Attempting to Pacify the Putrid Pandemonium Surrounding Parosmia

By: Olivia Morrison

My Experience...

What I can remember before parosmia is now merely contained to the echo chamber of my writing, merely transcriptions of past tastes and flavors of Christmas meals. Before every meal of sitting down to eat roast chicken, beef tenderloin, or turkey with family over the holidays I would, figuratively, cross my fingers that this was the moment my taste buds would return to normal. Every time, my mind arduously attempted to retrain my brain to interpret foods the right way, seeking to rediscover the unspoken expectation that food is, and should be, enjoyed. Every time, I would squint my eyes shut, hoping that maybe this time it’ll finally be like that scene from Ratatouille, where Remy eats a strawberry with a cube of old-aged stinky cheese; and the combination magically galvanizes his taste buds, and as his brain waves are shown on the screen they burst into crescendos of euphoria, just like the climax of a fireworks show on July 4th. When I opened my eyes, I was never surprised or shocked, instead, I would be unfazed with what has been my new normal since April 2021. The rotten stench suffocating my taste buds as I chewed my first bite of a richly prepared or homemade meal over the winter break was and still is a daily and mediocre tragedy. But just because I have been living through it since last April, doesn’t make it any more tolerable. Sometimes, I feel like I am stuck in a never-ending nightmare that restarts the loop each day I wake up. 

Food is the nucleus of family gatherings, kneading generations together with the dough of secret familial recipes, bridging the old with the new. Eating food with friends and family over the holidays is important, epitomizing appreciation, love, joy, companionship (and even romance) in a cohesive setting. I think of the rich and heart-warming tastes of a tender roast chicken leg, freshly cut by my dad. The buttery crunch of a cheddar and broccoli quiche from Whole Foods, passing for homemade, proudly sitting on my mom’s great grandmother’s coveted platter - lined with cracks and chipped paint, symbolizing the impressive timelessness of the seemingly ancient china as well as the prevailing experience of gathering with family to exchange stories and secrets with one another. But when the experience of reveling in food with loved ones is stained, the entire emotional and positive aspect also is ruined. Over the holidays, all the fond memories of my very own preferences during Christmas feasts dissipated. It was as if what I put on my plate, of what I liked and what I didn’t, of what I used to aggressively reach across the table to grab seconds for and what I would politely decline, were all sabotaged by an unequivocal intruder, robbing me from making choices and having control over my own preferences. I don’t get to choose what I like and what I don’t anymore.  Now I am a host for a malignant and stubborn parasite, parosmia, and it decides which flavors are manageable. Even the scientific name sounds like ‘parasite.’ Now, the flavors of Christmas dinner, or any heavy and rich meal for that matter, taste unequivocally unfamiliar, perverted, and, sometimes, even repulsive. 

In April 2021, when I first started smelling sulfur everywhere - the kitchen, Trader Joe’s, my bedroom, Taco Bell, the bathroom, the hair salon - I genuinely thought I was going insane. I didn’t even know how to describe it, but it was the worst possible smell one could ever imagine. So, I only used adjectives and nouns that connotated a universally disgusting smell - I mean, that was the only way to try and articulate what I was smelling to my roommates and friends. In this regard, the lingering smell that followed me didn’t necessarily emulate the stench of rotting food or silver polish, but that was as close as it got. “Do you smell that?” I would exclaim, with a permanent frown on my face - like Florence Pugh in Little Women. They repetitively answered with “no, what are you talking about?”

Since I had tested positive for Covid-19 in early February and this was happening more than two months after I had recovered, Covid-19 didn’t even seem like a plausible culprit. No one was talking about parosmia, and, plus, my understanding was that one of the “the only presenting symptoms” of being Covid-positive was an absence of taste and smell; the CDC never mentioned being stalked by the shadow of a suffocating sulfur stench (Lerner et al,. 2021). When this strange phenomenon wouldn’t dissipate, and as my roommates’ feelings of “she’s literally going insane” intensified, however, I did what we all do in times of uncertainty, I took to the internet. I searched up “incessant sulfur smell.” What a wrong decision that was. I had just sparked an insurmountable fire in my mind as flammable intrusive thoughts were instigated by what I read online. According to Google, I either had Crohn’s disease, a parasite in my gut, or I apparently was Celiac. I immediately slammed my computer shut. I had not, in fact, relieved my anxieties but, rather, tripled them. I decided to try and ignore it until after finals had finished.

A few weeks later, once I was home for the summer, I finally did what I should have done originally, I booked an appointment with an otolaryngologist - an ENT doctor. She asked me what issues I was having; I explained the lingering stench that makes meat, strawberries, eggs, popcorn, soda and so many other random foods strangely repulsive and intolerable. Then she asked me if I had ever had had Covid-19;  ‘it couldn’t be…there’s no way,’ I thought. She subsequently explained that, while there is still not enough research on how Covid-19 affects individuals in the long term, I was not alone in experiencing this strange phenomenon. She explained how a minority of people who test positive for Covid-19, lose their taste and smell entirely while infected, recover, but then, after a couple of months, wake up to find this unpleasant smell, and, thus, the pangs of parosmia have penetrated the wall of reality, wreaking havoc for all things food-related. 

