深圳小学高年级学生嗅觉功能的初步调查及与成绩的相关性初探

目的 探讨SniffinSticks在儿童嗅觉功能检查中的应用可行性。 方法 2015年4月至7月采用SniffinSticks法检测嗅觉正常的深圳某小学五、六年级小学生共70名,比较嗅觉评分与期末考试各科成绩的相互关联,探讨嗅觉记忆与学习能力的可能联系。 结果 选取对象中五年级30名,男17名,女13名;六年级40名,男22名,女18名。70名学生的SniffinSticks正常参考值是:气味阈值(OT):10.95±2.7,气味辨别值(OD):12.92±1.0,气味鉴别值(OI):13.74±1.6;嗅觉功能总分(TDI):37.54±2.2。男女间OT、OD、OI、TDI值差异无统计学意义,五、六年级间OT、OD、OI、TDI值差异亦无统计学意义。OT、TDI与英语成绩呈负相关(P<0.01)。 结论 SniffinSticks嗅觉检测方法能被较大儿童理解和接受,可用于儿童嗅觉测试。高年级男女学生嗅觉功能差异无统计学意义。     

Odour identification and discrimination in Dutch adults over 45 years

OBJECTIVES: The aim of the study was to establish normative values for the two culture dependent components (odour identification and odour discrimination) of the "Sniffin' Sticks" test battery in the Dutch population over 45 years of age, and to assess the influence of age and sex on olfactory function in this population. METHODS: This study was performed in 150 healthy Dutch subjects (87 male and 63 female, mean age 59.2 years, range 45-78 years). Olfactory performance was assessed using the odour identification and discrimination parts of the "Sniffin' Sticks" test battery. RESULTS: In women, odour discrimination scores declined significantly with age, whereas there was no effect of age on odour discrimination performance in men. For odour identification, there were no effects of age or sex in this population. A moderate correlation was found between identification and discrimination test scores. CONCLUSION: Provisional population-specific normative data for olfactory testing using the identification and discrimination parts of the "Sniffin' Sticks" olfactory test battery have been established for the Dutch population over 45 years of age. The current data are applicable to the clinical evaluation of patients with olfactory disorders.     

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.     

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.     

Screening of olfactory function using odourized markers

BACKGROUND: The goal of our study was to create a psychophysical test for the screening of olfactory function on the basis of commercially available odourized markers (OM). There are six coloured markers in one package filled with different odourants at suprathreshold levels. In order to identify the best approach, we investigated five different variations of the technique. MATERIALS AND METHODS: Olfaction was investigated in 189 subjects. Healthy participants as well as patients suffering from olfactory disorders were tested. Initially subjects were tested by one of five methods using OM. Finally, the "Sniffin' Sticks" test (butanol odour threshold, odour identification) was performed. RESULTS: Correlation of the OM screening test and the "Sniffin' Sticks" ranged from 0.49 to 0.93 indicating that variations of the technique strongly influence the results of testing. The best technique for evaluating olfactory function included spontaneous naming of odours and odour identification from a list of four distractors. The sensitivity of this method was sufficient to determine anosmia. CONCLUSIONS: The odourized markers screening test can be used to screen for anosmia in the general population. However, the precise quantification of olfactory function is not possible, because of the relatively small amount of odours.     

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.     

Change in olfaction after radiotherapy for nasopharyngeal cancer--a prospective study

PURPOSE: To evaluate the changes in olfactory function in patients with nasopharyngeal carcinoma who have received radiation to the head and neck. MATERIALS AND METHODS: Olfactory function of consecutive patients with nasopharyngeal carcinoma was assessed prospectively before irradiation and serially up to 1 year after radiotherapy by the Sniffin' Sticks (Erlangen, Germany) olfactory function test and by a patient symptom visual analogue scale. RESULTS: Fifty-eight patients were recruited before radiotherapy was commenced. Three patients could not give a reliable response to the Sniffin' Sticks test even in this first assessment, and 7 patients did not return for evaluation after irradiation. Forty-eight patients were available for follow-up assessment. Mean olfactory threshold scores by the Sniffin' Sticks test were found to deteriorate significantly at 12 months when compared with the scores before irradiation (8.3 at 12 months vs 11.5 before irradiation; P =.001). Scores for olfactory discrimination and for identification did not exhibit any significant changes when assessed at 12 months (P >.05 for both). Subjective patient assessment of olfactory function with the visual analogue scale at 12 months did not demonstrate any significant differences when compared with patients' assessment before irradiation (P =.90). An increase in discharge was the only nasal symptom that demonstrated a significant change at 12 months when compared with the assessment before irradiation (P < 001). CONCLUSIONS: Deterioration in olfactory threshold scores was found at 12 months after irradiation and was not noticed by the patients.     

