Application of the European Test of Olfactory Capabilities in patients with olfactory impairment

A central issue in olfaction concerns the characterization of loss of olfactory function: partial (hyposmia) or total (anosmia). This paper reports the application in a clinical setting of the European Test of Olfactory Capabilities (ETOC), combining odor detection and identification. The study included three phases. In phase 1, anosmics, hyposmics and controls were tested with the 16-items version of the ETOC. In phase 2, a short version of the ETOC was developed: patients with and controls without olfactory impairment were tested on a 6-items ETOC. In phase 3, to predict olfactory impairments in new individuals, the 16-items ETOC was administered on samples of young and older adults, and the 6-items version was applied in samples of young, elderly participants and Alzheimer patients. In phase 1, linear discriminant analysis (LDA) of ETOC scores classified patients and controls with 87.5 % accuracy. In phase 2, LDA provided 84 % correct classification. Results of phase 3 revealed: (1) 16-items ETOC: whereas in young adults, 10 % were classified as hyposmic and 90 % as normosmic, in elderly, 1 % were classified as anosmic, 39 % hyposmic and 60 % normosmic; (2) 6-items ETOC: 15 % of the young adults were classified as having olfactory impairment, compared to 28 % in the older group and 83 % in Alzheimer patients. In conclusion, the ETOC enables characterizing the prevalence of olfactory impairment in young subjects and in normal and pathological aging. Whereas the 16-items ETOC is more discriminant, the short ETOC may provide a fast (5–10 min) tool to assess olfaction in clinical settings.     

Clinical aspects of dysosmia and presentation of European Olfactory Test of "sniffin sticks": a review

The medical community has neglected olfactory dysfunction for a long time. However, over the last two decades, remarkable progress has been made in terms of understanding the sense of smell and both the assessment and diagnosis of olfactory dysfunction. Currently, there are only a few validated olfactory tests. The most commonly used one is the University of Pennsylvania Smell Identification Test. Owing to its cultural biases, this test is mostly used in the United States. "Sniffin' Sticks" are one of the first European tests to be widely used. Since their development in 1996, they have been applied in numerous studies and have found increasing use in otolaryngology clinics. The goal of this article is to present Sniffin' Sticks and to provide a review of clinical olfactory research during recent years.     

Relationship between the Korean Version of the Sniffin' Stick Test and the T&T Olfactometer in the Korean Population

Objectives

The Korean version of the Sniffin'' stick (KVSS) test is widely used in Korea to evaluate olfactory function. However, its validity and reliability have not been studied well. In this study, the authors administered the KVSS and the T%T olfactometer test to evaluate olfactory function and to establish relationships between these two test measures.

Methods

Two hundred and eleven patients participated in this prospective randomized study. One hundred and nine patients with no olfactory symptoms and 102 patients with decreased olfaction participated. All participants were underwent KVSS II and T&T olfactometer testing.

Results

The mean recognition threshold of the T&T olfactometer was -1.8±0.9 for patients with normal olfaction and 4.0±2.6 for patients with decreased olfaction. The mean Threshold-Discrimination-Identification score of the KVSS II was 30.0±3.8 for patients with normal olfaction and 15.9±7.1 for patients with decreased olfaction. Correlation coefficient between the two tests was significantly high (r_s=-0.725, P<0.01).

Conclusion

The KVSS and T&T olfactometry test are both reliable tests of olfactory function and their results are well correlated with each other.     

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.     

Olfactory ability as a function of nasal air flow volume in laryngectomees

This study tested a number of hypotheses concerning the interrelationships between the olfactory abilities and the volume of nasal airflow in laryngectomees. Data were collected from 25 laryngectomees and 25 control subjects and comprised the following: 1) Odor threshold and identification test results. In the threshold test, an 11-step aqueous dilution series of butanol was used. In the odor identification tests, 14 common odorants were used. 2) Measurement of nasal air flow volume in liters per minute. For olfaction and airflow, the laryngectomees' measurements were made under two conditions: 1) using unassisted airflow through the nose, and 2) using a laryngeal bypass that linked the stoma to the mouth and allowed airflow through the nose. The major findings showed that among laryngectomees olfactory abilities depend on nasal airflow. It is concluded that laryngectomees have intact olfactory mechanisms that function normally when adequate airflow volume is provided.     

