Murat Salihoglu

The applicability of the "Sniffin' Sticks" olfactory test in a Turkish population.

Background Olfactory assessment is often neglected in clinical practice, although olfactory loss can assist in diagnosis and may lead to significant morbidity. “Sniffin’ Sticks” is a modern test of nasal chemosensory performance that was developed in Germany and validated in many countries. Our aim was to validate the applicability of “Sniffin’ Sticks” in a Turkish population. Material/Methods The study included 123 healthy volunteers with a reported normal sense of smell and 51 patients complaining of a reduction in their olfactory function presenting either at rhinology or neurology clinics. The mean age of the subjects tested was 30.2±12.5 years in 126 males and 48 females. The participants were divided into 2 groups according to subjective olfactory function – healthy or abnormal. Each subject’s olfactory function was assessed using the “Sniffin’ Sticks” test. Results We found significant differences in “Sniffin’ Sticks” test results between the abnormal and healthy groups. In healthy subjects, the 10th percentiles of odor threshold score, odor discrimination score, odor identification score, and TDI score were 7.25, 12, 11, and 32, respectively. Considering the 2 groups together, apple and turpentine were the least well-recognized odors from the 16 odors presented. Conclusions Our study provides an update of normative values for routine clinical use of “Sniffin’ Sticks” in a Turkish population. Also, the present study validates that “Sniffin’ Sticks” olfactory test was applicable for clinical usage in a Turkish population.

Modified olfactory training in patients with postinfectious olfactory loss

Patients with olfactory dysfunction benefit from repeated exposure to odors, so‐called olfactory training (OT). This does not mean occasional smelling but the structured sniffing of a defined set of odors, twice daily, for a period of 4 months or longer. In this prospective study, we investigated whether the effect of OT might increase through the use of more odors and extension of the training period.

The effect of obstructive sleep apnea on olfactory functions.

The aim of this study was to investigate the effect of obstructive sleep apnea (OSA) on the parameters of olfactory functions (odor threshold, odor discrimination, and odor identification tests) for orthonasal olfaction, retronasal olfactory testing, and olfactory bulb (OB) volumes.

Comparison of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique after septoplasty in terms of immediate respiratory distress related to anesthesia and surgical complications

Abstract Conclusion: The patients who underwent septoplasty with bilateral totally occlusive nasal packing had an increased risk of experiencing respiratory distress (RD). Objective: To compare the immediate RD rates during recovery from anesthesia and surgical complications of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique. Methods: A total of 150 patients were assigned to one of three groups according to the technique utilized following septoplasty: transseptal suturing, internal nasal splint, or Merocel (nasal dressing without airway). To determine RD related to anesthesia in the operating theatre, the criterion was defined as any unanticipated hypoxemia, hypoventilation or upper airway obstruction (stridor or laryngospasm) requiring an active and specific intervention. Postoperative hemorrhage, infection, synechia formation, and septal perforation were evaluated. Results: Patients in the Merocel group were 3.6 times more likely to have RD than patients in the transseptal suture and internal nasal splint groups. Also, patients who smoked had an increased risk of RD during the recovery phase of anesthesia after the septoplasty. In addition, all three techniques resulted in similar complication rates after septoplasty, with the exception of minor hemorrhage, which had a significantly higher rate in the transseptal suture group.

Lateralized Differences in Olfactory Function and Olfactory Bulb Volume Relate to Nasal Septum Deviation

AbstractOne of the most common reasons for partial nasal obstruction is nasal septal deviation (NSD). The effect of a partial lateralized nasal obstruction on olfactory bulb (OB) volume remains unclear. Thus, the aim of this study was to investigate the side differences in olfactory function and OB in patients with serious NSD. Sixty-five volunteers were included: 22 patients with serious right NSD and 43 patients with left NSD. The patients’ mean age was 22 years. All participants received volumetric magnetic resonance imaging scans of the entire brain and detailed lateralized olfactory tests. The majority of the patients exhibited an overall decreased olfactory function (as judged for the better nostril: functional anosmia in 3%, hyposmia in 72%, normosmia in 25%), which seems to be mostly due to the overall severe changes in nasal anatomy. As expected, olfactory function was significantly lower at the narrower side as indicated for odor thresholds, odor discrimination, and odor identification (P ⩽ 0.005). When correlating relative scores and volumes (wider minus narrower side), a significantly positive correlation between the relative measures emerged for OB volume and odor identification, odor discrimination, and odor thresholds. Our study clearly highlights that septal deviation results in decreased olfactory function at the narrower side.

Laryngopharyngeal Reflux Has Negative Effects on Taste and Smell Functions

Objective We evaluated the halimetric, olfactory, and taste functions of patients with laryngopharyngeal reflux (LPR). Study Design Prospective clinical study. Setting Multicenter tertiary care hospital. Methods Patients who were diagnosed with LPR for the first time on the basis of a Reflux Finding Score (RFS) >11 and a Reflux Symptom Index (RSI) >13 were enrolled in this study. A control group was selected from patients without a complaint of LPR. OralChroma was used for the halimetric measurement; Sniffin’ Sticks were used for the smelling test; Taste Strips were used for the taste test; and monosodium L-glutamate was used for the umami test. Results A total of 110 subjects were included, with a mean age of 36.8 ± 10 years (range, 19-57 years). The differences in odor threshold scores were significant between the groups (P < .001), but no change was detected for the odor identification or discrimination scores between the groups. Bitter taste scores were significantly diminished in the reflux group compared with those in the control group (P = .001), whereas no impairments were found in the other taste scores (sweet, salty, and sour). The reflux group had significantly higher umami taste scores than those of the control group for the posterior tongue and soft palate anatomic sites (P < .001 and P < .001, respectively). Dimethyl sulfite levels were significantly higher in the reflux group than in the control (P = .001). Conclusion Questioning patients who present with halitosis, taste, or smelling disorders is important to diagnose LPR.

