Those phantom smells

Q:

Love your blogs.

Thank you.

Okay, here's my question/situation. I occasionally get a bad smell in my nose - like all the air I'm breathing is tainted with cigarette smoke or burnt coffee. Sometimes I have to force myself to breathe through my nose when it's particularly bad. I start to breathe, then my nose rebels and I have to tell it please breathe. (I am not a mouth breather unless absolutely necessary.) When this happens, it lasts about a week or two, then goes away for months. This has been going on and off for at least several years. More than three, for sure.

I have a history of annual sinus infections - mostly in February, early March - and I'm asthmatic and allergic to everything it seems.

Is this worth a visit RIGHT NOW to a specialist, or should I bring this up at my next visit to my regular internist.

The most likely explanation for these phantom odors is, indeed, sinus infection. You may have a chronic sinus infection which flares periodically, either directly producing the odor or indirectly creating a phantom odor by irritating the olfactory nerves.

The worry with any phantom odor, however, is tumor -- a tumor anywhere near or on the olfactory nerves. These are uncommon (much less common than sinusitis) but, as you might imagine, they're a good deal more serious than sinus infection. These can, in fact, be brain tumors.

Phantom odors from a brain tumor would not tend to come and go, however. Typically, the odors would come and stay, possibly get worse, and the tumor could eventually knock out the sense of smell altogether.

It may sound like I'm trying to reassure you, but the other shoe still has to drop. In medicine, we say, "Never say never." In other words, just because something is (A) rare in the first place, and (B) unlikely to present in the manner you have described, doesn't mean you have zero chance of that worst case scenario.

I hope you'll understand that I can't directly advise you how fast to see a doctor. When I do answer those questions, I always answer them the same way ("See your doctor immediately!") because I have to cover my ass. BUT: it sounds like this is making you miserable, so if I were you, I would take care of it sooner rather than later. A consultation with an ENT, who will most likely order a sinus CT and may also examine your nose with an endoscope, would certainly be worthwhile.

Hope this helps!

D.