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the column of lasting insignificance: May 05, 2012
by John Wilcock

IMAGINE, IF YOU CAN, (it’s difficult) that you had no sense of taste and everything had the flavor of potatoes mashed in tepid water. And because throat and nose are related you’d probably also lost your sense of smell (adosma), which could be dangerous if you weren’t able to detect gas leaks, smoke or decay. Complete loss of taste is known as augesia and partial as hypogeusia. Both frustratingly deprive you of the zestiness of delicacies as varied as marzipan cookies or spicy chicken curry.
    “The taste buds can only detect sweet, sour, salty and bitter – the full symphony of flavor comes from the nose,” said Dr. Charles P. Kimmelman, a Manhattan anosmia specialist. “But when your brain is hit really hard, it wiggles like Jell-O, and the little fibers going from the smell nerve endings up to the brain are stretched taut. Some of them get torn, injured or bruised.”
    Can the damaged fibers actually regenerate? “To a certain extent,” Dr. Kimmelman said. “But not necessarily along the same pathways they had before. It’s like a crossed circuit. And there’s usually a phantom sensation, like when a person loses a foot but still feels like his toe is hurting. The brain is trying to make sense of what little information it has coming in.”
    Anosmia may be caused not only by head trauma but also by upper respiratory infection, nasal or sinus disease and exposure to toxins. Some people are born with the condition, Dr. K added, with many anosmia patients recovering only 20 to 30 percent of their sensory function , even if that.
    The five taste sensations you’ll have lost (they also include umami, defined as “brothy, meaty, savory”) results in a boring diet, and only adding salt and pepper or some more piquant condiment gives a touch of minor substance to otherwise endlessly bland dishes. Without a sense of taste you are left merely with temperature and texture, and only memory helps to make whatever you’re eating worthwhile. Some stronger flavors such as blue cheese, anchovies, pepperoni pizza offer a hint of themselves, and ice cream remains delicious even if you can’t distinguish one kind from another. But, in general, if your smell and taste disappear you’re left bereft. Life has literally lost a lot of its flavor.
    Sadly, this was my fate a few months ago—to recover from a severe and long-lasting cough only to discover that I could neither taste anything or smell anything. Naturally I found this state to be profoundly depressing, and my angst was not relieved when I discovered that (a) it’s not an uncommon affliction when you get older; and (b) usually there’s no cure.
    Ordinary doctors often don’t have a clue about this and usually refer you to Ear, Nose and Throat specialists (known as ENT doctors) but even many of these are content to tell you that there’s nothing much you can do. The source, they say, is a virus which the dictionary defines as “the causative agent of an infectious disease” but which more generally seems to be regarded as “un-eradicable”.
    Thus, what became to me instantly apparent, was how little medicine knew about this state and, if they did know, how rarely they were willing to share the information. My own doctor referred me (via my health plan) to an ENT Specialist who averred there was little could be done, even if expensive tests found a cause (unlikely, he emphasized). Neither a Medicare session with a doctor in Ventura, followed by a $20-a-minute session ($25) over the Internet with another in Santa Barbara, gave me any suggestion about how to restore my taste. “Wait it out; it may come back” was the verdict.
    Unwilling to accept this depressing scenario—after all, the subject must have been thoroughly researched by now—I turned my attention to the professional body, the American Academy of Otorcaryngology to which most ENT doctors belong. As it happens they were having their annual meeting in San Francisco that month and, presenting myself as a professional reporter, I contacted them through their friendly PR department. After a series of e-mail exchanges I was given several contacts, among them Dr. Michael Hirsch in Chicago and Dr. Natasha Mirza at the University of Pennsylvania, both reputed to be experts. Both declined to answer my questions unless I flew across country to see them as a patient, an expensive proposition that I could not afford.
    Next I was advised to find an ENT doctor at UCLA which my health provider wouldn’t approve, although they offered a private appointment—with no promise about results—for a mere $800. I also declined this.