An investigation of retronasal testing of olfactory function in a Turkish population.

Background The aim of this study was: (1) to perform a preliminary study for the validation of “retronasal olfactory testing” in the Turkish population to find the best way to evaluate smell and taste disorders in Turkey; (2) to determine if cultural differences make application of the test more difficult; and (3) to determine the flavors that participants had not yet tasted by using the survey method. Material/Methods The study included 330 volunteers. Orthonasal olfactory function was assessed psycho-physically using the “Sniffin’ Sticks” olfactory test. Retronasal olfaction was assessed using a collection of 20 available food powders applied to the oral cavity. Also, all participants filled in a questionnaire of 50 items about the flavors they had not tasted before. Results The mean age of the participants was 26±7.3 years. Participants were divided into 3 groups according to the “Sniffin’ Sticks” test results: anosmia, hyposmia, and normosmia groups. Differences in retronasal olfaction scores were significant among the 3 groups. Conclusions The retronasal olfactory test appeared to perform well, but modifications of odorized powders or granules and distracters used in the retronasal olfactory test, taking into account Turkish cultural differences, is likely to improve its performance.

Clinical assessment of olfactory functions in children who underwent adenotonsillectomy during pre- and post-operative period

OBJECTIVE The aim of this study was to investigate the changes of both ortho- and retronasal olfactory function in children who underwent adenotonsillectomy (AT) operation due to infectious and/or obstructive adenotonsillar disease. MATERIAL AND METHODS A total of 25 children with adenotonsillar disease are included in the study; the children were followed for 6 months in the conducted clinics and underwent AT operation. An age- and sex-matched control group was constituted with 25 healthy children free of adenotonsillar disease. Adenoid and tonsillar hypertrophy was graded according to the subjective size scales. Each subjects orthonasal and retronasal olfactory functions were assessed using odor identification test and retronasal olfactory testing. These tests were performed once, at the beginning of the study, for the control group and performed twice, at the beginning of the study and the third month follow-up, for the disease group. Parents of children in the adenotonsillar disease group filled out a visual analog scale to evaluate the childrens appetite at the same time with olfactory testing. RESULTS The current investigation produced four major findings: (1) both ortho- and retronasal olfactory abilities of participants were improving following AT operation, (2) adenoid hypertrophy had a significant negative effect on both ortho- and retronasal olfaction, whereas tonsil hypertrophy had significant negative effect only on the retronasal olfactory score, (3) retronasal olfaction was found to be more affected by the adenoid size than the orthonasal, as shown with correlation analysis, and (4) the increase in appetite of children after AT operation had been specified by parents. CONCLUSIONS Children with adenotonsillar disease have increased olfaction abilities, namely ortho- and retronasal olfactory function following AT operation. In addition, retronasal olfactory function, an important component of flavor, seems to be more affected than orthonasal function. These results also explain the increased appetite of operated children.

Cross-culturally modified University of Pennsylvania Smell Identification Test for a Turkish population.

Background The University of Pennsylvania Smell Identification Test (UPSIT) is a well-developed and popular olfactory test, which has been validated in various populations. However, there was only one study in a Turkish population, and this study indicated that the North American version of the UPSIT was not enough to evaluate the olfactory functions of Turkish population. So, we developed a cross-cultural adaptation of the UPSIT, the UPSIT-Turkish (UPSIT-T). Thus, the goal of this study was to investigate the applicability of the UPSIT-T in healthy Turkish subjects. Material and Methods The study included 51 healthy individuals who reported having normal olfactory function. The participants were administered the North American version of the UPSIT firstly, and then, after a day UPSIT-T was applied to the participants. The results of two smell tests were compared, and the applicability of UPSIT-T was evaluated. Results The mean (standard deviation) value for correctly identified odors was 27.2 ± 5.7 (range, 14–38) with the UPSIT application, whereas the mean (standard deviation) value for correctly identified odors was 35.9 ± 3.1 for UPSIT-T. There was a statistically significant increase in the scores of the participants when UPSIT-T was performed (p < 0.001). The identification rates of 10 test odorants were <80% for our study group, and 2 of 10 were <70% for the UPSIT-T. Conclusion The UPSIT-T modification is an adequate olfactory test for clinical use in a Turkish population.

Postoperative changes in olfactory function after transcanalicular diode laser dacryocystorhinostomy.

Purpose: Transcanalicular diode laser dacryocystorhinostomy (TCL-DCR) is used much in recent years for the surgery of nasolacrimal duct obstruction (NLDO). Although TCL-DCR is accepted to be minimally invasive, safe, and effective, there is no report focusing on postoperative changes in olfactory function after this procedure. Hence, the aim of this current study was to investigate the changes in olfactory function after TCL-DCR procedure. Materials and Methods: This study was carried out in 42 volunteers (16 men and 26 women) between the ages of 20 and 81 years. All participants received detailed lateralized olfactory tests preoperatively and at the postoperative first week, first month, third month, and sixth month. After lateralized olfactory tests were performed, the results were grouped according to the side of the nasal passage where the operation was performed for NLDO: the nonoperated side served as the control. Results: The current investigation produced 2 major findings: (1) olfactory function decreased significantly after TCL-DCR procedure at the operated side of the nose compared with the nonoperated side; (2) olfactory abilities of the patients returned to normal within 3 months. Conclusion: The results of this study showed that transcanalicular diode laser could be used safely in terms of olfactory function for dacryocystorhinostomy. Temporary decrease of olfactory function on the side having TCL-DCR should be taken into account when obtaining informed patient consent.