Sensitivity to strong odors has a broad differential diagnosis. A presentation is made of a 60-year-old man with lifelong mild allergic rhinitis and a superimposed 4-year history of sensitivity to smells. He had no response to medical treatments or allergic immunotherapy. His physical examination was unremarkable. After obtaining a detailed history, a definitive imaging study was performed and the patient underwent corrective treatment for his potentially life-threatening disorder. A detailed differential and strong clinical history is sometimes required to uncover the etiology of non-allergic rhinitis. Overwhelming sensations of strong odors may be a sign of a more serious condition and require investigation. This presentation discusses the differential diagnosis and suggested evaluation for patients with abnormalities in olfaction.