This survey is being conducted by Fifth Sense to help the doctors who run Smell & Taste Clinics across Europe to see whether people who suffer with distortions of smell such as parosmia and phantosmia have any specific triggers that bring their symptoms on and anything they have found that helps to alleviate their problem. By gathering this information across several European countries the sum of information will be more powerful in helping doctors recommend treatments.

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* 1. How old are you?

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* 2. Are you male or female?

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* 3. Do you suffer with ...

  Yes No
Parosmia (distortions of smell when presented with normal daily smells)?
Phantosmia (sensation of a smell in the absence of something smelly)?

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* 4. Is the parosmia...

  Yes No I don't have parosmia?
a daily occurrence?
intense?
having an impact on your enjoyment of every day
is causing you to (or has done) lose weight?

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* 5. Is the phantosmia...

  Yes No I don't have phantosmia
a daily occurrence?
intense?
having an impact on your enjoyment of every day
is causing you to (or has done) lose weight?

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* 6. How long have you suffered with parosmia/phantosmia?

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* 7. Did this happen suddenly or gradually?

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* 8. Have you been told the cause for the problem or do you believe it happened because of one of the following?

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* 9. Have you had any treatment so far?

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* 10. On a daily basis is the

  Constant? Increasing? Changing day to day?
parosmia...
phantosmia...

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* 11. Have you tried any of the following manoeuvres?

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* 12. Do any of the following trigger your phantomsia/parosmia?

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