Sniffin' Sticks嗅觉心理物理测试方法的临床应用

目的 建立Sniffin' Sticks检查的中国人正常参考值,探讨其在我国临床应用的可行性.方法 2007年至2013年于首都医科大学附属北京同仁医院体检科,任意选取健康志愿者105例作为健康对照组,任意选取同期该院耳鼻咽喉头颈外科门诊嗅觉障碍患者165例作为试验组,其中嗅觉功能减退组92例,嗅觉功能丧失组73例.对270例受试者又分别分为青年组(＜ 35岁)、中年组(～55岁)和老年组(＞55岁)3个亚组,分别采用Sniffin' Sticks和T&T方法进行嗅觉功能检查.以SPSS12.0统计软件对数据结果进行分析.结果 Sniffin' Sticks正常参考值是:青年组TDI值(气味阈值T、气味辨别阈值D和气味识别阈值I,三项得分之和)＞30.12,中年组TDI值＞27.37,老年组TDI值＞20.43;健康对照组TDI平均((x-)±s)值为32.12±3.95,嗅觉功能减退组TDI平均值17.52±10.37,嗅觉功能丧失组TDI平均值3.56±3.49.嗅觉功能减退和嗅觉功能丧失组和健康对照组按照青年、中年和老年各亚组分别比较,TDI值、阈值、辨别阈和识别阈差异均有统计学意义(青年组:FTDI=125.136,FT=49.454,FD=89.037,FI=39.888,P值均为0.000;中年组:FTDI=190.240,FT=128.374,FD=174.122,FI=178.945,P值均为0.000;老年组:FTDI=72.992,FT=26.599,FD=77.119,FI=88.107,P值均为0.000).T&T嗅觉识别阈结果显示,健康对照组平均值为-1.00±0.98,嗅觉功能减退组为2.27 ±2.01,嗅觉功能丧失组为5.89±0.14.嗅觉功能减退和丧失组与健康对照组按照青年、中年和老年各亚组分组比较差异均有统计学意义(F青年=158.144,F中年=247.695,F老年=70.579,P值均为0.000).Sniffin' Sticks检查结果中的TDI值与T＆T嗅觉识别阈值呈负相关(r=-0.927,P＜0.01).T&T识别阈值与Sniffin' Sticks阈值呈负相关(rT=-0.846,P＜0.01);与辨别阈呈负相关(rD=-0.908,P＜0.01);与识别阈呈负相关(rI=-0.864,P＜0.01).结论 Sniffin' Sticks嗅觉检测方法均能很好地区分嗅觉功能正常、减退和丧失,其测试结果与T&T测试存在一致性,Sniffin' Sticks方法能多方面评价受试者的嗅觉功能状态,可以在中国人群中使用.     

慢性鼻窦炎伴鼻息肉患者嗅觉障碍的影响因素分析

目的分析慢性鼻窦炎伴鼻息肉(chronic rhinosinusitis with nasal polyps,CRSwNP)患者嗅觉障碍的影响因素。方法回顾性分析2014—2018年就诊于北京安贞医院行内镜鼻窦手术治疗的CRSwNP患者88例,男性22例,女性66例,年龄(48.1±11.3)岁(±s,下同)。所有入选患者均于术前行Sniffin′Sticks嗅觉测试、Lund-Mackay评分及改良鼻窦CT嗅区评分、鼻阻力及声反射检查、血常规及血生化等实验室检测、血清特异性IgE检测;术中取鼻息肉组织进行嗜酸粒细胞计数。根据Sniffin′Sticks嗅觉测试结果将患者分成嗅觉功能正常组和嗅觉功能障碍组,两组之间进行临床基线资料比较,根据单因素分析结果,结合临床有意义的指标进一步行多因素Logistic回归模型分析,并初步建立CRSwNP嗅觉障碍的预测模型。设P<0.05为差异有统计学意义。结果88例CRSwNP患者中,嗅觉正常32例(36.4%),嗅觉障碍56例(63.6%),其中嗅觉下降40例(45.5%)、失嗅16例(18.2%)。单因素分析发现,两组间组织嗜酸粒细胞数、血嗜酸粒细胞百分比、血尿素的差异存在统计学意义[12.7[2.0,52.3]个/高倍视野(M[P25,P75],下同)比38.6[16.2,87.0]个/高倍视野、2.75[1.60,4.80]%比4.35[2.50,6.60]%、(5.56±1.15)mmol/L比(4.98±1.33)mmol/L,P值均<0.05];改良鼻窦CT嗅区评分、除窦口鼻道复合体评分外的Lund-Mackay评分的差异均存在统计学意义(P值均<0.05)。多因素Logistic回归模型分析发现,改良鼻窦CT双侧嗅区总分和血尿素的差异具有统计学意义,其中双侧嗅区总分是嗅觉功能的危险因素(OR=2.108,95%CI:1.407~3.159,P<0.001);一定浓度的血尿素是嗅觉功能的保护因素(OR=0.461,95%CI:0.240~0.884,P=0.020)。进一步研究发现,由组织嗜酸粒细胞计数、血嗜酸粒细胞百分比、改良鼻窦CT双侧嗅区总分、总吸气、血尿素组成的预测模型受试者工作特征(ROC)曲线下面积(AUC)的值为0.888(P<0.01),对CRSwNP嗅觉障碍预测效果较好。结论改良鼻窦CT嗅区评分与CRSwNP患者的嗅觉障碍密切相关,一定程度的血尿素升高可能对CRSwNP患者的嗅觉功能有保护作用。     