So what is parosmia?

Experiencing olfactory dysfunction, in which one’s taste and smell sensories do not operate as they are meant to, is not a new phenomenon. Olfactory dysfunction can ensue as a result of “inherited causes, aging, head trauma, sinonasal abnormalities” (Duyan et al., 2021) as well as “neurodegenerative disorders like Parkinson’s and Alzheimer’s diseases” (Rashid et al,. 2021). Moreover, olfactory dysfunction is not limited to what I was experiencing - parosmia - there is a wide range of terms, defining different ways in which regular olfactory function becomes disrupted. While quantitative olfactory dysfunction includes anosmia, the “loss of smell” as well as hyposmia, “reduced smell,” parosmia is a qualitative form of olfactory dysfunction, “less common” and defined as having a “distorted sense of smell”  (Lerner et al., 2021; Burges Watson et al., 2021). Parosmia, more recently due to Covid-19, has been referred to as a “debilitating condition in which usual olfaction is distorted and unpleasant” (Rashid et al,. 2021). Covid-19 parosmia specifically, however, is “often reported as a foul-smelling, rancid odor, sometimes like rotting flesh,” in which patients may accidentally mistake the gross smell as actually having “dental issues” (Hopkins and Kelly, 2021). It is important to emphasize that this means that parosmia is so vivid and pervasive for the individual that it actually changes the reality of how things smell and taste, of what is real and imaginary. I can relate to this dental issues phenomenon…you can laugh, it is genuinely quite funny, smelling something so bad you’ve convinced yourself that you have dire dental problems. The thing about parosmia is that what one thinks is a smell or taste everyone around you is experiencing is actually just in your own mind, only you alone smell that unpleasant, rotten whiff. In this way, experiencing parosmia can be incredibly isolating and destabilizing; your brain is literally making smells up, tricking you…mocking you. 

Many viruses, not just Covid-19, commonly affect one’s taste and smell by “damaging the upper respiratory tract and, thus, one’s olfactory neurons” (Duyan, 2021). The “Epstein-Barr virus, parainfluenza, and rhinovirus” have all been found to “lead to olfactory dysfunction” (Chang, 2021). Think back to times before the pandemic, when you would momentarily completely lose your taste and smell when you had a nasty cold, unable to taste your orange juice at breakfast, and wholly unamused by the plain taste of toast and butter. Now, instead of your breakfast being unflavored and bland, think of the most disgusting smell you’ve ever smelt, and that’s how your toast and orange juice would taste if you had parosmia. 

Losing smell and taste is a telltale sign of being Covid-positive. Throughout the Covid-19 pandemic, around “52.73% of cases result in loss of smell,” and, yet, most had an “excellent recovery rate within less than 4 weeks” (Rashid et al,. 2021). However, around 10% of the Covid-positive population, experienced lingering issues with taste and smell. So, while nearly 79% of individuals who experienced a “loss of smell” have been found to recover quickly, some patients have reported seeing “unpleasant changes to their sense of smell after a COVID-19 diagnosis” (Rashid et al,. 2021). While the “pathogenesis of parosmia” is still yet to be wholly determined, there are two “competing theories: one believes it is a result of a “central deficit within integrative centers of the brain” and the other states a “peripheral process,” causes “abnormal olfactory fibers to convey an incomplete odorant picture” (Lerner, 2021). 

Additionally, while it is still a “conductive theory,” a study conducted with the Association of Otolaryngologists of India, speculated that parosmia might be due to a “neuronal invasion by the COVID-19 virus” (Rashid et al,. 2021). This study, published by the Indian Journal of Otolaryngology, was conducted with 268 patients. They found that all participants had experienced reduced smell and taste or none at all, prior to having parosmia.  The reported “unpleasant smells” were described as “sewage, moldy socks, rotten eggs, citrus, and rotten meats” (Rashid et al,. 2021). They also found that the “main odorant triggers” were “perfume,, a frying smell, and meat” (Rashid et al,. 2021). Another study found a very similar finding. A “cross-sectional cohort study of individuals with COVID-19” published by the American Laryngological, Rhinological, and Otological Society found that out of 222 patients, 148 individuals reported experiencing “parosmia at some point” over the course of being Covid positive (Lerner et al., 2021). Moreover, 56.8% of respondents reported experiencing “active parosmia” and “at a mean of 195 days since symptom onset, suggesting that parosmia symptoms often persist” (Lerner et al., 2021). While there is still not enough literature on the subject, one study found the research may suggest that females have a “higher risk of olfactory dysfunction;” this “preponderance,” however, may also just be a reflection of “a bias of females presenting to the clinic for care” (Lerner et al., 2021). 

