Olfactory and gustatory function in healthy adult Chinese subjects

How well can young adults and children discriminate between odors?

It is widely believed that people can distinguish between many odors although there is limited empirical evidence. Odor discrimination tasks are employed much less often than other measures of olfaction, but, interestingly, performance is typically ~ 75% correct. This less-than-perfect performance is rarely highlighted, although it suggests that people may not be as good at discriminating odors as is commonly believed. Odor discrimination is understudied in children, and although available evidence suggests that it improves with age, children perform better when the task is simpler. In the present study, we explored odor discrimination in children and young adults with a relatively simple same-different task using common and uncommon odors. We found that children perform as well as young adults, but that overall performance was less than perfect and depended on the odors to be discriminated. We found evidence that ability to discriminate between odors improves as the difference in pleasantness of the odors increases. In a second experiment, we tested this directly by exploring whether odors that differ in pleasantness and edibility, two dimensions that appear to be important in olfactory perception, are easier to discriminate than odors that are the same on those dimensions. We found further evidence that odors that differ in pleasantness are easier to discriminate.

Effect of Age and Gender on Taste Function as Measured by the Waterless Empirical Taste Test

The effect of age and gender on taste function is rarely investigated. Therefore, we tried to study the effect of age and gender on taste function as evaluated by the Waterless Empirical Taste Test (WETT®). The WETT® consists of 40 strips that are coated with one of five tastants (sucrose, citric acid, sodium chloride, caffeine, or monosodium glutamate). Each tastant is prepared with four different concentrations. These 40 strips are interspersed with an additional 13 tasteless strips. To implement the WETT®, a strip was placed on the middle portion of the tongue. The subjects closed their mouth and tasted the strip. They then chose one of six answers (sweet, sour, salty, bitter, brothy, or no taste at all). If the answer was correct, one score was acquired. One-hundred-and-twenty healthy men and women were collected in this study. Among them, there were 40 subjects in each age group of 20-39 years, 40-59 years, and ≥60 years. The overall taste and individual tastant function decreased with age, particularly between subjects aged 20-39 years and those aged ≥60 years. The overall taste and individual tastant function were better in females than in males, especially for subjects aged older than 59 years. Our results show that taste function is affected by both age and gender.

Sociodemographic Characteristics and Comorbidities of Patients With Long COVID and Persistent Olfactory Dysfunction

IMPORTANCE

Determining the characteristics, type, and severity of olfactory dysfunction in patients with long COVID is important for the prognosis and potential treatment of the affected population.

OBJECTIVE

To describe the sociodemographic and clinical features of patients with long COVID who develop persistent olfactory dysfunction.

DESIGN, SETTING, AND PARTICIPANTS

This cross-sectional study, conducted at a rehabilitation center at a public university in the Amazon region of Brazil between September 9, 2020, and October 20, 2021, comprised 219 patients with long COVID and self-reported neurologic symptoms. Of these 219 patients, 139 received a diagnosis of chronic olfactory dysfunction, as confirmed by the Connecticut Chemosensory Clinical Research Center (CCCRC) test.

EXPOSURE

Clinical diagnosis of long COVID.

MAIN OUTCOMES AND MEASURES

Electronic case report forms were prepared for the collection of sociodemographic and clinical data. Patients' sense of smell was evaluated via a CCCRC test, and the association of olfactory dysfunction with aspects of daily life was recorded using a questionnaire.

RESULTS

Of the 219 patients included in the study, 164 (74.9%) were women, 194 (88.6%) were between 18 and 59 years of age (mean [SD] age, 43.2 [12.9] years), 206 (94.1%) had more than 9 years of education, and 115 (52.5%) had a monthly income of up to US $192.00. In the study group, 139 patients (63.5%) had some degree of olfactory dysfunction, whereas 80 patients (36.5%) had normosmia. Patients with olfactory dysfunction had a significantly longer duration of long COVID symptoms than those in the normosmia group (mean [SD], 242.7 [101.9] vs 221.0 [97.5] days; P = .01). Among patients with anosmia, there was a significant association between olfactory dysfunction and daily activities, especially in terms of impairment in hazard detection (21 of 31 patients [67.7%]), personal hygiene (21 of 31 patients [67.7%]), and food intake (21 of 31 patients [67.7%]). Univariable logistic regression analyses found that ageusia symptoms were associated with the occurrence of olfactory dysfunction (odds ratio [OR], 11.14 [95% CI, 4.76-26.07]; P < .001), whereas headache (OR, 0.41 [95% CI, 0.22-0.76]; P < .001) and sleep disorders (OR, 0.48 [95% CI, 0.26-0.92]; P = .02) showed an inverse association with the occurrence of olfactory dysfunction.

CONCLUSIONS AND RELEVANCE

Olfactory dysfunction is one of the most important long-term neurologic symptoms of COVID-19, with the highest prevalence seen among women, adults, and outpatients. Patients with olfactory dysfunction may experience persistent severe hyposmia or anosmia more than 1 year from the onset of symptoms, suggesting the possibility of the condition becoming a permanent sequela.

