Jay Piccirillo, MD, Otolaryngologist at Washington University St. Louis talks about using essential oils to train the brain to regain smell.
Interview conducted by Ivanhoe Broadcast News in April 2019.
How prevalent is loss of smell and who does it happen to?
PICCIRILLO: A loss of smell does happen as we get older. It is part of the aging process. But many people who are not old can have a loss of sense of smell after a cold or after an injury to their nose or some other type of event or even people that have a congenital loss of sense of smell or never even developed a sense of smell. That’s very rare but what we’ve been focusing in are the people who lose their sense of smell after a virus, after the common cold. We don’t know exactly how common it is because so many people don’t report it or maybe don’t even recognize it for what it is which is a viral associated loss of sense of smell.
If you get it from a cold, this isn’t something that’s just going to fix itself in a couple of weeks.
PICCIRILLO: Most people after a cold or while they’re having the cold will have problems breathing and also have problems with smell. But as the cold goes away and as our nose becomes more normal again, we can breathe and can also smell again. That’s the typical situation but a small percentage of those people end up residual or persistent loss of smell. In other words after two or three weeks most people resume smelling. And that’s normal. What we find is some people realize hey what happened to my smell. My nose is no longer congested. I can breathe. But I can’t smell like I used to. That’s the virus attacking the nerve of smell and taking away their sense of smell, either completely taken away in some cases or reducing it in other cases.
Do you think is this one of those things some people notice but they never go see a doctor and they just think oh I don’t smell like I used to.
PICCIRILLO: Yes absolutely. We think a lot of people have this condition but they don’t seek medical care for a variety of reasons. Maybe they just don’t realize it’s a medical condition to see a doctor for. There is also a perception, partly correct that there isn’t a lot that doctors can do. And so why would I go see a doctor? This is just something I have to learn to live with. So those are the things that we were addressing a little bit as we tried to recruit patients for this project because we had a sense that there’s a lot of people out there with this loss of sense of smell after a cold but they just aren’t seeking medical attention or even thinking about participating in a research study.
I see. Before we talk about the smell training, has there been anything that you have been able to offer people to restore it or any medical interventions or anything like that?
PICCIRILLO: Well traditionally these people if they sought medical attention would be given steroid medication either steroids by mouth like prednisone or midrall or maybe nasal steroid sprays. You can buy them now over-the-counter. The whole idea behind the steroid medicine is to reduce the swelling and the inflammation in the nose whatever might be left in the cold or whatever might be there to allow more of the air more of a sense and odors to reach to the part of the nose that smells and hopes that that would help the sense of smell. But it’s not very effective.
Got it.
PICCIRILLO: Some patients may try vitamins or minerals like magnesium or zinc. There’s some suggestion that works, but not everybody. Some people might even try the over-the-counter zinc sprays for treatment.
But if the nerve is affected, those are probably not that effective.
PICCIRILLO: Right. We think the nerve of smell that enters from the brain into the nose has in one way or another been injured by the virus. And whether or not the medicines that we give people helps to bring that back or it would just come back on its own in some people is kind of unclear. It’s what we call spontaneous resolution. Some people will get the smell back or get parts of it back. Or sometimes patients who get the smell back get distorted sense of smell back. And then of course other people don’t get any smell back. We’re not sure if steroids or any of the medicines that we currently use can change or modify that it may just be the natural process.
There’s a lot of reasons that we need our sense of smell. Can you about that?
PICCIRILLO: So a sense of smell is important for appreciation of life like being able to smell flowers, being able to appreciate food. But more importantly it’s there for warning and for defense. For example smelling gasoline or smelling smoke or we hear from mothers that they can’t smell the baby’s diaper. Now some of us may think of that as an advantage, but actually it’s not. To be able to smell a soiled diaper is important. And for personal hygiene and for all of these things our sense of smell is so important so it’s not just a quality life to be able to smell that nice glass of wine or coffee or something like that but really really it’s a safety feature.
It’s both. It really is. But you can’t taste food without. That must lead to people not wanting to eat as much and maybe there could be some not getting enough nutrition for some people.
PICCIRILLO: A sense of smell works with sense of taste and they both amplify each other and help each other. If a patient’s having problems with smell they’re probably not tasting as well either and that can decrease appreciation of foods it can decrease the ability to detect foods that maybe are soiled or not healthy or spoiled foods. I’m not sure that it necessarily needs leads to a loss of weight or to diet but I think it definitely could in the sense that it takes away the desire to eat.
Tell me about your study. What are you looking at?
PICCIRILLO: We’re looking at whether or not something called olfactory training that is smelling certain odors, essential oils, on a regular daily basis can help retrain the brain to learn about those smells again. People who have lost their sense of smell following a cold or a virus are enrolled in the trial and asked to smell four different essential oils every day. And we’re looking to see if the brain can retrain itself.
How does that work? Do they do it in the morning? Does it matter what time they do it and for how long do they do it?
PICCIRILLO: Well we’d like them to do it twice a day. Generally morning and night basically 15 to 20 seconds of smell for the four different smells so total a minute or two in the morning and evening. And we do that for twelve weeks.
That doesn’t sound like a lot. A minute in the morning and at night. Can you explain why you think that that helps?