There were several questions for which I sought answers:  

  1. Is there any estimate of how many people lose their sense of taste/smell and what percentage of them regain it?  
  2. Apart from age and such maladies as flu, severe coughs and colds etc what  are the other causes of loss?   Can it get worse and spread to other things?           
  3. Why do so many doctors imply that they can give you something to cure diseases, infections etc, but viruses are beyond treatment? Could this be true?
  4. Is there any ‘cure’ for loss of taste and smell? anything one can take that might bring it back? or any lifestyle change or habits to adopt that might help?

None of the experts I had contacted would answer these questions and nor could I extract even so much as a courteous reply to either of my letters to Jane E. Brody whose Personal Health column in the New York Times has recently dealt with such subjects as calories, narcolepsy, IUDs and yoga. And so it was back to the Academy which this time referred me to Dr David Eibling, Chair Geriatric Committee of American Academy of Otolaryngology. He was more helpful.
    “You are right”, he wrote, “there are relatively few ‘experts’ in this field….The differential diagnosis is lengthy, and more is unknown than is known. The first fork in the diagnosis is whether it is conductive (like hearing loss) or sensori-neural. Conductive hyposmia (or anosmia) is due to blockage of the airflow through the upper part of the nasal passages. A regular cold can do it, although nasal polyps are the most common cause of long term loss. This diagnosis is easily made by any otolaryngologist just by placing a scope into the nose and looking. Treatment is usually very effective in returning the sense of smell.
    “Chronic infection can also be a cause - sometimes you can see with a scope, other times imaging, usually a CT scan is required. Again, treatment is effective. Most of the disorders are, unfortunately sensori-neural, and not likely to respond to treatment. Such loss can be caused by head trauma, severe infection, or some sort of neurodegenrative process.
    “There is considerable recent interest in toxins, particularly zinc, the active ingredient of Zicam, a zinc-containing OTC preparation used to reduce the duration of a cold. The Zicam controversy went on for several years, but I think now the jury is voting that it can lead to hyposmia. Other rare causes include medications, especially some common meds such as ACE inhibitors such as lisinopril.”
    There was one more stop in my quest (approved by my health plan via the helpful Ventura doctor Armin Alavi), an MRI scan – a curious experience resembling a 30-minute electronic concert that takes place after you have been slid recumbent into a narrow tunnel, head enclosed in a transparent plastic cover. Disappointingly, the MRI revealed nothing that took me any further, leaving me back where I began with no suggested cure or even helpful behavior. Six months later, I still have no sense of taste or smell. Happy to hear from anybody out there who knows anything more.

AMONG THE THINGS that I miss the most is my taste for chocolate, especially English brands to which I have been devoted since my long-ago childhood. Thus, I was intrigued by the information about the newly opened museum devoted to chocolate in York, the northern England town to which so many familiar brands owe their origin.
    When the Quaker son of a grocer Joseph Rowntree (1830-1926) started making chocolate in York it was hardly a new industry. Joseph Fry’s Bristol company dated back to the 1760’s and John Cadbury started up in Birmingham the following century. Both companies merged in 1919 but the scions of both Fry’s and Cadbury’s apprenticed in York with Rowntree who had become a generous philanthropist offering his 4,000 employees free education, a library, help care and a pension fund.
    The mid-19th century chocolate company of Joseph Terry remained in York until 2005 but a commercial development on the old site is still called The Chocolate Works. Six million Kit Kats are still churned out in York every day.
    In 1969, Rowntree merged with another famous name, that of John Mackintosh, widely known as “the toffee king”. And despite the inevitable buyouts by humongous global companies—Rowntree and Terry by Nestle, Cadbury by Kraft—most of those delicious chocolate bars have retained their original names. Attendance has been growing steadily since the opening last month of the new museum where chocolate’s history (since the Aztecs) and manufacturing processes are displayed. And, of course, there are free samples.

Candy Wrappers Nestle: Kit Kat, Walnut Whip, Yorkie, Aero, Turkish Delight
Kraft: Flake, Crunchie, Crème Egg, Chocolate Cream, Chocolate Orange




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