Patterns of Gray and White Matter Volume Alterations in Patients With Post-Traumatic Anosmia: A Voxel-Based Morphometry Study

Objective

Traumatic brain injury is one of the major causes of human olfactory dysfunction and leads to brain structure alterations, mainly in the cortical olfactory regions. Our study aimed to investigate volume changes in the gray matter (GM) and white matter (WM) in patients with post-traumatic anosmia and then to explore the relationship between GM volume and olfactory function.

Methods

Ethics committee approved prospective studies which included 22 patients with post-traumatic anosmia and 18 age- and gender-matched healthy volunteers. Olfactory function was assessed using the Sniffin' Sticks. High-resolution 3-dimensional T1 MRIs of the participants were acquired on a 3T scanner and the data were collected for voxel-based morphometry (VBM) analysis. Furthermore, the GM and WM volumes of the whole brain regions were compared and correlated with olfactory function.

Results

The analysis revealed significant GM volume reduction in the orbitofrontal cortex (OFC), gyrus rectus (GR), olfactory cortex, insula, parahippocampal, temporal pole, and cerebellum (all P &lt; 0.001) in patients. Besides, WM volume loss was also found in the OFC, GR, and insula (all P &lt; 0.001) in patients. All WM atrophy areas were connected to areas of GM volume loss spatially. Correlation analysis showed the olfactory scores were significantly positively correlated with the GM volume of the occipital cortex (P &lt; 0.001, and PFWE &lt; 0.05), while no significant correlation was found between the Sniffin' Sticks test scores and the WM volume in patients.

Conclusion

The reduction of GM and WM volume in olfactory-related regions was responsible for olfactory dysfunction in post-traumatic patients. The occipital cortex may play a compensation mechanism to maintain the residual olfactory function. To our knowledge, we report here for the first time on white matter volume alterations specifically in post-traumatic patients with anosmia.

Normative data on the subjective gustatory function of Chinese adults

PURPOSE

the study aims to assess the gustatory function of healthy Chinese adults with the whole-mouth test based on five basic tastants, including umami taste.

METHODS

the study recruited 464 participants reporting a normal sense of smell/taste (227 females and 237 males with an age range of 19-65 years). A drop (approximately 0.1 mL) of liquid tastant was applied on the anterior third of the extended tongue of each subject. The taste solutions involved 5 tastants (sour, sweet, salty, umami, and bitter) and 7 concentrations. Taste perception scores and recognition scores of the five basic tastants were obtained with this whole-mouth taste method.

RESULTS

total taste score of recognition showed a significant negative correlation with age. The elder group (51-65 years) had the lowest scores. The 10th percentile of total taste score of recognition in the group of 36 to 50 years was used to distinguish normogeusic subjects from hypogeusic subjects. The perception scores and recognition scores of females were higher than those of males. The perception and recognition thresholds of salty, umami, and bitter for females were lower than those for males. Total taste score of recognition for non-smokers was significantly higher than that of smokers. The whole-mouth method showed a high test-retest reliability with an intra-class correlation coefficient (ICC) from 0.774 to 0.833.

CONCLUSION

this whole-mouth method is simple and time-saving and can be easily adjusted to obtain reliable data. The gustatory function was significantly negatively correlated with age. Females were more sensitive to the sour, salty, umami and bitter tastes than males. The gustatory function of non-smokers was more sensitive.

Culturally modified olfactory test adapted to East-Turkey: A comparison with Sniffin' Sticks

BACKGROUND

Although the "Sniffin' Sticks" test (SST) is a widely used odor test, aplicability of odor tests is limited because of the high cost of the test and the regional-cultural differentiation of odor recognition. We aimed to evaluate our regional odor norms by applying the SST with a Modified odor test (MOT) we created for this study, and to develop a test similar to the SST, which was less expensive and probably had a higher odor definition for our region.

METHODS

This study includes 201 healthy volunteers: 91 men and 110 women over the age of 18 were included in the study. Tests were compared by applying the SST and MOT to all volunteers.

RESULTS

In all subjects, for the SST: the mean Threshold score (TS), Discrimination score (DS), and Identification score (IS) were, respectively, 10.73 ± 2.35, 11.11 ± 11.94 and 11.32 ± 2.15. TheTDI mean score was found to be 33.11 ± 5.9. In the TDI score, the 10th percentile value was found to be 26. For the MOT, the mean TS(mTS), DS(mDS), and IS(mIS) were 10.88 ± 2.31, 12 ± 2.06, and 11.95 ± 2.07, respectively, the modified test TDI(mTDI) mean was 34.68 ± 6.47. The mTDI 10th percentile value was found to be 26. In all volunteers, there was no statistically significant difference between the two tests for the mean threshold score, while the difference in the mean discrimination score, the average identification score, and the average TDI (thresold, discrimination, sum of identification scores) score was statistically significant (P < .01).

CONCLUSION

This study is the first study to compare the SST and the MOT in our region. Making low-cost modifications by adding more probable smells to the smell tests and using them in studies involving more participants will be more meaningful in evaluating normative odor scores and will result in more widespread use.