上呼吸道感染后嗅觉障碍患者脑形态学与嗅觉功能相关性分析

目的 通过探究上呼吸道感染后嗅觉障碍脑灰质形态变化,得出上呼吸道感染后嗅觉障碍患者嗅觉中枢结构的影像学特点。方法 选取上呼吸道感染后嗅觉障碍的患者24例与嗅觉功能正常的健康对照受试者20例,通过基于体素的大脑皮质形态学体积测量(VBM)比较患者的大脑灰质和白质体积与对照组的差异。结果 上呼吸道感染后嗅觉障碍组患者TDI[气味察觉阈(T)、气味辨别能力(D)、气味识别能力(I)]总分(16.45±5.62)分,T为(2.33±0.93)分,D为(6.54±2.60)分,I为(7.58±3.22)分;嗅觉障碍平均时长为(19.00±6.33)个月;视觉模拟量表评分(VAS)为(7.79±2.41)分,与对照组比较均存在统计学差异(P<0.05)。上呼吸道感染后嗅觉障碍患者的大脑灰质总体积和嗅皮质体积明显小于对照组(P<0.05),大脑灰质总体积占全脑体积的比例和皮质厚度与嗅觉功能评分TDI值呈正相关(r=0.71,P<0.000 1;r=0.69,P=0.000 9)。结论 上呼吸道感染后嗅觉障碍患者大脑灰质总体积和嗅皮质体积减少,且嗅觉功能与大脑灰质体积比例及皮质厚度呈...     

变应性鼻炎嗅觉障碍多因素研究

目的变应性鼻炎（allergic rhinitis, AR)的患者常伴有一定程度的嗅觉障碍,但目前潜在的机制尚不明了。本研究的目的就是分析变应性鼻炎造成嗅觉障碍的可能机制。方法采用 Sniffin’Sticks 嗅觉测试方法测定患者的嗅觉功能。鼻腔分泌物检测包括嗜酸粒细胞阳离子蛋白(eosinophil：ationicprotein,ECP)及类胰蛋白酶检测。鼻腔阻塞情况通过鼻气道阻力测定进行评估。结果变应性鼻炎组的患者出现了嗅觉障碍而对照组没有,但两组在鼻气道阻力测定上没有显著差异。变应性鼻炎组患者鼻腔分泌物的ECP和类胰蛋白酶较对照组明显增多。结论嗜酸粒细胞和肥大细胞的活性增加可能导致了变应性鼻炎患者的嗅觉障碍。因此,鼻腔阻塞可能不是引起变应性鼻炎患者嗅觉障碍的主要原因,而炎症所致的上皮反应可能较大。     

嗅觉味觉功能的临床检测

目的:探讨嗅觉障碍患者嗅觉和味觉功能的改变。方法:284例受试者中,健康人92例,嗅觉功能减退92例,嗅觉功能丧失100例,分别采用T&T、嗅觉事件相关电位(OERPs)及三滴法进行嗅觉和味觉功能检测。结果:T&T结果,嗅觉功能减退和丧失患者跟健康人比较差异有统计学意义(P<0.05)。OERPs结果显示,嗅觉功能障碍患者跟健康人比较N1、P2波潜伏期延长且振幅降低,差异有统计学意义(P<0.05)。三滴法结果显示,嗅觉功能障碍患者跟健康人比较味觉功能有明显减退,差异有统计学意义(P<0.05)。各组之间男女比较差异无统计学意义。结论:嗅觉功能障碍患者同时伴有味觉功能的减退,嗅觉和味觉功能的减退与性别关联不大。嗅觉味觉的联合检查可以全面系统反映受试者的化学感觉功能,为临床诊断和治疗提供科学依据。     

