Coming to Their Senses


 
Dr. Timothy Trone administers a smell and taste test to a patient as Drs. Justin Turner, Paul Russell and Rick Chandra (L-R) observe. Photo by Mandy Whitley

Vanderbilt Smell & Taste Center Offers Hope for Patients with Sensory Loss

A new initiative at the Vanderbilt Bill Wilkerson Center is offering hope to those with often overlooked, yet increasingly common symptoms. The Vanderbilt Smell and Taste Center kicked off in January with a monthly clinic designed to diagnose and begin treatment of smell and taste disorders.



Cause & Effect

Otolaryngology professor Rick Chandra, MD, said the dedicated focus is meant to streamline patient care and foster awareness of the problem.

"Symptoms of smell and taste loss are fairly prevalent because of larger conditions in Middle Tennessee like allergies, polyps and sinus congestion," Chandra said. "A lot of people don't even realize they have allergies or nasal polyps and just come to the ENT with symptoms of smell loss."

Chandra said the new center is a place for those with unknown causes of smell loss, as well as those whose loss is associated with something more common that hasn't yet been identified. Allergies, nerve loss, head trauma and neurological issues all are contributing factors.



Why Smell Matters

The loss of smell or taste might seem trivial, but it's life changing for those it affects.

"If you take the sense of smell out of the equation, all sense of flavor is lost," Chandra said. That's because the tongue can only distinguish salty from sour from sweet. "What people come in complaining about as a loss of taste or flavor is often a loss of smell," he said. "We tend to use the words 'taste' and 'flavor' interchangeably, but taste only refers to what the tongue is doing ... and all it can do is distinguish salty from sweet from bitter," he continued.


Rick Chandra, MD

To those for whom smell loss is a primary complaint, quality of life is greatly diminished. "Loss of smell is something you wouldn't think about as being detrimental to quality of life unless you lose it," Chandra noted. "Patients typically need a lot of counseling about what the diagnosis is and the prognosis, as treatment can take a very long time. It's not just a single ENT visit."

Chandra's team of specialists explores all possible causes including allergen sensitivity, toxic exposures and possible head trauma. They also look for underlying medical causes, including viral infections or family history of neurological disorders like Alzheimer's disease or Parkinson's. "It's more than just a stuffy nose that needs sprays," he said. "Figuring out what's wrong takes time and is often labor intensive."



Treating Loss of Smell

For some patients, regaining smell may be as simple as polyp surgery or allergy treatment. For others, head trauma can cause damage to smell nerves, or a severe cold can trigger secretion of chemicals that cause permanent loss of smell.

Sometimes, just identifying the problem can be therapeutic for patients. "Much of the satisfaction from patients with smell disorders comes from an explanation of what's wrong," Chandra said. "They want to know the underlying cause and prognosis. There's therapeutic value in that."

According to Chandra, most patients dismiss symptoms for a long time before seeking help. "If the patient has a stuffy nose and watery eyes, it's completely medically legitimate to treat them like any other allergy patient," he said. "If the primary complaint is, 'Doctor I can't smell,' that's a different situation."



Retraining the Senses

In cases where surgery or medication won't bring relief, rehabilitation often involves olfactory retraining. Patients will inhale recognizable scents like vanilla, cinnamon and eucalyptus in a specific order several times a day. Over time, the therapy has been shown to improve the body's ability to detect and identify odors.

"The smell neurons in your nose can regenerate, and they'll try to grow back and hook up with the memory and emotion part of the brain," Chandra explained. "Smell nerves that have grown back or survived inflammatory or traumatic insult can stimulate those and impact the brain so that patients can learn to identify new odors."

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Vanderbilt Bill Wilkerson Center

 
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Rick Chandra, Smell Loss, Taste Loss, Vanderbilt Bill Wilkerson Center, Vanderbilt Smell and Taste Center
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