[Reliability of whole-mouth taste test in assessment of gustatory function in healthy adults]

Objective:The purpose of this study was to evaluate the test-retest reliability of gustatory function using whole-mouth taste tests in healthy adults. Methods:Fifty healthy subjects were tested by whole-mouth taste test. The taste test involved 5 tastants（sour, sweet, salty, umami and bitter） and 7 concentrations. The tastant solutions were administered in a pseudo-random order starting with the lowest concentration. Record the perception and recognition scores of each tastant separately. The same operator performed test again by the same method two weeks later. The relative reliability and absolute reliability of the whole-mouth taste test were evaluated with intraclass correlation coefficient（ICC） and standard errors of measurement（SEM）, SEM% respectively. Results:The intraclass correlation coefficient of the perception scores of the sour, sweet, salty, umami and bitter in healthy subjects were from 0.753 to 0.819, ICC values of recognition score range from 0.751 to 0.828. In terms of absolute reliability, the SEM and SEM% values of perception scores were 0.329-0.463 and 6.60%-9.07% respectively; SEM of recognition scores were 0.425-0.581 and SEM%=9.09%-14.66%. Conclusion:The whole-mouth taste test could be a reliable tool for gustatory function test with good test-retest reliability in healthy adults.

Taste Sensitivity of Elderly People Is Associated with Quality of Life and Inadequate Dietary Intake

Aging has been implicated in the alteration of taste acuity. Diet can affect taste sensitivity. We aimed to investigate the types of tastes altered in elderly Korean people and factors associated with taste alteration in relation to dietary intake and other factors. Elderly participants (≥65 years) and young adults were assessed to determine their recognition thresholds (RT) for sweet, salty, bitter, sour, and umami tastes. Elderly participants were further surveyed for dietary intake and non-nutritional factors. Five taste RTs were correlated with age, but only four taste RTs, except sweetness, differed between the elderly participants and young adults. Inadequate intake of iron, thiamin, folic acid, zinc, and phosphorus among the elderly participants was related to elevated taste RT levels, except for bitter taste. In both correlation and regression analyses, only salty and sour RTs were associated with energy, iron, thiamin, fiber, vitamin C, and riboflavin levels in the elderly participants. The elderly participants’ taste RTs exhibited strong associations with quality of life (QOL) but showed partial relationships with physical activity, number of medicine intakes, social gatherings, and education. Taste sensitivity may decrease with age, which is further influenced by insufficient dietary intake, especially iron and thiamin, and QOL.

Altered glucose metabolism of the olfactory-related cortices in anosmia patients with traumatic brain injury

PURPOSE

Impaired brain cortices contribute significantly to the pathophysiological mechanisms of post-traumatic olfactory dysfunction (PTOD). This study aimed to use ¹⁸F-fluorodeoxyglucose positron emission tomography/computed tomography (¹⁸F-FDG PET/CT) to measure cerebral cortices' metabolism activity and then to explore their associations with olfaction in patients with PTOD.

METHODS

Ethics committee-approved prospective studies included 15 patients with post-traumatic anosmia and 11 healthy volunteers. Olfactory function was assessed using the Sniffin' Sticks. Participants underwent ¹⁸F-FDG PET/CT scan and the image data were collected for the voxel-based whole brain analysis. Furthermore, the standardized uptake value ratio (SUVR) of the whole brain regions was measured and correlated with olfactory function.

RESULTS

Patients with post-traumatic anosmia showed significantly reduced glucose metabolism in bilateral rectus, bilateral superior and medial orbitofrontal cortex (OFC), bilateral thalamus, left hippocampus and parahippocampus and left superior temporal pole (all p < 0.001). In contrast, patients with post-traumatic anosmia had significantly increased glucose metabolism in the bilateral insula (all p < 0.001). SUVR values among a total of 17 cerebral cortices including frontal, limbic, and temporal regions were significantly and positively correlated with olfactory function. The cerebral cortices with the top three correlations were the right middle frontal OFC (r = 0.765, p = 0.001), right caudate (r = 0.652, p = 0.010) and right putamen (r = 0.623, p = 0.002).

CONCLUSION

Patients with post-traumatic anosmia presented with distinct patterns of brain metabolism and key cortices that highly associated with the retained olfactory function were identified. The preliminary results further support the potential use of PET imaging for precisely assessing brain metabolism in patients with PTOD.

Development of Chinese odor identification test

Background

Olfactory dysfunction significantly reduces quality of life, with a prevalence as high as 20% in the general adult population. Odor identification (OI) tests are culturally dependent and widely used in clinical and epidemiological evaluations of olfaction. We aimed to develop a Chinese odor identification test (COIT) based on the Sniffin’ Sticks identification test.

Methods

Patients (n=60) with olfactory disorders and healthy controls (n=404) were recruited in the Smell and Taste Center of a tertiary-care university hospital. Unfamiliar odors in the Sniffin’ Sticks identification test were replaced to create a 16-item COIT, which was validated with a simplified Chinese version of the Cross-culture Smell Identification Test (CC-SIT) and Sniffin’ Sticks. A test-retest reliability of COIT was also conducted.