The Takeaway? Is there one? 
Before this past year, I had no idea what olfactory dysfunction even meant, and while, no, I am not pre-med, I also believe my previous lack of knowledge was, in large, because “olfactory disorders before the covid-19 pandemic were largely unrecognized, and often underestimated by researchers” (Rashid et al,. 2021). But now, a silently suffering minority of our generation is actively experiencing olfactory dysfunction. So that means this long-covid symptom is disrupting daily living in an unimaginable way, “impact[ing] psychological well-being, physical health, relationships and sense of self” (Burges Watson et al., 2021). Long-covid parosmia has also been found to be correlated with a “reduced desire and ability to eat and prepare food; weight gain, weight loss, and nutritional insufficiency; emotional wellbeing; professional practice; intimacy and social bonding; and the disruption of people’s sense of reality and themselves.” (Burges Watson et al., 2021) While a study from the UK “found that nearly half” of their COVID-19 cohort diagnosed with parosmia, had “a median interval of 2.5 months from the onset of loss of smell,” parosmia continued and continues to persist for at least “6 months in the majority of cases” (Hopkins and Kelly, 2021). 

It is not all so bad. In just this month alone, I have seen so much improvement in my olfactory function. While I still cannot eat some foods, like meat or eggs, for example, many foods and flavors that were unbearable for the majority of the summer and fall are now returning to normal. Additionally, having parosmia has previously been a “positive predictor associated with a lower chance of anosmia as the long term outcome following post-viral olfactory loss” as well as reflective of imminent “recovery of olfactory sensory neurons;” and so, hopefully, that means I will never lose my taste entirely again (Hopkins and Kelly). Lastly, while the experience of parosmia definitely actualizes differently for everyone, as I’ve said not everything has tasted unbearable; I only couldn’t (and still can’t) stomach incredibly rich or heavy homemade meals. But I hummus, pizza, some pasta dishes (depending on the sauce), salsa with chips all still pretty much tastes the same (- this is also not an exhaustive list, just a few of my favorites). Strangely enough - and I am not quite sure why but - sugar was and is the only thing that has always tasted the same. While sugar in large amounts is certainly not good for you, physically or mentally, it was nice to occasionally indulge in a bag of Haribo gummy bears. Now, if you ever wondered why I was obsessed with all things Haribo last semester, that’s your answer!

Reference List:

Burges Watson, D. L., Campbell, M., Hopkins, C., Smith, B., Kelly, C., & Deary, V. (2021). Altered smell and taste: Anosmia, parosmia and the impact of long Covid-19. PLOS ONE, 16(9). doi:10.1371/journal.pone.0256998

Chang, C., Yang, M., Chang, S., Hsieh, Y., Lee, C., Chen, Y. A., . . . Tyan, Y. (2021). Clinical significance of olfactory dysfunction in patients of COVID-19. Journal of the Chinese Medical Association, 84(7), 682-689. doi:10.1097/jcma.0000000000000560

Duyan, M., Ozturan, I. U., & Altas, M. (2021). Delayed parosmia following SARS-COV-2 infection: A rare late complication of COVID-19. SN Comprehensive Clinical Medicine, 3(5), 1200-1202. doi:10.1007/s42399-021-00876-6

Hopkins, C., & Kelly, C. (2021). Prevalence and persistence of smell and taste dysfunction in covid-19; how should dental practices apply diagnostic criteria? BDJ In Practice, 34(2), 22-23. doi:10.1038/s41404-021-0652-4

Khalifah, W., Damanhouri, B., Abushal, B., Marglani, O., Alharbi, B., Almaghrabi, M., . . . Basahal, A. (2021). Persistent Parosmia caused by COVID-19 infection: An emerging symptom. Cureus. doi:10.7759/cureus.19921

Lerner, D. K., Garvey, K. L., Arrighi‐Allisan, A. E., Filimonov, A., Filip, P., Shah, J., . . . Iloreta, A. M. (2021). Clinical Features of Parosmia Associated With COVID-19 Infection. The Laryngoscope. doi:10.1002/lary.29982

Rashid, R. A., Alaqeedy, A. A., & Al-Ani, R. M. (2021). Parosmia due to covid-19 disease: A 268 case series. Indian Journal of Otolaryngology and Head & Neck Surgery. doi:10.1007/s12070-021-02630-9

Schambeck, S. E., Crowell, C. S., Wagner, K. I., D’Ippolito, E., Burrell, T., Mijočević, H., . . . Beyer, H. (2021). Phantosmia, Parosmia, and Dysgeusia Are Prolonged and Late-Onset Symptoms of COVID-19. Journal of Clinical Medicine, 10(22), 5266. doi:10.3390/jcm10225266