健康人麻黄素局部使用与鼻化学感觉功能

为研究麻黄素局部使用在健康人嗅觉功能方面的剂量及相关效应 ,将 2 4位健康志愿者随机分为 3组 (每组 8人 ,男女各 4人 )作双盲对照试验。A组予安慰剂 ,B、C组予麻黄素 ,剂量分别为 0 .12 mg、0 .2 4 mg。所有药物均为双侧鼻内使用。比较 3组用药前后鼻阻力、嗅觉功能和三叉神经感觉功能。鼻开放度用鼻阻力测定的方法评估 ,药物作用则利用嗅觉及三叉神经的精神物理测定 (强度级别、气味辨别、丁醇和甲酸阈值测定 )评估。结果显示 :1局部使用麻黄素产生鼻气流量增加的倾向 ,观察期内两不同剂量组无明显差别 ;2通过气味的识别和辨别、丁醇…     

正常年轻人嗅觉事件相关电位的特点

目的:研究正常年轻人嗅觉事件相关电位(OERP)的特点.方法:嗅觉正常的健康年轻志愿者55例,使用OEP-98C型嗅觉诱发电位仪,以醋酸异戊酯(刺激浓度＜1 648×10-6)为气味刺激剂行OERP测试.在刺激间隔优化测试时,分别采用间隔5次(15 s)、10次(30 s)、20次(60 s)呼吸的刺激间隔.结果:OERP波形分类:①N1P2型;②P1N1P2型;③P1N1P2P3型;④P1N1P2N2P3型.引出率:正常年轻人OERP的引出率为100%.其中P1引出率为60.4%,P2引出率为100.O%,P3引出率为32.1%.男女引出率差异无统汁学意义(P＞0.05).潜伏期:P1、N1、P2、N2、P3潜伏期分别为(233±32)ms、(365±52)ms、(511±90)ms、(625±56)ms、(717±88)ms;男女各波潜伏期差异无统计学意义(P＞0.05).幅值:P1、N1、P2、N2、P3幅值分别为(7.22±5.93)μV、(-6.00±2.56)μV、(16.65±8.19)μV、(6.35±3.55)μV、(13.23±6.93)μV;以上各波男女间幅值差异无统计学意义(P＞0.05).N1P2幅值为(22.58±8.25)μV,男性为(19.53±6.89)μV,女性为(25.24±8.44)μV,女性N1P2幅值大于男性(P＜0.05).随刺激间隔增加,P2和N1P2幅值增加;潜伏期无显著改变.结论:正常年轻人OERP P2的引出率为100%,P1引出率较P3高,性别、刺激间隔足影响N1P2幅值的因素.     

喉切除者的嗅觉——是否发生废用性机能消失?

喉切除后患者的嗅觉功能是否失常?作者以直接吹入法对676例男性、76例女性患者作喉切除术后嗅觉功能测定,结果:完全嗅不到气味者203例(20％);仅进食时能嗅到气味者为50％;在工作时能嗅到气味者为21％,其余仅在进厕所时才能嗅到气味。     