Results

Six odors with a correct recognition rate <75% were replaced with familiar odors for Chinese. The COIT score significantly correlated with both Sniffin’ Sticks (r=0.755 P<0.0001) and CC-SIT score (r=0.7462 P<0.0001). Based on the testing results of an additional 120 subjects, we concluded that scores of 12–16, 7–11, and 0–6 corresponded to normosmia, hyposmia, and anosmia, respectively. The 3-month test-retest-reliability coefficient was as high as 0.83.

Conclusions

The COIT is an effective tool for assessing olfactory function in the Chinese population.

Prognostic value of olfactory evoked potentials in patients with post-infectious olfactory dysfunction

PURPOSE

Prognostic assessment of patients with post-infectious olfactory dysfunction (PIOD) poses a challenge for clinicians. While there have been some studies on the prognostic factors of PIOD focusing on demographic factors, the aim of this study was to investigate whether event-related potentials (ERPs) could be used as a new predictor of olfactory recovery in PIOD.

METHODS

This was a retrospective study involving patients who underwent olfactory examinations using Sniffin' Sticks test before treatment and after 1 year of follow-up. The responder group was defined by an increase of threshold-discrimination-identification (TDI) score of ≥ 6 points. All patients underwent ERP examination and the amplitude and latency of each wave of ERPs were recorded before treatment.

RESULTS

A total of 61 patients (age 47.50 ± 11.04 years, 27 males) were analyzed. The presence of olfactory ERPs (oERPs) was greater in the responder group than in the non-responder group (P = 0.007), while that of trigeminal ERPs (tERPs) did not differ between the two groups (P = 0.346). Logistic-regression analyses showed that factors associated with improvement of subjective olfactory function were duration (OR, 1.604; 95% CI, 1.062-2.423; P = 0.025), initial threshold (odds ratio [OR], 0.043; 95% confidence interval [CI], 0.004-0.439; P = 0.008), and latency of N1 in oERPs (OR, 1.007; 95% CI, 1.001-1.013; P = 0.021).

CONCLUSION

Our study shows that duration of OD, initial threshold, and latency of N1 in oERPs were associated with olfactory improvement in PIOD patients, which may provide guidance for clinicians.

Olfactory outcomes after endonasal skull base surgery: a systematic review

For the last two decades, endonasal approach has been regularly applied to treat skull base lesions. However, postoperative olfactory dysfunction remains an unsolved problem. This systematic review aimed to identify factors that might affect postoperative olfactory prognosis of patients undergoing endonasal surgery for resection of sellar/parasellar lesions. The literature search was conducted comprehensively to exhaust studies which focused on patients' olfaction with objective olfactory assessments after endonasal skull base surgery. We sought to characterize the potential factors that might affect postoperative olfactory outcomes. Nineteen articles met inclusion criteria. We found that (1) endoscopic surgery was beneficial to patients' olfactory prognosis than microscopic surgery (incidence of postoperative decreased olfactory function: 18.48% (39/211) for the endoscopic group and 36.88% (52/141) for the microscopic group, P < 0.01); meta-analysis for single rate, 20% (95% CI 9-30%) for the endoscopic group and 35% (95% CI 0-72%) for the microscopic group); (2) harvesting septal flaps was an unfavorable factor for olfactory recovery and the rescue flap technique should be preferred compared with the HB flap; (3) no evidence showed that resection of the middle turbinate was detrimental to recovery of olfaction. Patients undergoing endoscopic endonasal surgery may have better olfactory outcomes than those undergoing microscopic endonasal surgery for resection of sellar/parasellar lesions. Special attention should be paid when using septal flaps is planned and the rescue flap technique should be the preferred choice. After resecting the middle turbinate, patients' olfaction still has a great chance of returning to the baseline. More homogeneous and high-quality studies are needed for further assessment.

Type 1/type 2 inflammatory cytokines correlate with olfactory function in patients with chronic rhinosinusitis

BACKGROUND

Olfactory dysfunction secondary to chronic rhinosinusitis (CRS) has been highly associated with impaired quality of life. Asian CRS patients showed a distinct inflammatory profile, with less type 2 endotype compared with European and North American. This study aimed to explore the pattern of the inflammatory cytokines in CRS patients from China and their association with olfactory function.

METHODS

Institutional review board-approved prospective study in which the olfactory function of 71 CRS patients was assessed with Sniffin' Sticks before the nasal endoscopic surgery. A set of cytokines and inflammatory mediators including type 1 and type 2 inflammatory cytokines were measured in nasal mucus by using a multiplex flow cytometric bead assay (CBA). Baseline characteristics in CRS patients were collected and the Spearman r statistic was performed to assess the association of olfactory function with cytokines and inflammatory mediators.

RESULTS

A total of 71 nasal mucus samples of CRS patients, including 25 chronic rhinosinusitis without nasal polyposis (CRSsNP) patients and 46 chronic rhinosinusitis with nasal polyposis (CRSwNP) patients, were evaluated in this study. The nasal mucus levels of type 1 inflammatory cytokine IFN-γ (interferon-γ), type 2 inflammatory cytokines including IL-4, IL-5 and GM-CSF (granulocyte-macrophage colony-stimulating factor) and anti-inflammatory cytokine IL-10 were significantly and inversely correlated with olfactory function in total patients with CRS (r = -0.308, p = 0.009; r = -0.250, p = 0.036; r = -0.399, p = 0.001; r = -0.269, p = 0.023; r = -0.273, p = 0.021, respectively). In CRSsNP, the olfactory function was inversely correlated with levels of type 1 inflammatory cytokine TNF-α (tumor necrosis factor-α) (r = -0.637, p = 0.001) and IL-10 (r = -0.468, p = 0.018). Nevertheless, the olfactory function in CRSwNP was inversely correlated with type 2 inflammatory cytokines including IL-4 (r = -0.303, p = 0.041) and IL-5 (r = -0.383, p = 0.009).

