DR ELLIE CANNON: What’s to blame for this loss of smell when it’s not Covid?

My husband lost his sense of smell about two years ago and, as far as we know, has not had Covid. He has tried to train his sense of smell without success. Can he give us any advice on a possible treatment or even the cause?

Anosmia, or loss of the sense of smell, caught everyone’s attention as a symptom of Covid. It was particularly prevalent at the beginning of the pandemic; some experts suggest it was less likely with later variants of the virus.

But it can be caused by almost any virus or upper respiratory infection, such as the common cold, which damages the nerves that send olfactory signals to the brain. It can also be due to nerve degeneration or brain injury after a head injury or stroke, for example.

Short-term anosmia can be caused if the nose is blocked by a cold, but a long-term cause can be nasal polyps (fleshy growths inside the nasal cavity) or chronic nasal congestion related to allergies or smoking.

A persistent loss of smell would be worth seeing a GP and possibly referring you to an ENT to check for polyps. If found, they can be treated surgically or with sprays.

The condition is serious, as it can put you at risk of not being able to smell dangerous things, such as gas or fire, and as it also takes away the pleasure of eating and drinking, enduring it can be quite miserable.

Smell training kits are worth persisting with: they involve actively smelling the same aromas for about 20 seconds every day.

There are two charities that offer excellent advice to people with smell loss: AbScent (abscent.org) and Fifth Sense (fifthsense.org.uk).

Our 16-year-old grandson is very unwell: he suffers from nausea, fatigue, rushing to the bathroom, extreme anxiety and severe cramps under his ribs. He also seems jaundiced.

He has been diagnosed with Gilbert’s syndrome. We were told there is no treatment and he just has to live with it. Before this, he was a fit young man. Do you know where we can go? This year he has hardly attended school. You are our last hope.

Gilbert syndrome is considered harmless and is not even usually called a disease. Most people don’t even know when they have it and it is usually detected by accident when someone has a liver function test.

It does not cause anxiety, cramps, nausea, tiredness or stomach pains. If this happens in a teenager, it is necessary to look for other causes.

Gilbert syndrome is thought to affect approximately four percent of the population and often runs in families. It causes high levels of something called bilirubin, a waste product of red blood cells, and this can cause a jaundiced appearance. This can occur in people who are stressed, sick, or dehydrated.

The British Liver Trust (britishlivertrust.org.uk) offers good advice about the syndrome.

In a teenager with such significant problems, I would suggest investigations into inflammatory bowel diseases such as Crohn’s disease or colitis, celiac disease, or irritable bowel syndrome (IBS). More tests may be needed, including repeated blood tests, screening for infections, and very specific stool testing for inflammation.

It may also be worth giving them the opportunity to speak alone with their doctor, in case they have concerns that they cannot discuss with the family.

This is also an age when people begin to suffer from mental health problems that may initially manifest as physical symptoms.

My husband has been diagnosed with BPPV. He has been feeling dizzy and nauseous for weeks and is becoming increasingly unstable. No one has been able to suggest a treatment other than something called the Epley maneuver, which his osteopath did without any difference. Is there any medication that can be taken for this problem?

Benign paroxysmal positional vertigo, or BPPV, is a problem inside the ear and dizziness tends to occur when the patient is in certain positions, turning their head or rolling over in bed.

The tiny components that make up the inner ear control our sense of balance, so problems inside will cause these symptoms.

BPPV is surprisingly common, especially in people over 50, and can be quite distressing. In older people, it causes falls and makes normal life very difficult.

It may be comforting to know that recovery usually occurs spontaneously after several weeks without treatment. Simply being aware of trigger movements can help.

The Epley maneuver, which involves slowly moving the head to different positions, is designed to displace fluid and debris in the inner ear. This could be offered along with Brandt-Daroff exercises, which are similar and can be done at home.

If the Epley maneuver has not worked, it can be tried again.

Most commonly, vertigo is caused by problems within the ear and rarely the brain.

If things don’t get better or keep getting worse (BPPV can come and go), it’s worth talking to a doctor about an alternative diagnosis.

Can anyone seriously argue against a smoking ban?

When I was a child, you could smoke in restaurants, on public transportation, and even on airplanes.

When I told this to my own teenagers, they couldn’t believe it, even though it wasn’t that long ago. In fact, the concept seems totally foreign to them and that makes me very happy.

The progress in tobacco prevention in our society has been great, but I believe we can do more. I welcome the Government’s plan to continue raising the legal age to buy cigarettes by one year each year, meaning that younger teenagers will never be old enough to buy cigarettes.

Raising the smoking age from 16 to 18 in 2007 helped reduce the number of teens taking up the habit by about 30 percent, so we know these measures work.

I just can’t understand why anyone would argue against this, although I’ve seen some trying on social media. There is no value in a child buying cigarettes, other than money for the tobacco companies.

There is no free time for the ‘man-opause’

Does male menopause exist? I’m doubtful. And I’m even more doubtful about whether middle-aged men need time off work to deal with things like hot flashes and emotional changes that some say are similar to those experienced by many menopausal women.

Apparently this is happening in some NHS Trusts, which I find hard to believe. I’ve certainly never encountered that.

The battle for women to recognize menopause has been hard won and is absolutely justified given that menopause is physiologically proven due to the significant drop in the natural production of female hormones.

The same cannot be said for the so-called manopause. I often test men for testosterone, especially when they suffer from erectile dysfunction, and very, very few have abnormal levels.

Male menopause symptoms are much more likely to come from obvious things: lack of exercise, weight gain, depression, and failed relationships, for example.

Let’s not make this a thing when it isn’t.