原发性帕金森病患者嗅觉功能临床分析

目的 分析原发性帕金森病患者嗅球体积、嗅沟深度与嗅觉功能的相关性.方法 选取2011年1月至2013年12月天津市环湖医院原发性帕金森病患者(测试组)及无运动障碍的健康受试者(对照组)各100例,应用T&T嗅觉测试法检查所有受试者的嗅觉功能,并行嗅球体积、嗅沟深度的MRI检查及测量.对测试组进行H-Y分期、统一帕金森病评分量表(UPDRS)、左右肢体功能评分、简易精神状态检查表(MMSE)及蒙特利尔认知评估表(MoCA)检查.以SPSS 13.0软件进行统计学分析.结果 测试组T&T嗅觉识别阈分数为(3.0±0.3)分,明显高于对照组的(1.3±0.2)分,差异有统计学意义(t=2.537,P＜0.01),测试组、对照组男女嗅觉识别阈差异无统计学意义(t值分别为0.893、1.184,P值均＞0.05).测试组左右两侧嗅球体积[分别为(34.25 ±5.14)、(35.79±5.28)mm3]及平均嗅球体积[(35.28±5.21) mm3]均明显小于对照组[分别为(47.38±6.47)、(47.75 ±6.51)、(47.53±6.49)mm3],差异有统计学意义(t值分别为2.876、2.747、2.798,P值均＜0.01).测试组与对照组左右两侧嗅沟深度及平均嗅沟深度差异无统计学意义(t值分别为0.914、0.987、0.951,P值均＞0.05).测试组及对照组嗅觉识别阈与平均嗅球体积呈负相关趋势(r值分别为-0.537、-0.526,P值均＜0.05),与平均嗅沟深度无关(r值分别为-0.142,-0.157,P值均＞0.05).测试组平均嗅球体积与UPDRSⅢ、UPDRS总评分及H-Y分期具有相关趋势(r值分别为0.312、-0.419、-0.358,P值均＜0.05),与病程无相关性(r=-0.089,P＞0.05).结论 原发性帕金森病患者嗅球体积减小,嗅沟深度不变;其嗅觉功能与嗅球体积具有相关性,与嗅沟深度无关;其嗅觉减退的程度与疾病的严重程度具有一致性,与疾病的病程无关.     

鼻咽癌放疗后继发慢性鼻窦炎的临床特征

目的 分析鼻咽癌放疗后继发慢性鼻窦炎的临床特征。方法 对2011年1月至2013年5月来我科门诊及住院治疗的放疗致慢性鼻窦炎患者(放疗组)及单纯慢性鼻窦炎患者(对照组)各40例行视觉模拟评分法(VAS)评价鼻部主观症状、鼻内镜检查、鼻窦CT检查, 并给予相应评分。放疗组中15例及对照组中36例接受鼻内镜鼻窦手术, 术中行上颌窦穿刺, 抽取脓性分泌物行细菌培养。结果 VAS评分:放疗组为鼻塞4.0±0.8, 流脓涕6.5±1.2, 头痛4.3±0.6, 嗅觉减退5.1±1.4, 咳嗽2.7±1.2, 打喷嚏3.7±0.8, 面部疼痛和压迫感4.3±1.2, 耳痛5.3±1.1;对照组为鼻塞4.3±0.7, 流脓涕5.3±1.0, 头痛3.3±0.8, 嗅觉减退4.0±0.9, 咳嗽3.3±1.0, 打喷嚏3.7±0.9, 面部疼痛和压迫感2.2±0.5;其中流脓涕、耳痛症状放疗组较对照组明显;鼻窦CT Lund-Mackay评分: 放疗组为8.2±1.1, 对照组为 6.5±1.3;鼻内镜Lund-Kenndy评分:放疗组为6.2±1.1, 对照组为4.7±0.7;上颌窦分泌物细菌培养结果:放疗组以金黄色葡萄球菌(6/15)、流感嗜血杆菌(3/15)为主, 还有部分未查到细菌生长(4/15);对照组以金黄色葡萄球菌(24/36)、流感嗜血杆菌(6/36)、草绿色链球菌(5/36)为主。结论 放疗致鼻窦炎较单纯慢性鼻窦炎有其自身特点, 其发生机制可能与放射损伤鼻窦纤毛功能, 窦口肿胀、阻塞, 继发细菌感染有关。     

The effect of smoking on the olfactory function

Although smoking is a widely spread habit, its effect on olfaction has not been clearly established. The aim of this study was to investigate the effect of cigarette smoking on the olfactory function, using the "Sniffin' Sticks" test. Sixty-five smokers were studied, with a median period of smoking of 10 years (range: 1-45 years) and a median number of 15 cigarettes smoked per day (range: 5-20). Forty-nine non-smokers were used as controls. Olfactory function was evaluated using the "Sniffin' Sticks" test, which consists of odour threshold (OT), odour discrimination (OD) and odour identification (OI) and its overall results may be presented as a composite threshold-discrimination-identification (TDI) score. Multivariate linear and logistic regression analyses were performed. All OT, OD, OI and TDI scores were statistically significantly lower in smokers compared to non-smokers, even when controlled for gender and age. Low OT, OD, OI and TDI scores were more prevalent among smokers than non-smokers. Multivariate logistic regression analysis, adjusted for gender and age, revealed that smoking remained a strong independent risk factor for low OT, OD, OI and TDI scores. Among smokers, statistically significant negative relationships were found between pack-years and OT, OD, OI and TDI, controlling for age. In conclusion, smoking was found to be adversely associated with the olfactory ability in a dose-related manner. Smokers were found to be nearly six times as likely to evidence an olfactory deficit as non smokers, depending on the duration and the amount of cigarettes smoked.     