Polska wersja testu Sniffin’ Sticks – adaptacja i normalizacja

Introduction

Sniffin’ Sticks Test (SST) is a complex smell test, enabling the diagnosis of various aspects of olfactory sensitivity. It is one of the most popular tools for olfactory testing all over the world; however, so far it has not been commonly used in Poland.

Aim

The presented study had the following aims: assessment of the applicability of the SST in Poland, adaptation of the identification subtest, normalization of the whole battery and comparison of the Polish results to the norms in the original tool.

Materials and methods

We tested olfactory sensitivity of 281 healthy volunteers aged 18–87 years. We used the full version of the SST (threshold, discrimination and identification subtests).

Results

The results of the presented study are the modified version of the identification test response questionnaire and clearly defined normative values for the Polish people of different ages. Normative values and results in Poland were not significantly different from the previously reported findings for the original, German tool. Additionally, consistent with previous reports, olfactory sensitivity of the eldest group of the Polish people was lower than performance in younger age groups.

Conclusions

The presented findings suggest that the adapted version of the Sniffin’ Sticks Test might be used for both medical and research purposes in Poland.     

Performance on verbal and low-verbal false belief tasks: Evidence from children with Williams syndrome

Previous studies that have investigated the relationship between performance on theory of mind (ToM) tasks and verbal abilities in individuals with Williams syndrome (WS) have reported contradictory findings with some showing that language abilities aid performance on ToM tasks while others have found that participants with WS fail these tasks because of their verbal demands. The current study investigated this relationship again comparing performance on a classical change-location task to two newly developed low-verbal tasks, one change-location task and one unexpected content task. Thirty children with WS (aged 5–17;01 years) and 30 typically developing (TD) children (aged between 2;10 years and 9;09 years), who were matched for vocabulary comprehension scores were included in the study. Although performance in the WS group was significantly poorer compared to the TD group on all three tasks, performance was not predicted by their receptive vocabulary or grammatical ability scores. In addition, ToM abilities in both groups depended on the cognitive demands of the task at hand. This finding shows that performance on ToM tasks in WS is not necessarily hindered by their delayed language abilities but rather by the task administered. This could potentially affect the diagnosis of developmental disorders, such as Autism Spectrum Disorders, and comparison of ToM abilities across developmental disorders.Learning outcomes: Readers of this article should be able to (1) describe the current state of theory of mind research in Williams syndrome, (2) identify which cognitive abilities might explain performance on theory of mind tasks in both typically developing children and in children with Williams syndrome, and (3) interpret the importance of task demands when assessing children's theory of mind abilities.     

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   

The Scandinavian Odor-Identification Test: Development,Reliability, Validity and Normative Data

The Scandinavian Odor-Identification Test (SOIT) was developed to address the need for a culturally valid odor-identifi cation test for clinical use on the Scandinavian population that (i) has good ability to generalize performance to olfactory status, (ii) assesses olfactory and trigeminal function separately, (iii) requires only limited cognitive demands, (iv) has normative data and good sensitivity and specificity, and (v) is fast, easy to administer and inexpensive. Sixteen odorous test stimuli were selected that were relatively identifiable, familiar, strong in intensity and pleasant according to healthy participants. Four response alternatives were then selected for each test stimulus based on a confusion matrix of identification rates obtained from healthy participants, in a manner that controlled for task difficulty. Results on the SOIT from healthy persons and hyposmic patients showed satisfactory test-retest reliability, split-half reliability and validity. Cut-off scores for olfactory diagnosis (normosmia, hyposmia, anosmia) based on normative data obtained from 171 healthy persons showed a satisfactory sensitivity and specificity of the SOIT. Assessment of 22 anosmic patients with the SOIT revealed that three of the test stimuli were significant trigeminal stimulants.     

