the longer we live the more meaningful recalled smells become. Mr. James’ wistful note reminds us all of what we stand to lose as age takes its toll.

Annals of Anosmia 2: The Congenial Congenitals

A newly popular genre of newspaper features is the “how I lost my sense of smell” essay, or the first-person anosmic as we like to call it here in the olfactory blogosphere. I described its key elements in a previous post: list of doctors seen, mention of the 2004 Nobel prize, etc. 

It turns out there’s a parallel universe of essays written by congenital anosmics—people born without a sense of smell. In July, 2004, for example, Lucy Mangan published a piece in the Guardian about her lifelong inability to smell. Her anosmia doesn’t seem to weigh very heavily upon her—like many people who have never smelled anything, she finds it hard to understand what all the fuss is about. Her pioneering account gives the new subgenre its definitive element: how perplexing life is for a child who doesn’t get the whole odor thing.

In October, 2005, Jason Feifer published a piece in the Washington Post about his congenital anosmia. Like Mangan, he is nonchalant about what he has never experienced. This doesn’t stop him from deploying the succession-of-doctors theme. He describes several visits to a taste and smell research center where, after a battery of tests confirms the obvious, they advise him to buy a gas detector.

Suzy Banks arrived in print two months later, in the January, 2006, issue of Texas Monthly. Like Mangan and Feifer, Banks makes light of her in-born deficit. She boasts that she has turned it “into my greatest parlor trick.” She doesn’t stress the succession of doctors theme (her parents take her to only one neurologist) but she does mention Buck and Axel’s 2004 Nobel Prize.

Finally, Karen Ravn staggers across the finish line with a first-person congenital essay in an August, 2007 edition of the Los Angeles Times. She displays the blasé attitude often found in those who have never smelled, but is chagrined when the vet scolds her for not taking better care of her dogs’ teeth (“Didn’t you smell their breath?”). Her main concern is with food: nearly all of it feels disgusting in her mouth. Genre points: doctors, two; Nobel Prize, zero.

I’ve spoken with congential anosmics now and then and found they shared a puzzled curiousity about their condition.  They do get the occasional nasal sensation when they sniff ammonia or rubbing alcohol, for example. But those tinglings and stingings come courtesy of the trigeminal nerve fibers; true smell sensations are carried by the olfactory nerves. And while these folks presumably have been at increased risk all their lives of eating spoiled food or incinerating themselves in a gas explosion, they are noticeably less anxious about it than the adult-onset anosmia crowd.

Annals of Anosmia

In yesterday’s New York Times, Molly Birnbaum reflects on life without a sense of smell. She became anosmic following a head injury—she was hit by car while jogging. At the time she was training to become a chef. But after finding that without smell “taste is a mere whisper,” she gave up that career for a less nasal-intensive job in publishing. Over the next couple of years she gradually regained some limited smell function: first the aroma of sliced cucumber, later the smell of garlic. Now she can pick up the scent of a bagel shop a block away.

Birnbaum is fortunate: even such mildly happy endings are rare for people who suddenly lose their ability to smell. I know this because I’m a smell scientist and I read the medical journals. But you probably know it too—because not a year goes by without someone, somewhere, publishing a first-person essay on smell loss. Welcome to the annals of anosmia: the formerly obscure malady that has taken the feature pages by storm.

Why are essays about this particular medical misfortune so popular? One explanation is that we take smell for granted and therefore its sudden loss brings home in dramatic fashion all the subtle but important things it does for us. But we also take hearing for granted; where are the comparable essays on mid-life deafness? Frustration is another possible motivator: the scent-deprived are justifiably angry that so little is known about the causes—much less the cure—of their condition.

Molly Birnbaum’s first-person essay is not the first one to appear in the Times.  In 2003, they ran “I was a Middle-Aged Anosmic” by Tom Miller, a fellow left with no sense of smell after a respiratory virus. Importantly, for the future of the genre, he listed the succession of doctors he consulted in an effort to find a cure: a dentist, a chiropractor, a homeopath, and an ear, nose, and throat specialist. This troph effectively conveys how little doctors can do for such patients.