Comparison of two different odorants in an olfactory detection threshold test of the Sniffin&rsquo; Sticks

The olfactory test battery Sniffin’ Sticks is a test of nasal chemosensory function that is based on pen-like devices for odour presentation. It consists of three olfactory subtests: threshold, discrimination, and identification. The detection threshold can be measured using two different odorants--n-butanol or PEA (phenylethyl alcohol). Both tasks are commonly applied in published studies, but little is known about the formal comparison of values obtained using them. Unlike the Sniffin’ Sticks with n-butanol as odorant, there is poor validation for the threshold subtest with the odorant PEA. The purpose of this study was to compare these two different odorants. Both odorants were applied to 100 normosmic, healthy subjects (50 females). The experiment was divided into two sessions performed on two different days. After each threshold test the discrimination and identification subtests were conducted. We obtained significant differences in detection thresholds of PEA and n-butanol. The mean score of PEA threshold and PEA TDI (sum of threshold, discrimination, identification) was significantly higher compared to n-butanol. No significant correlation between individual PEA and n-butanol thresholds was observed. The differences between both odorants indicate that a formal validation of the Sniffin’ Sticks with PEA as odorant for probing olfactory thresholds may be required.     

Treatment of posttraumatic olfactory dysfunction with corticosteroids and olfactory training

Abstract

Background: Few have investigated long-term effect of treatment of posttraumatic olfactory dysfunction (OD).

Aims/objectives: To explore if sequential treatment with corticosteroids and olfactory training (OT) improved smell in patients with OD after moderate and severe traumatic brain injury (TBI).

Material and methods: Twenty-two patients with persistent OD, mean 62 months after trauma, completed an open uncontrolled intervention study of treatment for 10 d with oral corticosteroids and thereafter for 3 months with OT twice daily. Olfaction was assessed by Sniffin’ Sticks. They were tested at four-time points, with the last assessment 12 months after baseline measurements.

Results: Mean age at trauma was 45 (SD 14) years. Mean threshold, discrimination and identification (TDI) score at baseline was 14.4 (SD 7.3) and increased to mean 20.8 (SD 7.4) after 1 year (minimum ?3.0; maximum 19.5, p value <.001). Analysed separately, each TDI component increased significantly after 1 year. Half of the patients (11/22) experienced a clinically significant improvement of ≥6.0 TDI points. Improvement was not associated with any sociodemographic or trauma-related characteristics or with olfactory function at baseline.

Conclusions and significance: Treatment with corticosteroids and OT was promising in persistent OD after TBI and should be further studied.     

Grade 4 tonsillar hypertrophy associated with decreased retronasal olfactory function: a pilot study

Tonsillar hypertrophy is common in children, but it can also be present in adults. Enlarged tonsils, a significant anatomical barrier, may affect the flow of odor molecules from the oral cavity to the nasal passages, which has not yet been studied. Thus, we aimed to investigate the mass effect of palatine tonsillar hypertrophy on retronasal olfaction. This study was carried out in 146 subjects, with a mean age of 22.1 ± 2.2 years, ranging 20–29 years. An oropharyngeal examination of the participants was completed, and tonsillar hypertrophy was graded according to the subjective tonsil size scale. The participants were divided into four groups according to their tonsil size grading; then, each subject’s orthonasal olfactory and retronasal olfactory functions were assessed using “Sniffin’ Sticks” and retronasal olfactory testing. There were no differences observed between the groups in terms of age, gender, cigarette smoking, or alcohol consumption. In addition, there was no difference between the groups in terms of “Sniffin’ Sticks” subtests and TDI scores. It was determined that the retronasal olfactory scores of the participants with grade 4 tonsil size were significantly lower than the retronasal olfactory scores of the participants with grade 1 tonsil size. The current investigation demonstrates that grade 4 tonsillar hypertrophy has significant negative effects on the retronasal route of olfactory sensing, when compared with grade 1 tonsillar hypertrophy.     

