Smelling Foul Odor after Head Injury

Q.Several months ago, my husband fell 13 feet, landing on his back and head. He was unconscious for about 20 minutes. Four days after the accident, his brain swelled and severed nerves resulting in a loss of taste/smell. Ever since, the only odor he perceives is a constant foul odor (rotting garbage), which is always making him sick. We have seen several doctors who have never heard of this and don’t know what to do to make the foul odor go away or what may be causing it. Can you offer any help?

A.This symptom is known as cacosmia. If there is any alteration in the sense of smell following head trauma, it is usually anosmia (loss of the sense of smell). Your husband has that problem and cacosmia — in other words, the only thing he smells is a nonexistent foul smell.

A.Your husband’s problem is due to the fact that the tiny olfactory nerves were sheared during the initial injury (causing anosmia), and he probably also injured the olfactory bulbs at the base of his brain (causing cacosmia).

Your husband’s cacosmia is known as a phantom sensation, very similar to the phantom limb pain that amputees experience. This may or may not improve with time; in a 1997 study describing 268 head trauma patients, parosmia (a more general term describing “mistaken” olfaction — e.g., roses smell like gasoline) decreased from 41.1 percent to 15.4 percent over the eight years following the injury. So, depending on your husband’s degree of distress, he may or may not want to “wait it out.”

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