CONCLUSION

Both type 1 and type 2 inflammatory cytokines may contribute to the pathogenesis of CRS-associated olfactory dysfunction in the Chinese population.

Influence of age and sex on taste function of healthy subjects

The purpose of this study was to determine the influence of age and sex on the taste functions of healthy Taiwanese. Subjects were divided into groups based on their sex and age: 20-39 years, 40-59 years, or ≥ 60 years. We evaluated the taste functions of subjects using the whole mouth suprathreshold taste test and the taste quad test. For the whole-mouth test, subjects were instructed to sip and swish sweet, sour, salty, and bitter solutions, each at 5 different suprathreshold concentrations. Each subject was required to indicate the taste quality, and to rate the intensity and unpleasantness/pleasantness of each taste of the solutions. For the quad test, the 4 quadrants of the tongue surface were tested by applying a drop of one concentration of sweet, sour, salty, or bitter solutions 6 times. Subjects then indicated the taste quality and rated the intensity of the solution. We found that in the whole mouth test, the total correct identification score dropped with age, but the ability to identify sweet and salty qualities was not affected by age. No differences were found between males and females, except women scored better than men for sweetness in the 40-59 years age group. The intensity rating scores were higher in the 20-39 years age group, regardless of sex. With regard to the pleasantness of tastants, female subjects in the 20-39 years age group found sweet solution more pleasant than the older subjects did. In the quad test, the total correct identification score decreased with age, but there were no differences between males and females. Thus, our findings showed that both age and sex affected the taste functions of healthy Taiwanese to some extent, and differences were dependent on tongue region and taste quality.

Superior turbinate eosinophilia predicts olfactory decline in patients with chronic rhinosinusitis

BACKGROUND

Predicting postoperative olfactory decline in patients with chronic rhinosinusitis (CRS) remains a considerable challenge.

OBJECTIVE

To evaluate patterns of postoperative olfactory function in patients with CRS and explore potential predictors of postoperative olfactory decline.

METHODS

A total of 76 patients with CRS electing endoscopic sinus surgery (ESS) were enrolled in this prospective study. Olfaction was assessed with Sniffin' Sticks preoperatively and 3 months postoperatively. Preoperative peripheral venous blood and superior turbinate at surgery were collected for eosinophil quantification. Olfactory cleft was evaluated by computed tomography and endoscopy. Postoperative olfactory decline was defined by a decrease in threshold-discrimination-identification (TDI) score more than 0 point. Multivariable logistic regression analysis was conducted to identify potential predictors associated with postoperative olfactory decline in TDI score.

RESULTS

A total of 30.26% of patients with CRS (23/76) presented with olfactory decline 3 months post-ESS. Patients with CRS with olfactory decline showed significantly higher preoperative tissue eosinophils (P < .001), blood eosinophil count (P = .002), blood eosinophil percentage (P = .009), and preoperative TDI scores (P = .017) than patients with CRS without olfactory decline. After adjusting for patient demographics and comorbidities, the preoperative tissue eosinophilia was significantly associated with patients with CRS with postoperative olfactory decline (odds ratio = 1.103; P = .038). An absolute count of 23.5 eosinophils per high-power field in superior turbinate was the best predictor of olfactory decline with the highest area under the receiver operating characteristic curve of 0.901.

CONCLUSION

Superior turbinate eosinophilia is highly associated with olfactory decline in patients with CRS 3 months after ESS.

Development of the Chinese Smell Identification Test

Smell identification ability reflects the functional integrity of the human olfactory system. Its deficit is a prodromal marker for Parkinson's disease and is also implicated in Alzheimer's disease and other neurological and psychiatric disorders. Considering the impact of cultural factors on odor identifiability, we have developed a smell identification test specifically for the Chinese population (CSIT), which includes 40 odor items that are familiar to this population, presented in a multiple-choice format. The CSIT has a test-retest reliability of 0.92 and is validated against the University of Pennsylvania Smell Identification Test (UPSIT) and the Sniffin' Sticks Identification Test 16 (SS-16). In terms of identification accuracy, Chinese participants on average score 15% higher on the CSIT than on the UPSIT or SS-16. The CSIT is also sensitive to age and gender differences in smell identification ability. As such, the CSIT provides an effective tool for the assessment of olfactory function in the Chinese population.