Olfactory Identification Test Using Familiar Distracters for Koreans

Objectives

Odors used in an odor identification test should be familiar to the subject, but there are some unfamiliar distracters in Korean version of Sniffin'' stick (KVSS) II identification test. In this study, we used the results of the original version of KVSS II identification to modify the KVSS II identification test.

Methods

Eighty-three participants took an original version of KVSS II identification test and a visual analogue scale of subjective odor function. KVSS II identification which has 16 items was performed to choose one out of four odors items. And visual analogue scale was checked from 0 to 10 points of their subjective olfactory function. Two weeks later they took the modified version of KVSS II identification test. Hyposmic or anosmic patients were excluded.

Results

The mean score of the original version of KVSS II identification and modified version of KVSS II identification were 11.3 and 12.5, respectively (P<0.05). The KVSS II identification test and subjective olfactory function were positively correlated (r=0.247, P<0.05), as were the modified KVSS II identification test and subjective olfactory function (r=0.329, P<0.05).

Conclusion

After modification of distracters, KVSS II identification test appears to be suited for assessment of olfactory function.     

Do the blinds smell better?

If people lose a sense organ, there is thought to be an increase in the remaining sensory functions. Previous studies showed ambiguous results on this topic. In a prospective matched pair case-control study on 46 blind and 46 normal-sighted subjects, the olfactory performance was examined using the Sniffin’ Sticks Test [threshold-discrimination-identification (TDI) test], determining the olfactory threshold, the identification and the discrimination performance. There was no significant difference between the groups. Neither the overall olfactory performance (TDI score) nor any of its subtests did correlate with the vision or with the duration of blindness. The study could not detect any superior smell abilities of blind subjects as compared to sighted subjects.     

Olfactory disturbance screening with the odor stick identification test (OSIT-J) in executive checkups

The odor stick identification test for Japanese (OSIT-J) has been shown to be useful for detecting and evaluating olfactory disturbances in Japanese people. We studied the usefulness of OSIT-J in screening for olfactory disturbances in 83 Japanese participants (49 male, 34 female) participating in an executive checkup at NTT West Kanazawa Hospital in Japan. The olfactory ability was self-reported on a grade scale. Olfactory function was then evaluated with a three-odors OSIT-J (rose, curry and sweaty socks). Participants with low self-reported olfactory ability or less-than-full scores in the three-odor test were evaluated with an additional 10 odors of OSIT-J. Eight or less points are considered to be lower than average in the 13-odor test of OSIT-J (Saito S, et al.). Eleven of the 83 participants had low self-reported olfactory ability. Four participants with a full score in the three odors test with low self-reported olfactory ability scored more than eight points in the 13-odor test. Thirty-eight participants scored less than three points in the three-odor test. Seven of 29 participants with two points in the three-odor test scored eight or less in the 13-odor test. In the 29 participants, subjects with low self-reported olfactory ability scored significantly lower scores than those without a low self-reported olfactory ability in the 13-odor test. The self-reported olfactory ability was not related to the score in the 13-odor test in the nine participants with one point or less in the three-odor test. Males scored significantly lower scores than females in the three-odor test. However, gender was not significantly related to the rate of olfactory disability estimated based on the 13-odor test. Use of a three-odor OSIT-J along with a self-administered questionnaire pertaining to olfactory disability is useful for olfactory disturbance screening during executive health checkups.     

Hypothesis-testing abilities of language-impaired children.

Hypothesis-testing abilities were assessed using a modification of the discrimination-learning paradigm employed by Nelson, Kamhi, and Apel (1987) that was designed to minimize the short-term memory demands of the task. Sixteen language-impaired and 16 normal-language children in kindergarten and first and second grades participated in the study. The language-impaired children solved significantly fewer problems than normal-language controls equated on cognitive level, but the two groups used similar hypothesis types to solve the problems. Type of verbal feedback provided during the hypothesis testing task (explicit vs. nonexplicit) did not significantly affect the performance of either group. These results are interpreted as indicating that language-impaired children demonstrate inefficient use of problem-solving strategies that cannot be attributed solely to memory difficulties. Issues surrounding the investigation of language-impaired children's cognitive abilities are discussed.     

