SAN DIEGO — They come here from across the Western United States to have their noses peered into and probed and scraped and scanned.
There are people who haven't smelled Christmas turkey in years. There are people haunted by phantom odors. And there are people for whom everything smells like chemicals.
"Most have lost their sense of smell for anywhere from one to 15 years," said Dr. Terence Davidson of UC San Diego Medical Center. "They've all been to multiple physicians, all of whom have said, 'Yeah, your smell is gone. Don't worry about it.' It's not done heartlessly," he said.
"You've got to talk to 60 women who can't smell Thanksgiving dinner. You've got to talk to someone who can't smell their baby any more. And then you start to understand the emotions of this. It's not like losing a limb. But it is real," Davidson said.
"I keep thinking I smell something, because I remember it," said Frances Verbest, a Poway woman who has not tasted anything since a year ago Christmas. "What I have to do is eat and cook by ear. I just have to use my imagination."
She is a patient at the Nasal Dysfunction Clinic at the University of California at San Diego, one of only a handful of such clinics in the United States that explore the little-understood phenomenon of loss of smell, believed to afflict 2 million people nationwide.
Some suffer from anosmia, or the complete absence of smell. For others, their sensitivity was diminished or distorted or triggered unprovoked. For most, their first warning was what they took for loss of taste: Suddenly, everything seemed bland.
The causes of anosmia include infections, allergies, viruses and trauma, such as a severe blow to the head, according to Davidson. Some lose their smell from exposure to toxins like ammonia, photo-developing chemicals and hair-dressing chemicals. For a few, the problem is congenital.
Only some of the cases can be treated; for example, inflammations are treated with steroid hormones. In many cases, the loss appears to be permanent. In those cases, Davidson said, the aim is to help people accept their fate.
For them, future pleasure in food may depend on spices and hot sauces, which act on the taste buds on the tongue instead of the olfactory receptors in the nose. Davidson encourages them to savor the texture and appearance of food--now that the flavor is out of reach.
For a few, some satisfaction lingers in memories of smells, occasionally filtering back. Oliver Sacks, the British neurologist and author, called it "a veritable osmalgia," a nostalgic yearning for lost odors powerful enough to seem to bring them back.
The sense of smell is poorly understood because of its complexity and because of the traditional view that it is relatively insignificant. Yet smell is intimately connected to memory and emotions, perhaps because of the area of the brain where olfactory information is received.
Medical educations have included little about the nose, and until the late 1970s little money was available for research.
"There are some very basic science questions about the sense of smell that are as yet unanswered," said Claire Murphy, a psychologist who works with Davidson. "We still don't know how it is the olfactory system codes information about the quality of odor. Can you imagine someone in vision saying we don't know how it is that we tell the difference between red and blue?"
An odor is sensed when volatile molecules are sniffed into a person's nasal passages. There, they meet the mucus-coated epithelium, or lining of the nasal passages. They attach to minute, hair-like cilia, sending impulses through nerve cells to the brain.
That process can be disrupted at any stage--by a blockage in the nasal passage, or damage to the sensitive lining or damage to the brain. A head injury can shear the olfactory nerves. A virus can destroy the nasal olfactory cells.
In an interview, Davidson estimated that his clinic is able to reverse or reduce the smell dysfunction in one-third to one-half of all patients. For the rest, he said, an accurate diagnosis of their problem may finally enable them to come to terms with the loss of smell.
The problem is most upsetting to people like Verbest.
"I always had a very acute sense of smell and taste. Ask anybody," said Verbest, who attended the clinic last summer. "I love to cook and I love to eat. Now I can't do either. It's terrible." She has smelled and tasted nothing since December, 1985.
After much examination, Verbest was told that olfactory cells in her nose had been destroyed--an explanation she finds unconvincing. Unwilling to give up searching for help, she now plans to consult a nutritionist.