Screening of olfactory function with a four-minute odor identification test: reliability, normative data, and investigations in patients with olfactory loss

The study aimed to create a screening test on the basis of the odor identification test as used in the "Sniffin' Sticks" olfactory test kit. It should appeal to the practitioner in terms of 1) time required for testing, 2) reliability, 3) separation of "normal" from "abnormal," and 4) the fact that it allows lateralized screening. Experiments should provide a normative database (number of subjects > 1,000), establish test-retest reliability (n > 100), and compare results from patients with olfactory loss (n > 200). The correlation between results on 2 repetitive tests was .78. The test differentiated anosmics, hyposmics, and normosmics (p < .001). None of the 112 anosmics reached a score higher than 8; the 90th percentile was at a score of 6. When only 6 odors were used for calculating scores, for anosmics the 95th percentile was at a score of 4. These data provide a basis for the screening of patients by means of "Sniffin' Sticks."     

Intranasal trigeminal chemosensitivity in patients with postviral and post-traumatic olfactory dysfunction

Abstract Conclusions: The olfactory and intranasal trigeminal systems are closely connected. With regard to intranasal trigeminal event-related potential (ERP), patients with olfactory dysfunction (OD) showed longer latency and lower amplitude, which indicated decreased trigeminal sensitivity. Different age, etiology, and olfactory status also affect trigeminal sensitivity differently. Objective: OD is a common symptom in the rhinology clinic. ERP is considered an important method to evaluate chemosensitivity. The aim of this study was to investigate changes of intranasal trigeminal sense in patients with postviral OD (PVOD) and post-traumatic OD (PTOD). Methods: A total of 96 participants (30 healthy adults and 66 patients with OD) aged 20-65 years were investigated. The T&T olfactometer, the Sniffin' Sticks olfactory test, and trigeminal ERPs (tERPs) were used. We evaluated trigeminal sensitivity influenced by different factors (age, etiology, and olfactory status) in healthy subjects with normal olfactory function and in patients with PVOD and PTOD. Results: Patients with OD showed higher trigeminal thresholds than normal controls. Compared with controls, N1/P2 latencies of tERPs increased and amplitudes decreased in patients with OD. Older subjects showed longer latencies and lower amplitudes than young subjects in both controls and the OD group. Patients with PTOD exhibited worse psychophysical olfactory function and decreased trigeminal sensitivity.     

Post-infectious olfactory dysfunction exhibits a seasonal pattern

HYPOTHESIS: We investigated whether olfactory dysfunction following infections of the upper respiratory tract (post-URTI) has an incidence matching the seasonality of URTIs. Study design: Retrospective study. METHODS: In total, 457 patients (126 male, 331 female) with post-URTI olfactory loss were examined during a 6-year-period (1999-2004). Their records were assessed for age, sex, and time of onset of the disease. The severity of olfactory dysfunction was assessed using the "Sniffin' Sticks" (odour threshold, odour discrimination, and odour identification). RESULTS: Incidence of post-URTI olfactory dysfunction exhibited seasonal fluctuations with deviations from the winter seasonality of URTIs. The overall incidence of the disease differed significantly between months. March (12.7%) and May (12.6%) were the months with the highest incidence of the disease throughout the year. The lowest incidence was observed in September (5.6%). Significant differences were found between these months and months with a high incidence of URTIs. DISCUSSION: The peak incidence of post-URTI olfactory loss in March may be explained by the high incidence of influenza at this time. However, it is unclear why the incidence of the disease presents a second peak in May, when the incidence of respiratory viruses is relatively low. Climate conditions at this time might play a role in the susceptibility of the nasal epithelia towards certain viral infections, e.g. parainfluenza type III. CONCLUSION: Post-URTI olfactory dysfunction exhibits spring seasonality with peaks in March and May and possible causative factors being influenza and parainfluenza viruses (type III), respectively.     

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.     

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.     

Trigeminal event-related potentials in patients with olfactory dysfunction

OBJECTIVE: There are mutual interactions between the olfactory and trigeminal systems. The purpose of this study was (1) to assess trigeminal sensitivity using chemosensory event-related potentials (CSERPs) in patients with olfactory dysfunction and (2) to evaluate whether trigeminal ERPs were different with regard to the presence or absence of olfactory ERPs. MATERIALS AND METHODS: Prospective study of 60 patients who presented with olfactory dysfunction (postinfectious olfactory loss: n = 19, posttraumatic olfactory loss: n = 28, and olfactory loss due to idiopathic, or toxic causes: n = 13). All patients were extensively evaluated with an orthonasal olfactory test based on the "Sniffin' Sticks". In addition, chemosensory ERPs were recorded in response to olfactory and trigeminal stimulation. RESULTS: Olfactory/trigeminal ERPs were recorded in 25/60 patients, respectively. Patients with no detectable olfactory ERPs, considered as severely affected, demonstrated an altered trigeminal sensitivity as indicated by an increase in P2 latencies and a decrease in both, P2 and N1-P2 amplitudes compared to patients with detectable olfactory ERPs. A regression analysis showed a negative relation between P2 latencies and the "Sniffin' Sticks"score (r = -0.46, p < 0.001). CONCLUSIONS: Patients with severe olfactory dysfunction demonstrated decreased trigeminal sensitivity as indicated by electrophysiological measures. This study supports the idea of interactions between the chemical senses. Whether altered responses to trigeminal stimulation may be used as a prognostic measure related to recovery from olfactory loss remains to be demonstrated.     

