DEAR DR. ROACH: I am an 88-year-old widower. My wife died six years ago. I live alone, care for myself, drive, and consider myself healthy. I take five prescription meds and seven over-the-counter meds, three of which were strongly recommended by doctors. I go to a 1-hour seniors’ exercise class twice a week and attend church and home Bible study every week. I have diabetes and had a triple bypass surgery seven years ago.

I am writing because in 2024, I began having auditory and olfactory hallucinations. The auditory hallucinations have mostly been the sound of doors or cabinets closing. The olfactory ones range from perfume, to freshly baked goods, to smoke, peppermint, and an obnoxious chemical smell.

My primary care physician referred me to a neurologist, who ordered an MRI of my brain. It showed no tumors or evidence of stroke. The neurologist advised me to simply ignore the hallucinations if they continued.

My self-diagnosis is possible Lewy body dementia (LBD) since I have some mild Parkinson’s symptoms. Both the neurologist and the primary care physician have assured me that I do not have Parkinson’s or LBD. I don’t think that ignoring my hallucinations is good advice. Your opinion? — R.L.R.

ANSWER: The combination of auditory and olfactory hallucinations is suggestive of a neurological disorder, such as Parkinson’s disease (PD) and the closely related LBD. You are right to be concerned. (I am also very impressed with your research skills and deductive powers.)

I am honestly surprised that the neurologist did not bring up these possibilities since phantosmia (smelling odors that aren’t there) is a well-recognized symptom of PD that can show up before abnormalities in the muscles. Approximately 10% of people with PD will have auditory hallucinations (hearing noises that aren’t there).

Getting an MRI was a good idea since tumors and strokes can sometimes cause these symptoms, and it’s good news that you don’t have one of these. But I remain puzzled as to why they seem adamant that you don’t have PD when you have symptoms of PD along with these hallucinations.

There is a treatment for hallucinations associated with PD, called pimavanserin. A visit to a neurologist with special expertise in PD (a movement disorder neurologist) would be helpful to see if you have PD or LBD and to consider treatment. It may be that your current symptoms are not causing you distress and that the risks of treatment may outweigh the benefit, but this is a decision that takes expertise and judgment. It is a decision that you should be a part of, which is why I recommend a neurologist with special expertise.

DEAR DR. ROACH: My daughter has had asthma since childhood, and after using her inhaler, she swallows the rinse water. She said she should so that she can get all the medication. I have an inhaler to use as needed for sinus congestion in my lungs. My doctor and the video that was included in your recent column both advise to spit it out. Is there harm in swallowing the rinse/medication? — T.W.

ANSWER: For inhalers like albuterol, the medicine you swallow will be absorbed and can cause a fast heart rate, but it provides almost no benefit to your lungs on top of what was inhaled. So, I don’t recommend swallowing it.

For steroid inhalers, the steroids won’t be well-absorbed, so there is no benefit to swallowing them. However, they can predispose people to the development of a fungal infection (thrush) in the mouth or esophagus, so I recommend against swallowing in this case as well.

Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu. (c) 2026 North America Syndicate Inc. All Rights Reserved