A Question of Health: Sniffing around for the cause of a bad smell

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MY ELDERLY mother frequently complains that she can smell an unpleasant odour that no one else is aware of. What can cause this?

This is a surprisingly common complaint that can be very distressing. It can be caused by a variety of physical or mental problems. Diseases that affect the nose, such as sinus infections and nasal polyps, can cause smell disturbances and these should be checked for first. A thorough ear, nose and throat examination should be able to pick up most of these problems, but sometimes X-rays of the sinuses or even magnetic resonance imaging (MRI) scans are necessary. The next place to look is at the teeth and gums. Dental disease, particularly infections and denture problems, can produce unpleasant smells. Very rarely, head injuries or even brain tumours can cause smell disturbance by damaging the olfactory nerves which transmit smells from the nose to the brain.

If no physical cause is found, an underlying depression may be contributing to your mother's problem, and it could improve if she is treated for depression.

MY THREE-MONTH-OLD daughter is developing a strawberry mark under her chin. We have been advised to leave it alone, but it is very embarrassing and unsightly and seems to be getting bigger. Can it be removed?

Strawberry marks, which are also known as cavernous haemangiomas, are collections of blood vessels that can occur anywhere on the body, but are common around the head and neck of babies. They usually appear soon after birth and then increase in size, often quite rapidly. For the next two or three years they tend to remain fairly stable, and they then gradually begin to shrink and disappear. By the age of five they are nearly always gone, although they can leave a slightly dimpled appearance on the skin. It is not sensible to have it removed for two reasons: first, it will disappear by itself; and second, an operation will inevitably leave a scar. Patient waiting will produce the best cosmetic result.

MY PREMENSTRUAL tension is so bad that it is beginning to affect me at work. I get aggressive and intolerant and this can last for two weeks. I have tried evening primrose oil, vitamins and hormones, none of which help much. Are there any diets that might help me?

A low-fat, high-carbohydrate diet can help the symptoms of premenstrual syndrome. You should avoid caffeine and avoid or severely restrict alcohol. The carbohydrates that you eat should be unrefined, complex carbohydrates, which means that you should avoid sugar (both white and brown) and foods that contain sugars. Some women benefit by eating these carbohydrates at regular three-hourly intervals. It may take several months before you notice the effects, so it is worth persisting. You can get more information from NAPS (National Association for Premenstrual Syndrome), 7 Swift's Court, High Street, Seal, Kent TN15 0EG. Their helpline telephone is 01732 760012. They provide individual telephone counsellors, including male counsellors for partners of PMT sufferers.

Write to: A Question of Health, `The Independent', 1 Canada Square, Canary Wharf, London E14 5DL; fax 0171-293 2182; or e-mail to health@independent.co.uk. Dr Kavalier cannot respond personally to questions