Anosmia Treated with Acupuncture Wevitavidanalage Michael Introduction

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ACUPUNCTURE IN MEDICINE 2003;21(4):153-154.

www.medical-acupuncture.co.uk/aimintro.htm

Anosmia Treated with Acupuncture

Wevitavidanalage Michael

Introduction

Anosmia or hyposmia is a rare condition which is

difficult to treat especially when the cause cannot

be identified. Often patients get used to coping

with the condition since the treatments available

are considered limited and hopeless. The common

causes of anosmia or hyposmia are trauma,

tumours of the frontal lobe or atrophic rhinitis.

Another very important cause is psychological

factors, especially when a cause cannot be found.

Acupuncture is a safe and simple method to offer

to patients with anosmia.

History

A 55 year-old lady was attending the pain clinic

for pain in her right hypochondrium. One day she

mentioned that she had not been able to smell

things for the past two years. She had been

investigated by the Ear Nose and Throat (ENT)

department over the same period. I suggested a

trial of acupuncture for her problem, since there

had been no signs of improvement up to that point

with conventional management. She said that she

was willing to try anything.

Her inability to smell developed suddenly. She

gave no history of trauma, injury or surgery to her

head or nose or any bleeding from the nose. There

was no history of headaches, migraines or any

psychological condition to account for such an

attack, and nor was there any history of spinal or

epidural injections in the past. She was a non

smoker and did not use any inhalers. She was not

allergic to any known substances and gave no

history of hay fever. She was medically fit apart

from having  hypercholesterolaemia, for which she

was taking atorvastatin 40mg daily. She had

recently been diagnosed as having non-alcoholic

steatohepatitis by a gastroenterologist. She gave

no history of previous attacks of anosmia. The

ENT assessment did not reveal a cause for her

anosmia. CT and MRI scans of her head and

sinuses were reported as normal by the radiologist.

Examination of her nervous system did not

reveal any abnormality apart from her olfactory

deficit. Her olfactory function was tested using

items available in the clinic (lime, apple, banana,

strawberry and perfumes). Tests were performed

on each nostril with the patient’s eyes open and

also blindfolded. No irritating substances were

used. She was unable to identify any of the

substances used.

Treatment

The acupuncture points used were Yin Tang, LI20

(Yingxiang) on both sides and GV23 (Shangxing)

and the needles were left for five minutes. She 

was seen a week later. She mentioned that she

could smell almost everything. She was able to

smell her grandchild’s nappies and also the strong

smell that you get when passing a farm. Her

olfactory function was tested again blindfolded

using the same substances as before. She was able

Wevitavidanalage

Michael

associate specialist in

anaesthesia and pain

management

Ormskirk, UK

[e-mail]

Summary

This is a report detailing the successful treatment of a case of anosmia with acupuncture. The patient was

managed conventionally for two years with no sign of improvement. She regained the sense of smell

following one session of acupuncture. Such patients should be investigated for any detectable organic

cause prior to treatment with acupuncture.

Keywords

Acupuncture, anosmia

Case Reports

Case Reports

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ACUPUNCTURE IN MEDICINE 2003;21(4):153-154.

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to identify all the substances presented to her. She

was seen seven months and 20 months later, and

her sense of smell had remained intact.

Discussion

This is the first occasion in which the author used

acupuncture to treat anosmia. No identifiable

cause was detected to account for the patient’s

anosmia. One of the rare potential causes of

anosmia is a frontal lobe tumour; however, CT and

MRI scans were unremarkable. She denied any

surgery or injury to her nose. She did not use

inhalers. Use of inhalers can cause some

impairment of smell. Atorvastatin was the only

medication that she took, and the British National

Formulary does not give anosmia as a side-effect

of atorvastatin.

1

The gastroenterologist was asked

whether non-alcoholic steatohepatitis could be the

cause for her anosmia. He felt that it was very

unlikely to be the cause. The testing of olfactory

function was rather crude; however, the items used

were the best available at the time. 

Yin Tang is a local point and is indicated in the

treatment of frontal headache, eye disorders,

rhinitis, sinusitis and insomnia.

2

LI20 in Chinese

is  Yingxiang which means ‘welcome fragrance’.

LI20 is indicated in nasal obstruction and loss of

sense of smell. Needling LI20, in traditional

terms, helps the ‘lung’ to perform its dispersing

function, so that the nose can smell fragrant scent,

hence the name ‘welcome fragrance’.

3;4

Hecker et

al also mention LI20 for the treatment of anosmia.

GV23 (Shangxing) was used as a local point for

the nose and over frontal sinus. De Smul had used

low frequency electroacupuncture for 10 minutes

at LI4 and LI20.

5

He had treated 19 patients, with

total recovery in eight of them. Jung and Qingping

treated 23 cases of atrophic rhinitis with

acupuncture.

6

One of the symptoms of these

patients was anosmia due to dryness and atrophy

of the nasal mucosa. They used the acupuncture

points Yin Tang and bilateral Shangyingxiang (an

extra point 0.5cun inferior to the inner canthus of

the eye) as their main points. It was effective in 10

patients and markedly effective in seven. In six

patients it was ineffective.

A safety consideration to bear in mind when

needling points close to the nose and eyes is that

the veins in this area communicate directly with the

cavernous sinus, and therefore there is a theoretical,

albeit remote, risk of cavernous sinus infection

and thrombosis. Any advantage in disinfecting the

skin prior to needling remains debatable.

Conclusion

Acupuncture is a simple treatment that may be worth

considering in cases of anosmia or hyposmia. 

Acknowledgements

I would like to thank Dr J Watt for his helpful criticism.

Reference list

1.

British National Formulary 45. London: British Medical

Association and Royal Pharmaceutical Society of Great

Britain; March 2003.

2.

Hecker HU, Steveling A, Peuker E, Kastner J, Liebchen K.

Color Atlas of Acupuncture. Stuttgart: Georg Thieme Verlag;

2001.

3.

Li D. Acupuncture, Meridian Theory and Acupuncture

Points. Berkeley: Pacific View Press; 1992.

4.

So JTY. The Book of Acupuncture Points. Brookline:

Paradigm Publications; 1985.

5.

De Smul A. Anosmia, Hyposmia Treatment with Electro-

acupuncture. Acupunct Electrother Res 1987;12(3-4):260. 

6.

Yang J, Zhang Q. Twenty-three cases of atrophic rhinitis

treated by deep puncture at three points in the nasal region.

J Tradit Chin Med 1999;19(2):115-7.