Validation study of the "Sniffin' Sticks" olfactory test in a British population: a preliminary communication

Clin. Otolaryngol. 2012, 37 , 23–27 Objective: The ‘Sniffin’ Sticks’ olfactory test contains pen‐like odour dispensing devices which are used to assess olfactory threshold, discrimination and identification. Odour identification is strongly dependent on familiarity with the odours and has an important cultural component which has limited the usefulness of other validated tests. The ‘Sniffin’ Sticks’ test was developed in Germany and is validated in other countries but not in the UK. This study aims to validate the applicability of ‘Sniffin’ Sticks’ in a local population. Design: Prospective controlled study. Setting: Rhinology or olfactory disorder clinic. Participants: About 82 subjects, 33 healthy volunteers with a reported normal sense of smell, and 49 patients with an impaired sense of smell presenting either at a rhinology or an olfactory disorder clinic. Each subject’s olfactory function was assessed using the ‘Sniffin’ Sticks’ test with a maximum score of 48. Main outcome measures: Threshold, discrimination and identification scores along with the combined olfactory score. Results: The mean age of the subjects tested was 46.7 years; 46 female and 36 male. In the patient group 36 were hyposmic and 13 anosmic. In the healthy volunteers group all subjects were normosmic. In the control group the mean combined olfactory score was 34.5 (±2.5). The mean combined score in the patients group was 20.8 (±7.4). Odour threshold scores were 3.7(±2.8) for patients (hyposmics and anomics) and 8.3(±1.8) for controls. In the identification test the controls mean score was 13.6 (±1.2) for while the patients’ mean score was 8.6 (±3.5). Conclusions: In our sample of the local population the combined olfactory and odour identification scores for healthy volunteers and patients with olfactory disorders are comparable with the normative data published on large samples of European populations. However, modification of a few of the distracters is recommended for British patients based on our findings.     

An evaluation of olfactory function in adults with gastro-esophageal reflux disease

Conclusion: To the best of the authors’ knowledge, this study is the first to evaluate the olfactory function of adult patients diagnosed with GERD. The results revealed that adults with GERD have diminished olfactory function. Objective: This study aimed to evaluate the olfactory abilities of subjects using the ‘Sniffin’ Sticks’ olfactory test. Methods: A total of 35 men and women aged 18–60 years with a diagnosis of GERD and 45 healthy controls were included in the study. The Sniffin’ Sticks olfactory test results of the two groups were compared, and the relationship between the study findings and the olfactory parameters was evaluated. Results: The odor threshold (10.1; 9.5, p?=?0.016), odor identification (9.6; 8.1, p?p?相似文献   

Olfactory training for patients with olfactory loss after upper respiratory tract infections

Olfactory training consisting of daily suprathreshold odor exposure over 12 weeks seems to improve olfactory function. It is unknown if a longer period of training might be more effective. A prospective non-randomized clinical study was performed including 39 patients with olfactory loss after an upper respiratory tract infection (URTI) of less than 24 months duration. Patients exposed themselves with suprathreshold concentrations of four odors (rose, eucalyptus, lemon, cloves) applied in ‘‘Sniffin’ Sticks’’ felt-tip pens over 32 weeks. Olfactory function was performed before (T1), after 16 weeks (T2), and 32 weeks of training (T3) using the ‘the Sniffin’ Sticks test kit calculating the TDI score (Threshold, Discrimination, Identification). The mean TDI score showed a non-significant trend of improvement at T2, and was significantly increased at T3 (p = 0.021). Overall, 31 patients (79 %) showed an increased TDI score at T3. The increase of TDI from T1 to T3 was 4.6 ± 5.1. Age, gender, duration and initial severity of olfactory loss had no influence on the improvement (all p > 0.05). Only patients with a D score lower than the median value of 8 showed a significantly higher increase of the D score at T3 (p = 0.004). The present study confirmed that olfactory training improves olfactory function in patients with olfactory loss after URTI. A longer duration of training over 32 weeks seems to increase the effectiveness in comparison to a 12-week period. This was tested in a completed German multicenter trial to be published soon containing a control group to include the effect of a spontaneous recovery after URTI.     

