Mats Bende

“Taste Strips” – A rapid, lateralized, gustatory bedside identification test based on impregnated filter papers

ObjectiveTo elaborate normative values for a clinical psychophysical taste test (“Taste Strips”).BackgroundThe “Taste Strips” are a psychophysical chemical taste test. So far, no definitive normative data had been published and only a fairly small sample size has been investigated. In light of this shortcoming for this easy, reliable and quick taste testing device, we attempted to provide normative values suitable for the clinical use.SettingNormative value acquisition study, multicenter study.MethodsThe investigation involved 537 participants reporting a normal sense of smell and taste (318 female, 219 male, mean age 44 years, age range 18–87 years). The taste test was based on spoonshaped filter paper strips (“Taste Strips”) impregnated with the four (sweet, sour, salty, and bitter) taste qualities in four different concentrations. The strips were placed on the left or right side of the anterior third of the extended tongue, resulting in a total of 32 trials. With their tongue still extended, patients had to identify the taste from a list of four descriptors, i. e., sweet, sour, salty, and bitter (multiple forcedchoice). To obtain an impression of overall gustatory function, the number of correctly identified tastes was summed up for a “taste score”.ResultsTaste function decreased significantly with age. Women exhibited significantly higher taste scores than men which was true for all age groups. The taste score at the 10th percentile was selected as a cut-off value to distinguish normogeusia from hypogeusia. Results from a small series of patients with ageusia confirmed the clinical usefulness of the proposed normative values.ConclusionThe present data provide normative values for the “Taste Strips” based on over 500 subjects tested.

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-identification 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.

Prevalence of nasal polyps in adults: the Skövde population-based study.

Patients with nasal polyps present repeatedly in otorhinolaryngology practices, but the prevalence of nasal polyps in the general population is not known. Our objective was to investigate the prevalence of nasal polyps in an adult Swedish population in relation to age, gender, asthma, and aspirin intolerance. A random sample of 1,900 inhabitants over the age of 20 years, stratified for age and gender, was drawn from the municipal population register in Skövde, Sweden, in December 2000. The subjects were called to clinical visits that included questions about rhinitis, asthma, and aspirin intolerance and examination by nasal endoscopy. In total, 1,387 volunteers (73% of the sample) were investigated. The sample size was adequate, with a good fit to the whole population. The prevalence of nasal polyps was 2.7% (95% confidence interval, 1.9–3.5), and polyps were more frequent in men (2.2 to 1), the elderly (5% at ≥60 years of age), and asthmatics. Subjective symptoms of aspirin intolerance were not found to correlate with polyps. Nasal polyps were more common in adults than was stated by the a priori estimate. The Skövde population-based study is considered representative for the Swedish population.

Perceptual learning in olfaction: professional wine tasters versus controls.

By having professional wine tasters and controls perform olfactory tasks of absolute detection (1-butanol), discrimination (lemon and cloves), and identification (common household odors), the present two experiments studied (a) if perceptual odor learning takes place from odor experience acquired under nonlaboratory conditions, (b) if this learning generalizes to odors for which experience is limited, and (c) if generalized learning can be referred to increased general interest for odors that increases attention to odorous features. The results showed that whereas wine tasters were not better than controls on detection, they were superior to controls on discrimination and identification, the latter due to only a few odors. Ratings of experience with certain odors during professional evaluation suggest that generalized perceptual learning may take place in discrimination but not in identification. Wine tasters did not show more general interest for odorous features than did controls. The nonsuperiority in detection may be explained by the fact wine tasters have no professional experience of a detection task per se, implying that perceptual odor learning does not generalize from the olfactory tasks of discrimination and identification to detection.

The Chemical Sensitivity Scale: Psychometric properties and comparison with the noise sensitivity scale

Abstract A questionnaire-based tool for quantifying self-reported affective reactions to and behavioral disruptions by odorous/pungent substances, called the Chemical Sensitivity Scale (CSS), analogous to the Noise Sensitivity Scale (NSS), was evaluated regarding psychometric properties. Twenty-six members from the Swedish Asthma and Allergy Association and 124 control participants responded to the CSS, the NSS, and to additional questions for evaluation of the validity of the CSS and NSS. The results showed that the CSS generates approximately normal distributions, has good test–retest reliability ( r xy =0.87), good internal consistency ( r α =0.88), and satisfying predictive and concurrent validity. These metric properties of the CSS and NSS were in general very similar. The content validity of the CSS is discussed. Two major dimensions of the CSS appear to represent sensory/somatic and neurasthenic symptoms, respectively. The analogy of the CSS to the NSS implies that use of both scales in combination may enhance understanding for the issue of general environmental sensitivity versus specific sensitivity to chemicals. Correlation coefficients between CSS and NSS scores for the asthma and allergy members ( r xy =0.40) and controls ( r xy =0.42) imply a moderate correspondence between chemical and noise sensitivity.