PICCIRILLO: The medical term is neuroplasticity. We’re trying to help the brain change itself so through brain training, through smelling these smells, we’re trying to again get the brain neurons to come back and to allow them to smell
OK. And what did your study show?
PICCIRILLO: We showed that people are willing to do this. They’re very motivated. They want to get better. And that in some patients they were able to appreciate smells better than before the trial. It was difficult to show essentially that they could breathe better or smell better the smells that they were smelling, but there’s a general sense that I’m smelling better. I’m appreciating foods better and that the training has been effective for me. I think it also has to be viewed in the context that for most of these patients there’s really no other treatment option and smelling twice a day for two to four minutes total a day for 12 weeks is such a little commitment that most patients are willing to do that. And through this process to get a general sense of smelling better.
Why is this important to be able to improve the smells in such a non-medicated way?
PICCIRILLO: We’re just helping or hoping to be able to help people to bring back that appreciation of foods, smell, and also for the protective properties that a good sense of smell can provide us.
Tell me a little bit about Patrick, how his sense of smell improved.
PICCIRILLO: Well again his sense of smell returned to more of a general global sense as opposed to being able to smell oranges better than grapefruits or being able to detect blueberries from strawberries or something to that effect. I don’t know that the fine detection that is normal is something that we’re seeing in any of our patients including Patrick. But just this idea that I feel more confident being able to smell smells. I know that this is a long term process and that maybe over time I’ll continue to have improving my sense of smell is what we’re hearing.
Even though the studies over are they still doing this? Are they still smelling the oils? Have some of them chosen to?
PICCIRILLO: Yeah, I’m not really clear how many are continuing to smell but certainly that’s an option for them and we’ve even encouraged them to expand maybe into other smells maybe other things that are more relevant to them so I could see certain patients wanting to have a better smell of a coffee or something like that and so we would hope that they would try to use these same principles of smelling these odors twice a day for 15, 20, half a half a minute or so and we’d continue into other areas that they want to improve their sense of smell.
Is this something that is harmless enough to do on your own?
PICCIRILLO: Absolutely. We would encourage patients to try improving their sense of smell by smelling those smells or those odors that are important to them and that they want to or hope to get better. Absolutely.
Great. Is the improvement maintained or if they stop doing it, does that go away? Do they need to keep doing this?
PICCIRILLO: So unfortunately, we don’t have long term follow up on our patients so we don’t know whatever gains they get. As a part of the trial remains for the long term we wouldn’t necessarily think that they would lose it but we would also encourage them to continue doing their training and maybe as I said expand the smells into additional smells that they want to get better at.
Right. It seems like a pretty easy thing to do. For some pretty big payoff.
PICCIRILLO: Absolutely. And potentially a big payoff for little investment in time and effort. You bet. It doesn’t cost a whole lot either.
They can use the essential oils at Whole Foods. You can pick them up.
PICCIRILLO: Yeah. We’d encourage him to go to their local stores or holistic markets and things like that and look for essential oils and things like that to use.
Can people who have not lost their sense of smell improve their sense of smell with this? Can you make it better?
PICCIRILLO: So can we make super smellers out of normal smellers or people for whom smell is such an important part of their job. I don’t know that that’s really true, but I do think there is this assumption that people that work in the perfume industry or the wine industry or again coffee smellers, at least they think they have a better sense of smell and we probably hope that they do. So I don’t think there’s any doubt that maybe they started out with a predisposition to have a good sense of smell but through their job and occupation and love of these smells have actually probably got to be better than most of us.
Got you. Their essential oils are the wines and the coffees.
PICCIRILLO: Correct. Right.
They came and got trained and then they did this at home right?
PICCIRILLO: All the participants did their olfactory training or their smell training at home, again, usually once in the morning, once in the evening.
I know you mentioned some of the steroids, but are you stuck with that if that happens?
PICCIRILLO: We’re also conducting a new trial looking at an old drug called theothaline. So that’s a drug that’s used for asthma and that drug is being used in a spray into the nose to see if that might help people with loss of sense of smell. We haven’t started enrolling I don’t have any answers yet but there’s some suggestion that maybe intranasal theothaline spray in the nose could help our sense of smell. And we’re anxious to start that study.
Is that a steroid drug or?
PICCIRILLO: Theothaline is a zanthine. It’s related to caffeine. It’s a drug that helps open up the lungs and make it easier to breathe. But there’s some basic science thoughts and chemical thoughts about why it might help in the olfactory system or the smell system.
Is there anything else we should talk about with this study and this research before we go into the next one?
PICCIRILLO: The four scents that we use our essential oils and the oils that have been used in other research projects. They’re sort of the standard essential oils that are used. I don’t know that there’s any clear reason why these four smells in particular been selected.
People who do smell normally know that those are strong smells and so you want something pretty potent if you’re picking out some oils, I would guess. Right?
PICCIRILLO: The four essential oils that we’ve selected for our project are oils that have been used in other research projects. We think they’ve probably been chosen because they’re fairly common essential oil smells. People are familiar with them. They’re strong. But beyond that I don’t think there’s any other scientific reason why these four have been selected. We wonder if maybe selecting essential oils that are particularly relevant to each individual person might be more meaningful. For example we’ve had some patients that don’t really know the smell of cloves. Lemons are quite common. Rose is common. Eucalyptus – not everyone knows eucalyptus.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Judy Martin
Washington University, St. Louis
314-286-0105
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