Hope for People with Anosmia
By Eddie Edwards
Richmond Family Magazine
The ear guy and the nose guy joined forces at a world-class institution and great things are happening. “With a $500,000 grant from MEDARVA, we have an exciting opportunity to improve lives through groundbreaking, translational research.” At least that’s how Richard Costanzo, Ph.D., professor of physiology and biophysics at Virginia Commonwealth University, explains it.
Or in other words, “Basic science and clinical medicine are merging in just the right way on this project,” continues Dr. Costanzo, whom for the sake of clarification we’ll call the nose guy.
Daniel Coelho, M.D., (also known as the ear guy) is assistant professor of otolaryngology at VCU. Together with Dr. Costanzo, he is on a scientific mission to solve an enduring medical mystery of the senses: how to help people with anosmia, or a complete loss of smell.
“A surprising number of people have permanently lost their sense of smell – and therefore taste – and we are determined to do something about it,” says Dr. Coelho.
It’s the best kind of science in action.aDr. Costanzo’s long history of olfactory and brain research and Dr. Coelho’s expertise in treating sensory hearing loss allowed a seamless merge of skill sets in the development of a new, potentially life-changing concept.
So the nose guy’s background in the olfactory field is understandable, but how does the ear guy fit into this innovative scientific discovery?
The two Richmond doctors were discussing advancements in Dr. Coelho’s field, specifically cochlear implants that are used to give hearing to the profoundly deaf, when they experienced a eureka moment. Why not try to develop something modeled after cochlear implants, the device implanted into the skull with electrodes that send signals to the brain, to restore the sense of smell in the same way cochlear implants have helped restore the sense of hearing?
According to Dr. Coelho, initially the pair thought the device was such a simple idea that they “wondered why no one in the field had thought of it before.”
“Before now, if a patient had complete loss of smell,” Dr. Coelho says, “the doctors would just tell them they would have to live with it because there was no treatment. While we can’t offer a treatment just yet, we can, and do, offer hope. We are very pleased with the progress of our research to this point.”
You’ll find these experts at VCU, one of the few centers in the world performing comprehensive olfactory nerve testing and a place people visit from around the world for consultation and advice. Still, while mild loss of the sense of smell may recover through nerve regeneration, recovery from total loss is not yet possible.
The ear guy and the nose guy are working to change that.
What’s behind anosmia, or loss of the ability to smell, in the first place? A common cause is head injury. Anything that jars the head and neck – motor vehicle accidents, bicycle accidents, falls, or shock waves from loud blasts – causes the brain to slosh back and forth inside the skull. Delicate nerve fibers that control the sense of smell pass through tiny holes in the skull above the nose and merge into the olfactory bulb, which then transmits the information to different parts of the brain. Once these fragile olfactory nerves are damaged, odor detection can be lost, sometimes forever.Fortunately, the relatively recent use of helmets by motorcyclists, bicyclists, and other athletes has prevented many otherwise devastating injuries.
The sense of smell also declines with age.A recent study found that about six percent of people in their fifties have olfactory impairment, increasing to nearly 65 percent of people after the age of eighty. Other causes include viruses, sinus infections, and severe colds, after which some people do not regain their senses of smell and taste.
The sense of smell is critical to the sense of taste. When we lose the ability to smell, it follows that taste is greatly affected.Research shows that the majority of taste perception originates with the aromas of various foods. In a popular test known as the jellybean test, kids held their noses and were given a jellybean to eat. When asked the flavor, they couldn’t identify it.Given the ability to smell again, they could identify the flavor within milliseconds.
“It can be more important than you might think,” Dr. Coelho says. “Besides the quality of life issues – like the loss of taste – anosmia can occasionally be a lifethreatening issue. I’ve seen many patients over the years who were not aware that their sense of smell was damaged until there was a fire or gas leak, which fortunately someone else was able to smell.”
There are other issues that arise from anosmia that may not seem as serious, but are still matters of health and safety. For example, what often stops you from eating spoiled foods? It’s the odor in many cases.
Up until fairly recently, sensory research was mainly focused on vision and hearing, but a few experts – Dr. Costanzo among them – have concentrated on the sense of smell. Research has revealed that the olfactory nerves have the ability to regenerate under certain circumstances, explaining why mild loss of smell can sometimes be reversed. In 2004, the sense of smell garnered new attention when the nobel Prize in Physiology or Medicine was awarded jointly to Richard Axel and LindaB. Buck for their discoveries of “odorant receptors and the organization of the olfactory system.”
As Dr. Costanzo explains, the research he and Dr. Coehlo are conducting focuses on the connections needed to restore function within the olfactory system.”There are complex connections between the nerve fibers and brain. We not only have to get the information to the brain for odor detection, we have to make sure it gets to different spots in the brain so that the person knows whether it’s peanut butter or garlic he’s smelling. This is called odor identification,” says Dr. Costanzo.
This explains why the device itself is being developed in two phases. The first phase will replace lost odor detection.Using gas sensors, chemical information can be gathered and electronically transmitted to olfactory centers in the brain. The second phase will involve retraining the brain and programming the device to get the information where it needs to be for proper odor identification.
None of this groundbreaking work would be possible without funding from MEDARVA. The Richmond foundation stepped in to provide support, giving the scientists the opportunity to develop the device that emerged from the eureka moment. Dr. Costanzo explains that Richmond FamilyMagazine government cuts in spending on medical research might have delayed the project if MEDARVA hadn’t signed on. According to Dr. Costanzo, in the past, medical research has traditionally relied upon federal monies, such as grants from the National Institutes of Health. With the decline in federal funding, support from local foundations has become even more important.
“Within the current economic climate, we are grateful for this research grant from MEDARVA. As researchers, we’re encouraged to see local foundations, companies, and other sources of non-governmental support stepping in,” says Dr. Costanzo.”This grant has allowed us to continue our research and keep the hope alive.”
Dr. Coelho adds that the collaboration with MEDARVA has put him and Dr. Costanzo in a unique and special position to be able to make a real difference in people’s lives. “Giving patients hope where there was none before is an awesome and humbling experience, and we are grateful for the opportunities this special set of circumstances has provided,” says Dr. Coelho.