After a fallow period in 2004, first-person anosmics really took off. In June, 2005, Matthew Kaminski, an American living in Paris, wrote in the Wall Street Journal about a cold that took down his sense of smell the summer before. He amusingly described the shrugs and indifference of his French physicians, and weighed the drawbacks and possible benefits of his newly reduced condition.

When Barbara Lantin tried to serve her children spoiled fish for dinner she realized that her sense of smell had quietly vanished. The cause turned out to be nasal polyps blocking airflow to the olfactory nerve endings high in her nasal passages. Once these growths were removed her smell ability was substantially restored, leaving her a ready-made premise for an August, 2005, feature in London’s Telegraph, “Scent is not to be sniffed at.”

The following month, Mick O’Hare wrote in New Scientist about his attempts to cure a smell loss that arrived with a head cold and never left. Like Lantin, O’Hare quotes smell experts on the causes and prevalence of anosmia. True to the genre, he lists the doctors consulted on his case: a GP, various ENTs, and a neurologist. Then he introduces what will become another classic element of the first-person anosmic: an obligatory mention of the 2004 Nobel Prize in medicine awarded to Linda Buck and Richard Axel for discovering the olfactory receptors. It’s timely, fascinating, and accurate, but of only glancing relevance to the clinical issues at hand. This major advance in basic science has yet to translate into new treatments for anosmia.

Next up, in January, 2006, was Anita Chang’s personal account, “The Scent of a Woman—Lost.” Her anosmia resulted from head trauma when she was hit by a car five months earlier. Life for her is now “like living behind a film of Saran Wrap.” Chang’s tone is upbeat, even though there was no evidence at press time that her smell abilities would ever return. While short on essential genre elements (she sees only one neurologist and doesn’t mention the Nobel Prize) she offers one uniquely distressing observation: “Not having my sense of smell has made kissing quite dull.”

By April, 2006, the anosmia trend had trickled all the way down to The Philadelphia Inquirer. Bryan David Finlayson relates how he lost his sense of smell eight years earlier after taking a tumble from a speeding skateboard in Santa Barbara. He’s bummed because he can’t smell the ocean anymore and frustrated that so little is known about his condition. Succession of doctors: one neurologist. Nobel Prize mention: absent.

Sometimes, as with Hayden’s late quartets, the greatest works appear when an art form is so well established no one expects anything further from it. So it is with Elizabeth Zierah, who wrote a genre masterpiece for Slate.com in June, 2008. A head cold three years earlier left her without a sense of smell, and the results were devastating: worse, she says, than the lingering sensorimotor aftereffects of a mild stroke suffered years before. “As the scentless and flavorless days passed, I felt trapped inside my own head, a kind of bodily claustrophobia, disassociated.” She has to force herself to eat and worries about personal hygiene. For one tantalizing week her smell ability returns and her spirits soar; but the reprieve proves temporary. Succession of doctors: internists, allergists, otolaryngologists, acupuncturists. Nobel Prize: yes. All genre elements present and accounted for.

All of which brings us back to Molly Birnbaum’s essay on Sunday. It lacks the key elements of the genre: no succession of doctors, no Nobel Prize. But her story—running under the slug “New York Observed”—is adorned with local scents: West Village coffee shops, public restrooms in Penn Station, containers of Chinese take-out going bad in the fridge. What’s remarkable is that these odors figure in her story because she is unable to smell them. It's a most post-modern literary achievement.

Where do we go from here? Clearly, we can expect first-person anosmics by celebrities to appear in People or even Vanity Fair. But I predict that the next big thing will be soul-searching essays by physicians who have labored in vain to help the victims of anosmia. Prediction number two: these first-person diagnostics will be accompanied by selfless pleas for more Federal research dollars.

So, who will be first? Jerome Groopman? Oliver Sacks? Anyone? Anyone? Bueller?