Causes
There are two possible causations of phantosmia, the cause can either be peripheral or central. It is also possible for it to be caused by combination of the two. The peripheral explanation of this disorder is that the rogue neurons malfunction and transmit incorrect signals to the brain or it may be due to the malfunction of the olfactory neurons. The central explanation is that the active or incorrectly functioning cells of the brain cause the perception of the disturbing odor. Another central cause is that the perception of the phantom odor usually follows after the occurrence of seizures. The time span of the symptoms usually lasts a few seconds
Other studies on phantosmia patients have found that the perception of the odor initiates with a sneeze, thus they avoid any nasal activity. It has also been found that the perception of the odor is worse in the nostril that is weaker in olfaction ability. It has also been noted that about a quarter of patients suffering from phantosmia in one nostril will usually develop it in the other nostril as well over a time period of a few months or years.
Interestingly, several patients that have received surgical treatment have stated that they have a feeling or intuition that the phantom odor is about to occur, however it does not. This sensation has been supported by positron emission tomography, and it has been found that these patients have a high level of activity in their contralateral frontal, insular and temporal regions. The significance of the activity in these regions is not definitive as not a significant number of patients have been studied to conclude any relation of this activity with the symptoms. However the intensity of the activity in these regions was reduced by excising the olfactory epithelium from the associated nasal cavity.
There are a few causes for phantosmia, but one of the most common and well-documented involves brain injury or seizures in the temporal lobe. During a temporal lobe seizure the victim rarely faints, but usually blacks out and cannot remember anything that happened during the seizure. Several people who have had these seizures did, however, recollect having phantosmia just prior to blacking out. Epilepsy is a disease characterized by seizures. In the case of phantosmia, if smelling and something else become so strongly linked, the action of "something else" occurring can induce activation of the olfactory bulb even though there was no stimulus for the bulb present. This is an example of plasticity gone awry. Those with lesions on the temporal lobe, often brought about by a stroke but also from trauma to the head, also experience these olfactory hallucinations.
Other leading causes of phantosmia include neurological disorders such as schizophrenia and Alzheimer's disease. Both of these disorders have well documented cases of hallucinations, most commonly visual and auditory. Both also, however, have instances of phantosmia too, although not as frequently. In both cases, incidences of olfactory delusions are more common, especially in Alzheimer's, where it is exceedingly difficult to convince the patient that these are in fact hallucinations and not real. Specifically in Alzheimer's disease, atrophy in the temporal lobe has been known to occur. As evidenced in trauma and seizures, phantosmia is strongly associated with this area; leading to its appearance in some Alzheimer's patients. Parkinson's disease patients can also experience phantosmia, as well as parosmia, however their appearance is more uncommon than the muscle tremors the patients experience.
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