Clinical significance of olfactory event-related potentials related to orthonasal and retronasal olfactory testing

OBJECTIVE: The purpose of this study was to evaluate the likelihood of recording olfactory event-related potentials (OERPs) in patients with an olfactory dysfunction and to correlate the electrophysiological responses to orthonasal and retronasal olfactory testing. DESIGN/MATERIALS AND METHODS: This was a prospective study of 65 patients with different origins of their olfactory loss. Orthonasal olfactory function was assessed with the "Sniffin' Sticks" test (orthonasal score; maximal score 48) and retronasal olfactory function with odorized powders presented intraorally (retronasal score; maximal score 20). The OERPs were obtained after presentation of 2-phenyl ethyl alcohol, the selected olfactory stimulus. Causes of olfactory dysfunction included postinfectious olfactory loss (n = 15), head trauma (n = 26), nasal polyposis (n = 15), and mixed causes (idiopathic, toxic, drug induced) (n = 9). RESULTS: Based on orthonasal testing, 32 and 33 patients were diagnosed with anosmia and hyposmia, respectively. Twenty-two patients from the hyposmic group demonstrated reliable OERPs. No OERPs were recorded in the anosmic group. Prevalence of OERPs in a cohort of patients with olfactory dysfunction was 33.8% (22 of 65). Median score (expressed as the percentage of the maximal score that could be obtained theoretically) in which OERPs were recorded was 50% (24 of 48) with orthonasal testing and 80% (16 of 20) with retronasal testing. CONCLUSIONS: Patients with olfactory dysfunction usually demonstrate OERPs in one third of the cases. When olfactory dysfunction is in the range that separates normosmic subjects from anosmic patients, patients may have identifiable OERPs. Interpretation of both orthonasal and retronasal psychophysical olfactory testing should be supported by the recording of OERPs in a clinical setting.     

Olfactory function in patients with chronic rhinosinusitis before and after functional endoscopic sinus surgery

BACKGROUND: The olfactory loss in patients with chronic rhinosinusitis has been measured by different methods. However, the results have been variable and it is not clear whether functional endoscopic sinus surgery (FESS) significantly improves olfactory function. This study was performed to evaluate the influences of FESS on olfactory function in patients with chronic rhinosinusitis using three different types of olfactory tests. METHODS: Seventy patients with chronic rhinosinusitis were administered the University of Pennsylvania Smell Identification Test (UPSIT), a single staircase phenyl ethyl alcohol odor detection threshold test (STT), and a short-term odor memory/discrimination test a day before and 6 months after FESS. A questionnaire inquiring about the patients' self-perception of olfactory function was administered also. Independent ratings of the severity of chronic rhinosinusitis before FESS were established from CT scans. RESULTS: Fifty-two (74.3%) of the patients reported that their olfactory function was impaired before surgery, and 68.6% of the patients reported impaired olfactory function after surgery, a difference that was not significant. No meaningful changes in any of the olfactory test scores were noted 6 or more months after FESS. Preoperatively, small correlations between CT scores and the symptom scores (r = 0.278; p = 0.024), threshold scores (r = -0.27; p = 0.031), and UPSIT scores (r = -0.36; p = 0.003) were observed. CONCLUSION: In patients with severe rhinosinusitis, FESS had little impact on the ability to smell, regardless of the method for assessing smell function. Subtle associations between olfactory function and the severity of chronic rhinosinusitis determined by CT were observed, however, preoperatively. The olfactory test measures were correlated with one another both pre- and postoperatively.     