Sampling, identification and sensory evaluation of odors of a newborn baby's head and amniotic fluid

For baby odor analyses, noninvasive, stress-free sample collection is important. Using a simple method, we succeeded in obtaining fresh odors from the head of five newborn babies. These odors were chemically analyzed by two-dimensional gas chromatography coupled with mass spectrometry (GC × GC-MS), and compared with each other or with the odor of amniotic fluid from the baby's mother. We identified 31 chemical components of the volatile odors from neonate heads and 21 from amniotic fluid. Although 15 of these components were common to both sources, there was an apparent difference in the GC × GC patterns between the head and amniotic fluid odors, so the neonate head odor might be individually distinct immediately after birth. Therefore, we made artificial mixtures of the major odor components of the neonate head and maternal amniotic fluid, and used psychological tests to examine whether or not these odors could be distinguished from each other. Our data show that the artificial odor of a neonate head could be distinguished from that of amniotic fluid, and that the odors of artificial head odor mixtures could be correctly discriminated for neonates within an hour after birth and at 2 or 3 days of age.

Sex Differences in Human Olfaction: A Meta-Analysis

Although the view that women's olfactory abilities outperform men's is taken for granted, some studies involving large samples suggested that male and female olfactory abilities are actually similar. To address this discrepancy, we conducted a meta-analysis of existing studies on olfaction, targeting possible sex differences. The analyzed sample comprised n = 8 848 (5 065 women and 3 783 men) for olfactory threshold (as measured with the Sniffin Sticks Test; SST), n = 8 067 (4 496 women and 3 571 men) for discrimination (SST), n = 13 670 (7 501 women and 6 169 men) for identification (SST), and a total sample of n = 7 154 (3 866 women and 3 288 men) for works using University of Pennsylvania Smell Identification Test (UPSIT). We conducted separate meta-analyses for each aspect of olfaction: identification, discrimination and threshold. The results of our meta-analysis indicate that women generally outperform men in olfactory abilities. What is more, they do so in every aspect of olfaction analyzed in the current study. However, the effect sizes were weak and ranged between g = 0.08 and g = 0.30. We discuss our findings in the context of factors that potentially shape sex differences in olfaction. Nevertheless, although our findings seem to confirm the "common knowledge" on female olfactory superiority, it needs to be emphasized that the effect sizes we observed were notably small.

Association between autonomic dysfunction and olfactory dysfunction in Parkinson's disease in southern Chinese

BACKGROUND

The aim was to investigate the autonomic dysfunction between Parkinson's disease (PD) patients with olfactory dysfunction and PD patients without olfactory dysfunction in southern Chinese population.

METHODS

Fifty-six PD patients with olfactory dysfunction and 44 patients without olfactory dysfunction were included. All patients were evaluated by Sniffin' sticks (SS-16), scales for outcomes in Parkinson's disease-autonomic questionnaire, Hamilton anxiety rating scale and Hamilton depression rating scale RESULTS: The score of subpart of gastrointestinal symptoms and subpart of urinary symptoms were different in two groups (gastrointestinal symptoms: p value: 0.024; urinary symptoms: p value: 0.008). As for each question items, questions 2, 8, 10, 11, 13, 14 were correlated with SS-16 scores (Question 2: p value: 0.013; question 6: p value: 0.006; question 8: p value: 0.025; question 10: p value: 0.005; question 11: p value: 0.022; question 13: p value: < 0.001; question 14: p value: 0.038). Question 10 and 14 were associated with olfactory dysfunction after adjusting disease duration and gender (Question 10: p value: 0.011, OR: 3.91; Question 14: p value: 0.027, OR: 3.27).

CONCLUSIONS

Gastrointestinal, urinary and a part of cardiovascular symptoms of SCOPA-AUT were associated with olfactory dysfunction in PD patients.

Evaluation of idiopathic olfactory loss with chemosensory event-related potentials and magnetic resonance imaging

Background

Idiopathic olfactory loss (IOL) accounts for a sizable fraction of olfactory dysfunction, but very little is known about its etiology and electrophysiological changes in the olfactory pathway.

Methods

We analyzed the physiology of IOL using chemosensory event‐related potentials (ERPs) (olfactory and trigeminal: oERP and tERP) and olfactory pathway magnetic resonance imaging (MRI) measured in adult patients with IOL and healthy controls. Subjective olfactory function was measured by Toyota and Takagi (T&T) olfactometry and Sniffin’ Sticks (SS).

Results

Olfactory function was worse in patients with IOL compared to controls (T&T, p < 0.001; SS, p < 0.001). oERPs could be evoked in 17 IOL patients. Signals in these patients showed lower amplitude in the N₁ and P₂ waves than controls (p < 0.05 for both), but there were no difference in latency between the 2 groups (p > 0.05). tERP were detected in all patients and controls; there were no differences in latency and nor amplitude between the 2 groups (p > 0.05). The olfactory bulb (OB) volume was significantly smaller in the IOL group than controls (p < 0.001), but there was no difference in the olfactory sulcus depth between groups (p > 0.05). Better olfactory function was associated with increasing magnitude of N₁ amplitude in oERPs (p < 0.05) and increasing OB volume (p < 0.05).

Conclusion

IOL patients show neurophysiologic deficits and some anatomic differences compared to healthy controls.

