What is the treatment for olfactory hallucinations of a burnt smell?

From the Guidelines

Burnt smell hallucinations, known as phantosmia, should be treated by addressing the underlying cause, with a focus on thorough nasal and neurological examination, as recommended by the most recent study 1. When treating burnt smell hallucinations, it is essential to consider the various potential causes, including conduction loss from sinonasal passage obstruction, sensorineural loss from olfactory neuroepithelial damage, and dysfunction from central nervous system disorders 1. Some key points to consider in treatment include:

• Consulting a healthcare provider for proper diagnosis, as these hallucinations may result from conditions like sinus infections, seizures, migraines, or neurological disorders
• Medical treatments may include anticonvulsants like gabapentin (300-900 mg daily) or pregabalin (150-300 mg daily), antidepressants such as venlafaxine (75-225 mg daily), or nasal saline rinses for sinus-related causes
• For temporary relief, some patients benefit from forcefully exhaling through the nose while pinching it closed, or rinsing the nasal passages with saline solution twice daily
• If phantosmia is related to migraines, migraine medications like sumatriptan (50-100 mg as needed) may help
• Persistent symptoms warrant further investigation with imaging studies like MRI to rule out serious conditions, as most patients with olfactory symptoms do not require imaging, unless history or physical examination warrants it 1
• Lifestyle modifications including avoiding strong odors, quitting smoking, and maintaining good nasal hygiene can complement medical treatment It is crucial to prioritize the most recent and highest quality study, which in this case is the 2022 update on acr appropriateness criteria® cranial neuropathy 1, to ensure the best possible outcome in terms of morbidity, mortality, and quality of life.

From the Research

Burnt Smell Hallucinations Treatment

• There are no direct research papers on burnt smell hallucinations treatment in the provided studies.
• However, the studies discuss the treatment of hallucinations in general, which may be relevant to burnt smell hallucinations.
• According to 2, the successful management of hallucinations depends on accurate differential diagnosis to identify subtypes, which would then determine the most appropriate treatment.
• The studies also discuss the use of antipsychotic medications such as olanzapine and risperidone in the treatment of hallucinations in schizophrenia and other psychiatric disorders 3, 4.
• It is noted that olanzapine has benefits against symptoms of aggression and agitation, and is effective in the treatment of depressive symptomatology 3.
• The choice of treatment for hallucinations should be based on the individual patient's symptoms and diagnosis, and may involve a combination of medication and other therapies 2, 5.

Treatment Options

• Antipsychotic medications such as olanzapine and risperidone may be effective in treating hallucinations 3, 4.
• The dosing regimen of these medications may also be important, with once-daily dosing potentially being more effective and having a better side effect profile than twice-daily dosing 4.
• Accurate differential diagnosis is crucial in determining the most appropriate treatment for hallucinations 2.
• A combination of medication and other therapies may be necessary to effectively manage hallucinations 2, 5.