Evaluation of Methods for Endoscopic Staging of Nasal Polyposis

Endoscopy is needed for reliable evaluation of the treatment of nasal polyposis. In this study, we compared the reproducibility of various score systems for staging nasal polyposis and the inter-individual variations between investigators. The mass of the polyps was assessed by five methods, three new techniques (numbers 1, 2 and 3) and two established ones (numbers 4 and 5). These were: 1, lateral imaging?projecting the extension of the polyps by drawing on a schematic picture of the lateral wall of each nasal cavity; 2, assessment of polyp obstruction?estimating the proportion of the total nasal cavity volume occupied by polyps; 3, nasal airway patency?determining the relationship between the patient?s patent airway lumen and an imaginary maximal nasal airway lumen; 4, a score system with four steps ad modum Lildholdt et al.?determining their relationship to fixed anatomical landmarks; and 5, a score system with three steps ad modum Lund and Mackay?determining their relationship to the middle meatus. High correlations were found between the first and the second assessments by a given investigator with all five methods used to score nasal polyposis. High correlations were also shown between the various methods. When three investigators examined a given patient, there were no significant differences between the investigators using score systems 1, 3 and 4. However, with score systems 2 and 5, there was insufficient agreement between the investigators. The patient?s symptom of nasal blockage was not a good indicator of the size of the polyps, especially as regards small polyps. Two of the best methods tested (1 and 4) were selected for further clinical studies regarding evaluation of the sensitivity of score systems to detect changes in polyp size during treatment.Endoscopy is needed for reliable evaluation of the treatment of nasal polyposis. In this study, we compared the reproducibility of various score systems for staging nasal polyposis and the inter-individual variations between investigators. The mass of the polyps was assessed by five methods, three new techniques (numbers 1, 2 and 3) and two established ones (numbers 4 and 5). These were: 1, lateral imaging projecting the extension of the polyps by drawing on a schematic picture of the lateral wall of each nasal cavity; 2, assessment of polyp obstruction estimating the proportion of the total nasal cavity volume occupied by polyps; 3, nasal airway patency--determining the relationship between the patients patent airway lumen and an imaginary maximal nasal airway lumen; 4, a score system with four steps ad modum Lildholdt et al.--determining their relationship to fixed anatomical landmarks; and 5, a score system with three steps ad modum Lund and Mackay--determining their relationship to the middle meatus. High correlations were found between the first and the second assessments by a given investigator with all five methods used to score nasal polyposis. High correlations were also shown between the various methods. When three investigators examined a given patient, there were no significant differences between the investigators using score systems 1, 3 and 4. However, with score systems 2 and 5, there was insufficient agreement between the investigators. The patients symptom of nasal blockage was not a good indicator of the size of the polyps, especially as regards small polyps. Two of the best methods tested (1 and 4) were selected for further clinical studies regarding evaluation of the sensitivity of score systems to detect changes in polyp size during treatment.

Reference Values for Acoustic Rhinometry in Subjects without Nasal Symptoms

Reference values for acoustic rhinometry are presented from 334 individuals without nasal symptoms between 4 years and 61 years old. There was a significant correlation between the minimal cross-sectional area (MCA) and nasal volume. Although the reproducibility of the method was good, the MCA varied widely. MCA correlated weakly to weight, height, age, and body mass index. Our data suggest that acoustic rhinometry is valuable for inter-individual comparisons.

Clinical experience with patients with olfactory complaints, and their quality of life

Conclusion. A special consulting team for patients with olfactory disorders would be able to verify, describe, and explain the characteristics of the disorders, also in cases where a patient experiences a disorder, but has a normal sense of smell. Objectives. The general purpose of this paper was to present our experience with patients seeking medical attention for olfactory disorders, and to describe how quantitative and qualitative olfactory disorders are diagnosed, what the etiologies are, and how quality of life is compromised in patients with olfactory disorders. Subjects and methods. This investigation was performed prospectively over a 10-year period by one physician responsible for the consulting team for patients with olfactory disorders. Based on a standardized clinical examination, a structured interview, and assessment of olfactory function, its aim was to diagnose quantitative and qualitative disorders in 303 consecutive patients. Health-related quality of life was assessed with the Nottingham Health Profile (NHP) in about one-third of patients. Results. In the majority of patients, a reduced sense of smell was found after testing. Often, but not always, this was combined with qualitative disorders. Dominating etiologies were infections, nasal polyposis, head trauma, and aging. Patients complaining of olfactory disorders experience a significantly reduced quality of life regarding the impact of their health problem on paid employment, household work, and social and family life.

A Method for Determination of Blood Flow with 133 Xe in Human Nasal Mucosa

The 133Xe wash-out technique was used as a method for calculation of the blood flow in human nasal mucosa. The disappearance of 133Xe from the nasal mucosa was followed using scintillation detectors. In laryngectomies it was shown that the disappearance of 133Xe from the mucosa depended mainly on the blood flow. Leakage of 133Xe from the mucosa to the nasal air was unimportant. The disappearance rate of 133Xe was decreased by oxymetazoline and increased by histamine, mostly likely due to the effects of these vasoactive drugs on the mucosa blood flow. The 133Xe wash-out technique would seem to be a simple method to study nasal mucosal blood-flow changes in humans.

Nasal Stuffiness During Pregnancy

Objective: To investigate the occurrence of nasal stuffiness during pregnancy. Study Design: Prospective longitudinal study, with collection of data during 1 year in a cohort of 2,264 pregnant women. Methods: Self‐reported nasal stuffiness in gestational weeks 12, 20, 30, and 36 was correlated to age, parity, body mass index, and smoking habits. Results: The prevalence of nasal stuffiness increased during pregnancy and occurred in 27% of the women at 12 weeks of gestation, in 37% at 20 weeks, in 40% at 30 weeks and in 42% at 36 weeks. Sixty‐five percent of the women reported stuffiness at some time when asked. It was commoner in multiparous than in nulliparous women. Age, body mass index, and smoking habits were not associated with nasal stuffiness. Conclusion: Self‐reported nasal stuffiness for 3 or more weeks was common during pregnancy and could occur at any time in two thirds of the women. Treatment regimens to alleviate this symptom should be developed.