June had no sense of smell for 37 years. But a sinus rinse brought it back in three hours
01:15 GMT, 27 November 2012
Like many grandparents, June Blythe is eagerly anticipating the birth of her new grandchild. But it’s not the first smile, the first grab of the finger or the first steps she’s most looking forward to — it’s the scent: ‘That mix of baby, baby powder and soap,’ as she puts it.
Her daughter Susie’s second baby is due in February. ‘I’m counting down the days — nothing smells as gorgeous as a baby,’ explains June, 65, a retired legal secretary who lives in Norfolk.
June has particular reason to relish that aroma. For after 37 years without a sense of smell as a result of chronic sinusitis, she has finally regained it following surgery at England’s only specialist smell and taste clinic.
Heaven scent: June is able to smell and can enjoy activities such as cooking and gardening again
‘If people experienced what I have, if only for a month, they’d know how much difference it makes to your life,’ says June. ‘Being unable to smell means you miss out on so much.’
Anosmia, as it is known, affects around 5 per cent of the population, although up to 11 per cent could have it to a lesser degree, says Carl Philpott, honorary consultant ear, nose and throat (ENT) surgeon at James Paget University Hospital in Norfolk, where the smell and taste clinic is based.
Our sense of smell is triggered when microscopic particles released by substances — such as freshly ground coffee — are breathed in. It’s also triggered by chewing food, through a channel that connects the back of the throat to the nose.
‘These particles then hit specialised sensory cells, or neurotransmitters, at the roof of the nose, which send a signal to the smell area in the brain, known as the primary olfactory cortex,’ he explains.
When we lose our sense of smell with a cold it’s because congestion restricts airflow to the top of the nose, stopping those microscopic particles going up the nostril.
This is temporary, but damage to the sensory cells or the smell area in the brain can cause a lasting loss.
‘Causes can include head injury, or more rarely Parkinson’s or Alzheimer’s. But often it’s down to more mundane causes,’ says Mr Philpott.
‘This includes the common cold — in virulent cases, the virus may damage the sensory cells on the delicate lining of the nose. And chronic sinusitis, or inflammation of the nose.’
The sinuses are small, empty spaces on either side of the nose behind the eyes, cheekbones and forehead. With chronic sinusitis, loss of smell is linked either to polyps (abnormal tissue growths caused by inflammation) blocking the airways, or long-term inflammation damaging the sensory cells.
And because up to 80 per cent of our sense of taste is down to smell, anosmia can also significantly affect that.
‘Despite ear, nose and throat problems making up around a quarter of a GP’s workload, medical students get very little training on this subject — probably a week or two out of five years at medical school,’ explains Andrew McCombe, an ENT consultant surgeon, and spokesman for ENT UK.
‘This means they may trivialise anosmia — or think nothing can be done. Little do they realise that patients can suffer severe depression and emotional issues because of the detrimental effect it has on their lives.
‘Even if patients do get referred on to an ENT consultant, unblocking the nose is often the main concern; if a sense of smell doesn’t return, it’s seen as unfortunate but not the end of the world.’
This is improving with greater specialisation of ENT consultants, so that some focus exclusively on problems with the nose, for instance.
‘In the meantime, the onus does fall on the patients to be proactive, make GPs aware of the detrimental effect of their anosmia, and ensure they are referred on,’ adds Mr McCombe. June’s case was typical of the kind many think cannot be treated.
As a child, she was always ‘congested’ and suffered from pressure in the sinus cavities under her cheeks and eyes.
In her early 20s, she developed polyps, and was told to use nasal sprays every day — but the congestion worsened so that by her late 20s she couldn’t breathe through her nose or smell anything.
She says: ‘Suddenly, all those evocative smells such as freshly laundered clothes, coffee or bread mean nothing to you. Nor could I taste things — food was suddenly just texture, nothing else.’
June was prescribed a short course of strong steroids. When this didn’t work she had a polypectomy — a 30- minute operation under general anaesthetic to remove the polyps, which now completely blocked the airways.
‘Despite waking up being able to breathe a bit better, my sense of smell failed to return,’ she says.
‘Without a sense of smell or taste life really does lose its colour. Cooking was drained of all pleasure. Gardening became purely visual; all the glorious scents of roses, honeysuckle and lavender were lost on me.’
Along with this affecting June’s enjoyment of life, she had to be extremely alert. ‘I’ve had to become fastidious about sell-by dates; you just cannot afford to risk things when you can’t smell or taste things to double check.’
Over the years, June has had a further 15 courses of strong steroids and undergone two more polypectomies — to no avail.
‘Eventually, around ten years ago my doctor said I had to come to terms with the fact smell and taste were not senses I’d enjoy again. I found the finality of it all very difficult to accept.’
Then, last year she read in her local paper about the new clinic and asked for a referral. After an initial consultation in 2011, she underwent scans which showed all four pairs of sinuses were blocked.
In some cases a course of steroids to reduce inflammation along with a nasal spray or rinse can be enough to help treat the problem, says Mr Philpott. ‘However what’s really making the difference is surgery,’ he adds, although this varies with the surgeon.
‘With polyps, for instance, we offer what’s known as bi-lateral computer-aided endoscopic sinus surgery — a far more in-depth operation than the traditional 30-minute op that simply removes polyps from the nose itself.’
He adds: ‘The operation, which can take up to three hours, involves opening up the individual sinuses, washing them out with antibiotic solution and then removing the polyps.
‘From my experience at the clinic, up to 50 per cent of anosmia (those cases triggered by sinus problems or colds) can be helped to varying degrees. Since we opened in October 2010 we’ve helped more than 200 patients to regain some — or all — of their sense of smell and taste.’
When June underwent the op last year, she was told that while her breathing would improve, there was no guarantee her sense of smell would return. But just over a week after the operation ‘something incredible happened’, she says. ‘I was zesting lemon when all of a sudden I got a distinct waft of that zingy, acid smell. I burst into tears.
‘John told me to open a coffee packet and I could smell that, too. Then I was well away — John’s shower gel, cookies baking in the oven, I smelled them all again for the first time in decades. As my sense of smell improved, so did my sense of taste.
‘There is a chance the polyps could grow back — but I’m now in a much better position to get treated straight away. My life really is a complete joy.’