Factors Associated With Phantom Odor Perception Among US Adults: Findings From the National Health and Nutrition Examination Survey | Traumatic Brain Injury | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Original Investigation
September 2018

Factors Associated With Phantom Odor Perception Among US Adults: Findings From the National Health and Nutrition Examination Survey

Author Affiliations
  • 1National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Bethesda, Maryland
  • 2Social & Scientific Systems, Inc, Silver Spring, Maryland
  • 3University of Vermont Medical Center, Burlington
JAMA Otolaryngol Head Neck Surg. 2018;144(9):807-814. doi:10.1001/jamaoto.2018.1446
Key Points

Question  How does the prevalence of phantom odor perception vary by age, sex, socioeconomic position, health status, health behaviors, smell function, and oral and sinonasal symptoms among US adults?

Findings  In this cross-sectional study of 7417 adults, the prevalence of phantom odor perception was 6.5% (n = 534) and was greater among women, younger age groups, and those of lower socioeconomic position. Phantom odor perception was more common among those with poorer health, a history of head injury, or dry mouth symptoms.

Meaning  Epidemiologic characterization may provide clues to cause and alert clinicians to the importance of this disorder.


Importance  Phantom odor perception can be a debilitating condition. Factors associated with phantom odor perception have not been reported using population-based epidemiologic data.

Objective  To estimate the prevalence of phantom odor perception among US adults 40 years and older and identify factors associated with this condition.

Design, Setting, and Participants  In this cross-sectional study with complex sampling design, 7417 adults 40 years and older made up a nationally representative sample from data collected in 2011 through 2014 as part of the National Health and Nutrition Examination Survey.

Exposures  Sociodemographic characteristics, cigarette and alcohol use, head injury, persistent dry mouth, smell function, and general health status.

Main Outcomes and Measures  Phantom odor perception ascertained as report of unpleasant, bad, or burning odor when no actual odor exists.

Results  Of the 7417 participants in the study, 52.8% (3862) were women, the mean (SD) age was 58 (12) years, and the prevalence of phantom odor perception occurred in 534 participants, which was 6.5% of the population (95% CI, 5.7%-7.5%). Phantom odor prevalence varied considerably by age and sex. Women 60 years and older reported phantom odors less commonly (7.5% [n = 935] and 5.5% [n = 937] among women aged 60-69 years and 70 years and older, respectively) than younger women (9.6% [n = 1028] and 10.1% [n = 962] among those aged 40-49 years and 50-59 years, respectively). The prevalence among men varied from 2.5% (n = 846) among men 70 years and older to 5.3% (n = 913) among men 60 to 69 years old. Phantom odor perception was 60% (n = 1602) to 65% (n = 2521) more likely among those with an income-to-poverty ratio of less than 3 compared with those in the highest income-to-poverty ratio group (odds ratio [OR], 1.65; 95% CI, 1.06-2.56; and OR, 1.60; 95% CI, 1.01-2.54 for income-to-poverty ratio <1.5 and 1.5-2.9, respectively). Health conditions associated with phantom odor perception included persistent dry mouth (OR, 3.03; 95% CI, 2.17-4.24) and history of head injury (OR, 1.74; 95% CI, 1.20-2.51).

Conclusions and Relevance  An age-related decline in the prevalence of phantom odor perception is observed in women but not in men. Only 11% (n = 64) of people who report phantom odor perception have discussed a taste or smell problem with a clinician. Associations of phantom odor perception with poorer health and persistent dry mouth point to medication use as a potential explanation. Prevention of serious head injuries could have the added benefit of reducing phantom odor perception.