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.     

Can we smell without an olfactory bulb?

BACKGROUND: Lack of an olfactory bulb (OB) is typically associated with anosmia. METHODS: We present a patient with subnormal olfactory function in whom the OB could not be detected with magnetic resonance imaging (MRI). RESULTS: Olfactory function was evaluated on two occasions. Orthonasal olfactory function was assessed with the "Sniffin' Sticks" test providing a score equivalent to hyposmia. Retronasal olfactory function was studied with "smell powders" indicating a decreased, but not absence of, olfactory function. Importantly, chemosensory event-related potentials were clearly present in response to olfactory and trigeminal stimuli. CONCLUSION: This indicates that olfactory function may be present in some subjects even when an OB can not be detected with MRI.     

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.     

Recovery of olfactory function following closed head injury or infections of the upper respiratory tract

OBJECTIVE: To investigate the outcome of olfactory function in patients with olfactory loss following infections of the upper respiratory tract (post-URTI) or head trauma. DESIGN: Retrospective patient-based study. SETTING: Smell and Taste Outpatient Clinic at a university hospital. PATIENTS: A total of 361 patients (228 women, 133 men) were included. MAIN OUTCOME MEASURES: Olfactory function was assessed using the "Sniffin' Sticks" test battery, which result in a threshold, discrimination, and identification score. The mean interval between first and last visit was 14 months. RESULTS: In comparing the overall threshold, discrimination, and identification scores between the last and first visit, olfactory function improved in 26% of the patients whereas it decreased in 6%. The cause of olfactory impairment had a significant effect on the recovery rate of olfactory function. Within the post-URTI group (n = 262), 32% of the patients improved, but in the posttraumatic group (n = 99) only 10% improved. In patients with post-URTI olfactory loss, a negative correlation was found between age and recovery of olfactory function. In general, the factor "sex" had no significant effect on recovery of smell function. CONCLUSIONS: To our knowledge, the series of patients presented herein is the largest in the literature to date in which standardized testing methods were used to assess the progression of impaired olfaction. It showed that the rate of improvement of olfactory function was significantly higher in patients with post-URTI dysosmia compared with patients with posttraumatic dysosmia. During an observation period of approximately 1 year, more than 30% of patients with post-URTI olfactory loss experienced improvement, whereas only 10% of patients with posttraumatic olfactory loss experienced improvement. Furthermore, age plays a significant role in the recovery of olfactory function.     

Olfactory function and olfactory bulb volume in patients with postinfectious olfactory loss

OBJECTIVE: The study aimed to investigate whether the degree of postinfectious olfactory loss is reflected in volume of the olfactory bulb (OB). STUDY DESIGN: Retrospective study of 26 patients with postinfectious olfactory loss. MATERIALS AND METHODS: Olfactory function was assessed with the "Sniffin' Sticks" test kit, and the magnetic resonance imaging study focused on OB volume and the olfactory sulcus. RESULTS: The study revealed that 1) OB volume varies with regard to olfactory function, 2) OB volume decreases with duration of olfactory loss, and 3) patients with parosmia had smaller OB volumes than patients who did not report such smell distortions, although their overall olfactory function was not significantly different from each other. CONCLUSION: The study emphasizes that OB volume is a gauge of olfactory function.     

Smoking and tympanoplasty: implications for prognosis and the Middle Ear Risk Index (MERI).

OBJECTIVES/HYPOTHESIS: The objectives of this study are to review the effects of smoking on preoperative middle ear disease severity, long-term surgical outcome, type and extent of surgery required, the need for ossicular chain reconstruction, and the long-term hearing results. STUDY DESIGN: A retrospective chart review. MATERIALS AND METHODS: The charts of 74 smokers and non-smokers who underwent over-under tympanoplasty were reviewed. An analysis of the disease severity (using the Middle Ear Risk Index [MERI]) at presentation and type of surgery was performed. A review of graft take and delayed failure (late perforation or atelectasis after 6 mo) and audiologic data were performed. RESULTS: Fifteen patients smoked a mean of 20 cigarettes daily for a mean of 15 years. The MERI was well matched for both groups. There was a trend toward smokers having a higher incidence of otorrhea preoperatively and requiring a more extensive surgical procedure. All patients had full take of the tympanic membrane graft at 6 months; however, delayed surgical failure was seen in 20% of non-smokers compared with 60% of smokers (P = .050). No statistically significant difference was seen in hearing outcome. CONCLUSIONS: Cigarette smoking is associated with more severe middle ear disease preoperatively. More extensive surgery is often needed in smokers to eradicate the disease. Most significantly, smoking is associated with a threefold increase in the chance of long-term graft failure. Based on the results of this study, the MERI has been revised to include smoking as a risk factor.