Olfactory assessment in the Chinese pediatric population

Young children with olfactory disturbance are sometimes encountered in ENT clinics. We investigated the clinical applicability of olfactory testing to the pediatric population in China.One hundred and ninety-three healthy children aged 6 to 17 years were enrolled. All participants were asked for demographic information (age, sex, body mass index [BMI], and rating of olfactory function) in a structured questionnaire and underwent olfactory testing including T&T Olfactometer (T&T), odor discrimination (OD), and odor identification (OI) tests of Sniffin' Sticks.Age had a significant influence on the outcome of olfactory testing, sex, BMI, or self-rating had no influence. Children had better performance on T&T than OI and OD tests of Sniffin' Sticks.T&T and Sniffin' Sticks can be completed by Chinese children. Performance on olfactory tests increased with increasing age. T&T may be more suitable to assess olfactory function in the Chinese pediatric population.

Development of a Gustatory Function Test for Clinical Application in Korean Subjects

PURPOSE

To obtain validated clinical values suitable for developing a gustatory function test, including umami taste, in a Korean population.

MATERIALS AND METHODS

The investigation involved 297 participants with self-reported normal sense of taste and smell. Liquid solutions were used for the assessment of gustatory function. The test consisted of 30 taste solutions [six concentrations of five tastants (sweet, bitter, salty, sour, and umami)]. For evaluation of overall gustatory function, the number of detected or correctly recognized taste thresholds was combined to form a "taste score."

RESULTS

Mean values of each detection and recognition threshold for the five tastes in men were consistently lower than those of women. The 10th percentile of taste score for recognition was used as the cut-off value for distinguishing normogeusia from hypogeusia. In subgroup analysis, total taste score from recognition thresholds revealed a significant negative correlation with age, indicating lower scores for increasing age. Taste score for non-smokers was significantly higher than that of smokers, in terms of detection and recognition of taste sensitivities.

CONCLUSION

This gustatory function test was easy to perform, affordable, and time-saving, with the capacity to self-produce and obtain reliable data. Gustatory function was more sensitive in young people, women, and non-smokers.

Gender difference in Chinese adults with post-viral olfactory disorder:a hospital-based study

CONCLUSIONS

This hospital-based study found a gender differences in Chinese subjects with post-viral olfactory disorder (PVOD). Women appear to face higher susceptibility to PVOD, a finding that appears to be magnified with age and duration of olfactory loss.

OBJECTIVES

PVOD is one of the most common reasons for acquired olfactory dysfunction, but there is little data in Chinese populations. We analyzed Chinese subjects with PVOD in order to determine demographic risk factors and clinical features in this major population group.

METHODS

Data from 143 consecutive subjects with PVOD and 117 subjects with other olfactory disorders (controls) were analyzed. This study examined age, duration, and severity of olfactory loss, and compared the differences of subjective and objective olfactory function tests between two groups, using Sniffin' Sticks, Olfactory Event Related Potential (OERP), and olfactory pathway MRI.

RESULTS

There were more women in the PVOD group compared to controls (p < 0.001). Older subjects with PVOD were more likely to be women (p = 0.027), and the proportion of women with PVOD increased with the duration of olfactory loss (p = 0.032). There were no differences in the prevalence of abnormal OERP between two groups, although the female-to-male ratio was higher in the PVOD group (p = 0.041). Women with PVOD were less likely to have olfactory pathway abnormalities by MRI compared to controls (p < 0.001).

What does the nose know? Olfactory function predicts social network size in human

Olfaction is an important medium of social communication in humans. However, it is not known whether olfactory function is associated with social network size. This study aimed to explore the underlying neural mechanism between olfactory function and social network. Thirty-one healthy individuals participated in this study. Social network size was estimated using the Social Network Index. Olfactory function was assessed with the Sniffin' Stick Test. The results showed that there is a significant positive correlation between the size of an individual's social network and their olfactory sensitivity. We also found that amygdala functional connectivity with the orbitofrontal cortex appeared to be related to olfactory sensitivity and social network size.

Gray matter volume reduction of olfactory cortices in patients with idiopathic olfactory loss

Idiopathic olfactory loss (IOL) is a common olfactory disorder. Little is known about the pathophysiology of this disease. Previous studies demonstrated decreased olfactory bulb (OB) volume in IOL patients when compared with controls. The aim of our study was to investigate structural brain alterations in areas beyond the OB. We acquired T1-weighted magnetic resonance images from 16 patients with IOL and from 16 age- and sex-matched controls on a 3T scanner. Voxel-based morphometry (VBM) was performed using VBM8 toolbox and SPM8 in a Matlab environment. Psychophysical testing confirmed that patients had higher scores for Toyota and Takagi olfactometer and lower scores for Sniffin' Sticks olfactory test than controls (t = 46.9, P < 0.001 and t = 21.4, P < 0.001, respectively), consistent with olfactory dysfunction. There was a significant negative correlation between the 2 olfactory tests (r = -0.6, P = 0.01). In a volume of interest analysis including primary and secondary olfactory areas, we found patients with IOL to exhibit gray matter volume loss in the orbitofrontal cortex, anterior cingulate cortex, insular cortex, parahippocampal cortex, and the piriform cortex. The present study indicates that changes in the central brain structures proximal to the OB occur in IOL. Further investigations of this phenomenon may be helpful to elucidate the etiology of IOL.