基于REDCap嗅觉障碍患者交互式电子数据库的设计

目的 采用REDCap设计嗅觉障碍患者长期随访管理交互式共享电子数据库。方法 基于嗅觉障碍患者随访管理的实际需要,使用西安交通大学开放研究数据平台提供的中文版REDCap临床研究数据收集系统,以患者基本资料、嗅觉障碍自我评估表、检查结果、医师评估表及治疗情况为主要内容,以治疗前,治疗后1个月、3个月、6个月、1年为5个事件采集点,设置和创建问卷工具表单,设置数据质量控制程序,设置用户使用权限,建立交互式共享电子数据库。结果 按预定目标实现了上述交互式共享电子数据库的设计并投入临床使用。该数据库可实现多地点多终端同时输入,可实现医疗数据录入、质控及权限管理,可构建随访工作日历。结论 运用REDCap搭建嗅觉障碍患者交互式共享电子数据库,设计流程简单、操作容易、信息收集完整,为耳鼻喉科医师开展嗅觉障碍相关临床研究提供一个免费、便利、高效及标准化的数据管理工具。     

A new clinical olfactory function test: cross-cultural influence

OBJECTIVE: To investigate whether a new clinical olfactory test, the Odor Stick Identification Test for Japanese (OSIT-J), can be used to assess olfactory function cross-culturally in a US patient population. DESIGN: Cross-sectional prospective study. SETTING: A university medical center otolaryngology clinic. PATIENTS: Fifty US patients presenting with complaints of olfactory dysfunction from December 2004 to January 2006. INTERVENTIONS: Olfactory testing and patient interview. MAIN OUTCOME MEASURES: Comparison of test results obtained with the OSIT-J, the Connecticut Chemosensory Clinical Research Center (CCCRC) olfactory function test, and patients' self-reported level of olfactory function. Patients' opinions regarding the 2 test methods were also recorded. RESULTS: The mean +/- SD time required to administer the OSIT-J (8 +/- 1 minutes) was shorter than that required for the standard CCCRC test (21 +/- 6 minutes). Significant Spearman rank correlations were found between the OSIT-J and CCCRC test scores (r(s) = 0.80, P<.001, n = 50), and patients' self-reported level of olfactory function (r(s) = 0.73, P<.001, n = 50). Although 3 of the 13 odors used in the OSIT-J were not familiar to US subjects, patients reported that the OSIT-J was easier, more interesting, and the odors used more pleasant than the CCCRC test. CONCLUSIONS: Olfactory function tests developed in different countries should be evaluated to determine if a cross-cultural bias exists among test odorants. Although a cultural bias was detected for a few odorants, this study demonstrates that a modified version of the OSIT-J can be used to assess olfactory function in US patients.     

A study of olfactory testing in patients with rhinological pathology in the ENT clinic

BACKGROUND: Despite the common occurrence of rhinological pathology presenting to the ENT clinic, routine testing of olfactory ability is rarely performed. OBJECTIVES: The aim of this study was to determine the role of routine olfactory testing. METHODS: This was a prospective study conducted in the outpatient clinic of a district general hospital. Patients presenting with rhinological complaints had their olfactory status assessed using the combined olfactory test (COT) before and after rhinological surgery. RESULTS: Eighty patients (56 men, 24 women) had tests completed over a 12-month period. Patients assessed mostly had nasal polyposis, chronic rhinosinusitis or septal deformity. 83% of patients had either a complaint of olfactory disturbance or a COT score of 6 or less, or had both; but correlation between symptoms and scores was poor. Post-operative COT scores showed significant improvement (p = 0.02) with post-septoplasty patients showing the most significant improvement as a group (p = 0.001). CONCLUSIONS: Olfactory disturbance is very common in rhinological pathology and the patient's history alone cannot be relied upon. Simple olfactory assessment, such as with the combined olfactory test, is easy to perform and cheap to use and should be a commonly used resource in the ENT clinic. Formal testing can help to document any pre-existing olfactory loss and any post-operative changes as well as detecting unreported hyposmia.