Clinical significance of results from olfactory testing

BACKGROUND: Although widely used in healthy subjects and patients with olfactory loss, the significance of changes of scores from validated olfactory tests is unknown. AIM AND METHODS: The aim of the present study was to relate the self-assigned changes of olfactory function in terms of "better," "unchanged," and "worse" in patients with smell disorders with the results from olfactory testing by means of a validated test set. Olfactory function of 83 anosmic or hyposmic patients (40 women, 43 men; age 12-84 yr) was tested on two occasions (mean interval 136 days, minimum 7 days, maximum 6.7 yr). Olfactory function was assessed using a validated technique ("Sniffin' Sticks"). This test consists of three subtests, one for odor threshold (T), odor discrimination (D), and odor identification (I), with possible results ranging up to 16 points each. From the sum of the results from the three subtests a composite "TDI" score was obtained. RESULTS: Forty-four patients indicated an improvement of olfactory function, whereas 39 patients reported no change. No subject reported deterioration of olfactory sensitivity. Subjects assigned to group BETTER had higher TDI scores in the second olfactory tests than subjects assigned to the group UNCHANGED, both in absolute terms and as compared with the first olfactory test (effect "test occasion" by "self-assessed improvement," P < .001). There was no significant difference between groups with respect to age and sex (P = .99 and .84, respectively). Logistic regression showed that more than 60% of the subjects reported an improvement of olfactory sensitivity when the TDI score increased by 5.5 points. CONCLUSION: We show that there is a statistically significant relation between measured and perceived improvement of olfactory function in patients who first presented with the diagnosis of anosmia or hyposmia. The results indicate that improved olfactory function in patients with olfactory deficiency is perceived as such in everyday life and is quantitatively related to an improvement in the composite TDI score of the "Sniffin' Sticks" olfactory test battery. This is the basis for the application of a specific therapy for olfactory loss because of a possible gain in quality of life for the patients.     

Normative values of olfactory function testing using the 'sniffin' sticks'

OBJECTIVES: Quantitative olfactory assessment is often neglected in clinical practice, although olfactory loss can assist to diagnosis and may lead to significant morbidity. "Sniffin' Sticks" is a modern test of nasal chemosensory performance that is based on penlike odor-dispensing devices. It consists of three tests of olfactory function: odor threshold, odor discrimination, and odor identification. The results of this test may be presented as a composite threshold-discrimination-identification (TDI) score. The aim of this study was first to develop normative data of olfactory function for the Greek population using this test and second to relate olfactory performance to age, sex, and side examined. STUDY DESIGN: The authors conducted a prospective clinical trial. METHODS: A total of 93 healthy subjects were included in the study, 48 males and 45 females, mean age of 44.5 years (range, 6-84 years). RESULTS: A database of normal values for olfactory testing was established for the Greek population. Females performed better than males and older subjects performed less efficiently in all tests. We also found a right nostril advantage compared with the left. Additionally, scores obtained from bilateral presentation were similar with scores obtained from the nostril with the better performance. CONCLUSIONS: The "Sniffin' Sticks" can be used effectively in the Greek population to evaluate olfactory performance. Mean values of olfactory tests obtained were better in comparison with data from settings located in central and northern Europe.     

Twice-daily application of topical corticosteroids with a squirt system for patients with steroid-responsive olfactory impairment

Conclusion: Twice-daily topical corticosteroid treatment using a squirt system was beneficial in maintaining improvements in olfactory dysfunction which had been achieved by oral steroid treatment.

Objectives: Some patients suffering from olfactory dysfunction respond well to corticosteroids. However, maintaining these improvements is challenging. The aim of this study was to evaluate the maintenance effect of twice-daily topical steroid treatment using a squirt system.

Methods: Twenty-two anosmic patients with an increase in odor threshold, discrimination, and identification (TDI) scores in Sniffin’ Sticks tests by more than six points after 1-week of oral steroid treatment were enrolled. All the patients used a squirt system to apply topical corticosteroids and were followed up at 1, 3, and 6 months.

Results: Nineteen, 16, and 10 patients were followed-up at 1, 3, and 6 months after treatment, respectively. All the patients had significant visual analog scale scores improvements compared to pre-treatment. The mean improvements in TDI scores were 9.80 (p?p?=?0.001), and 13.87 (p?=?0.005) after 1, 3, and 6 months of treatment, respectively. The self-rated and objective olfactory function scores were maintained with steroid squirt therapy without significant decline, even in the patients who were followed up for 6 months.