[Polish version of the Sniffin' Sticks Test - adaptation and normalization]

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.

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

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.

Ageing and taste

Taste perception has been studied frequently in young and older adult groups. This paper systematically reviews these studies to determine the effect of ageing on taste perception and establish the reported extent of sensory decline. Five databases were searched from 1900 to April 2012. Articles relating to healthy ageing in human subjects were included, reviewed and rated (Downs and Black scoring system). Sixty-nine studies investigated the effect of ageing on taste perception; forty examined detection thresholds of which twenty-three provided sufficient data for meta-analysis, eighteen reported identification thresholds and twenty-five considered supra-threshold intensity perception. Researchers investigating detection thresholds considered between one and thirteen taste compounds per paper. Overall, the consensus was that taste detection thresholds increased with age (Hedges’ g = 0·91, P < 0·001), across all taste modalities. Identification thresholds were reported to be higher for older adults in seventeen out of eighteen studies. Sixteen out of twenty-five studies reported perception of taste intensity at supra-threshold levels to be significantly lower for older adults. However, six out of nine studies concerning sucrose found perceived intensity of sweet taste not to diminish with age. The findings of this systematic review suggest taste perception declines during the healthy ageing process, although the extent of decline varies between studies. Overall, the studies reviewed had low Downs and Black scores (mean 16 (SD 2)) highlighting the need for more robust large scale and longitudinal studies monitoring the impact of ageing on the sensory system, and how this influences the perception of foods and beverages.

Examination of chemosensory functions in patients with dysosmia

Background

To examine changes of chemical sensory functions in patients with dysosmia.

Material/Methods

The 272 study subjects included 98 healthy volunteers, 86 subjects with hyposmia and 88 subjects with functional anosmia. Their chemical sensory functions were examined using olfactory event-related potentials (oERPs), trigeminal event-related potentials (tERPs), T&T olfactometer and triple drop method, respectively.

Results

The T&T results showed that the difference between patients and healthy subjects had statistical significance. The oERPs and tERPs results showed that patients with functional anosmia had N1 and P2 waves of prolonged latency and reduced amplitude when compared to healthy subjects with the difference of statistical significance. When compared to healthy subjects, patients with functional anosmia had clear hypogeusia and the difference had statistical significance. For the younger group there was significant difference between healthy subjects and patients in T&T, oERPs and tERPs results.

Conclusions

It is suggested by the apparently concomitant trigeminal nerve dysfunction and hypogeusia in patients with functional anosmia in this study that olfactory and nasal trigeminal function in young patients was clearly decreased. Our study suggests the possible application of oERPs, tERPs and three drops method in clinical diagnosis in Chinese populations and provides scientific evidence for treatment.

Application of odor identification test in Parkinson's disease in China: a matched case-control study

As one of the most common non-motor symptoms in Parkinson's disease (PD), hyposmia is of great importance in establishing the early diagnosis of PD. To date, there are still no studies on the application of the 16-item odor identification test from Sniffin' Sticks (SS-16) in Chinese patients with PD. The aim of this study was to investigate the validity of SS-16 in Chinese PD patients (n=110) compared with age and gender matched controls (n=110), and to explore the associated factors with olfactory function in PD patients. The 16 odors in the original odor identification test were retained but some alternative descriptions were developed before applications. Mean identification scores in patients were significantly lower than in controls (7.3 ± 2.8 VS. 11.6 ± 2.0 P<0.01), with 66.4% of patients had an impairment of odor identification as evaluated by 95% confidential interval of the identification score of the control group. Receiver operating characteristic curves revealed 86% sensitivity and 81% specificity in separating PD and healthy controls with a cut-off value of 9.5. Multiple linear regression analysis revealed that autonomic dysfunction was a significant influential factor of odor identification scores in patients with PD. In conclusion, SS-16 provides a valid instrument for olfactory assessment in Chinese PD patients, and hyposmia may correlate with autonomic dysfunction in patients with PD.

Evaluation of Factors Concerning the Olfaction Using the Sniffin’ Sticks Test

Objective. This study aimed to research the normative values of olfactory function in the Turkish population using the Sniffin’ Sticks test and to relate olfactory performance to age, sex, smoking, educational level, and the side examined. It also aimed to compare the results with other countries’ normative values, especially Europe, using the same test and procedure.

Study Design. Prospective clinical study.

Setting. Tertiary referral center.

Subjects and Methods. This study was a prospective clinical trial conducted in a tertiary clinic. A total of 100 healthy subjects were included in the study. Of these, 50 were men and 50 were women. The mean (SD) age of the subjects was 37.7 (14.8) years (range, 18-77 years).

Results. Odor scores were lower than the scores of other countries, and the scores decreased significantly with age. There was no relationship between olfaction and sex or smoking. Subjects with a lower educational status had lower scores compared with the scores of median and highly educated subjects.

Conclusion. This is the first study that evaluated the relationship between education level and olfaction. According to the results, the cultural differences, education level, and age seemed to influence odor scores. The Sniffin’ Sticks test can be used to assess olfactory performance in a Turkish population, but identification of odors in this test battery may show variability because of local and cultural factors.