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INTRODUCTION: Olfaction impairment occurs in about 90% of patients with Parkinson's disease. The Sniffin Sticks Test is a widely used instrument to measure olfactory performance and is divided into three subtests that assess olfactory threshold, discrimination and identification. However, cultural and socioeconomic differences can influence test performance. OBJECTIVES: We performed a systematic review and meta-analysis of the existent data about Sniffin Sticks Test performance of Parkinson's disease patients and healthy controls in different countries and investigated if there are other cofactors which could influence the olfactory test results. A subgroup analysis by country was performed as well as a meta-regression using age, gender and air pollution as covariates. RESULTS: Four hundred and thirty studies were found and 66 articles were included in the meta-analysis. Parkinson's disease patients showed significantly lower scores on the Sniffin Sticks Test and all its subtests than healthy controls. Overall, the heterogeneity among studies was moderate to high as well as the intra-country heterogeneity. The subgroup analysis, stratifying by country, maintained a high residual heterogeneity. CONCLUSION: The meta-regression showed a significant correlation with age and air pollution in a few subtests. A high heterogeneity was found among studies which was not significantly decreased after subgroup analysis by country. This fact signalizes that maybe cultural influence has a small impact on the Sniffin Sticks Test results. Age and air pollution have influence in a few olfactory subtests.

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OBJECTIVE: To assess olfactory function in children and to create and validate an odor identification test to diagnose olfactory dysfunction in children, which we called the Universal Sniff (U-Sniff) test. STUDY DESIGN: This is a multicenter study involving 19 countries. The U-Sniff test was developed in 3 phases including 1760 children age 5-7 years. Phase 1: identification of potentially recognizable odors; phase 2: selection of odorants for the odor identification test; and phase 3: evaluation of the test and acquisition of normative data. Test-retest reliability was evaluated in a subgroup of children (n = 27), and the test was validated using children with congenital anosmia (n = 14). RESULTS: Twelve odors were familiar to children and, therefore, included in the U-Sniff test. Children scored a mean ± SD of 9.88 ± 1.80 points out of 12. Normative data was obtained and reported for each country. The U-Sniff test demonstrated a high test-retest reliability (r27 = 0.83, P < .001) and enabled discrimination between normosmia and children with congenital anosmia with a sensitivity of 100% and specificity of 86%. CONCLUSIONS: The U-Sniff is a valid and reliable method of testing olfaction in children and can be used internationally.

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Abstract Introduction: The olfactory system is affected by the nutritional balance and chemical state of the body, serving as an internal sensor. All bodily functions are affected by energy loss, including olfaction; hunger can alter odour perception. Objective: In this study, we investigated the effect of fasting on olfactory perception in humans, and also assessed perceptual changes during satiation. Methods: The "Sniffin' Sticks" olfactory test was applied after 16 h of fasting, and again at least 1 h after Ramadan supper during periods of satiation. All participants were informed about the study procedure and provided informed consent. The study protocol was approved by the local Ethics Committee of Gaziosmanpaşa Taksim Education and Research Hospital (09/07/2014 no: 60). The study was conducted in accordance with the basic principles of the Declaration of Helsinki. Results: This prospective study included 48 subjects (20 males, 28 females) with a mean age of 33.6 ± 9.7 (range 20-72) years; their mean height was 169.1 ± 7.6 (range 150.0-185.0) cm, mean weight was 71.2 ± 17.6 (range 50.0-85.0) kg, and average BMI was 24.8 ± 5.3 (range 19.5-55.9). Scores were higher on all items pertaining to olfactory identification, thresholds and discrimination during fasting vs. satiation (p < 0.05). Identification (I) results: Identification scores were significantly higher during the fasting (median = 14.0) vs. satiation period (median = 13.0). Threshold (T) results: Threshold scores were significantly higher during the fasting (median = 7.3) vs. satiation period (median = 6.2). Discrimination (D) results: Discrimination scores were significantly higher during the fasting (median = 14.0) vs. satiation period (median = 13.0). The total TDI scores were 35.2 (fasting) vs. 32.6 (satiation). When we compared fasting threshold value of >9 and ≤9, the gap between the fasting and satiety thresholds was significantly greater in >9 (p < 0.05). Conclusion: Olfactory function improved during fasting and declined during satiation. The olfactory system is more sensitive, and more reactive to odours, under starvation conditions, and is characterised by reduced activity during satiation. This situation was more pronounced in patients with a better sense of smell. Olfaction-related neurotransmitters should be the target of further study.

Resumo Introdução: O sistema olfatório é afetado pelo equilíbrio nutricional e estado químico do corpo, que serve como um sensor interno. Todas as funções corporais são afetadas pela perda de energia, inclusive o olfato; a fome pode alterar a percepção do odor. Objetivo: Neste estudo, investigamos o efeito do jejum sobre a percepção olfativa em seres humanos, e também avaliamos as mudanças de percepção durante a saciedade. Método: O teste olfatório Sniffin Sticks foi aplicado após 16 horas de jejum e novamente pelo menos 1 hora após a ceia do Ramadã durante os períodos de saciedade. Todos os participantes foram informados sobre os procedimentos do estudo e forneceram o consentimento informado. O protocolo do estudo foi aprovado pelo Comitê de Ética do Gaziosmanpaşa Taksim Education e Research Hospital (2014/09/07 n° 60). O estudo foi conduzido de acordo com os princípios básicos da Declaração de Helsinki. Resultados: Foram incluídos 48 pacientes (20 homens, 28 mulheres) com média de 33,6 ± 9,7 aos (variação 20-72); a altura média deles era de 169,1 ± 7,6 cm (variação 150-185), o peso médio era de 71,2 ± 17,6 kg (variação de 50-85) e o IMC médio era de 24,8 ± 5,3 (variação de 19,5-55,9). Os escores foram maiores em todos os itens correspondentes à identificação olfativa, limiares e discriminação durante jejum vs. saciedade (p < 0,05). Resultados da identificação (I): os escores de identificação foram significativamente maiores durante o jejum (mediana = 14) vs. período de saciedade (mediana = 13). Resultados limiares (T): os escores limiares foram significativamente maiores durante o jejum (mediana = 7,3) vs. período de saciedade (mediana = 6,2). Resultados de discriminação (D): os escores de discriminação foram significativamente maiores durante o jejum (mediana = 14) vs. período de saciedade (mediana = 13). Os escores totais de TDI foram de 35,2 (jejum) vs. 32,6 (saciedade). Quando comparamos o valor do limiar de jejum de > 9 e ≤ 9, a diferença entre os limiares de jejum e de saciedade foi significativamente maior em > 9 (p < 0,05). Conclusão: A função olfatória melhorou durante o jejum e diminuiu durante a saciedade. O sistema olfatório é mais sensível e mais reativo aos odores em condições de fome e é caracterizado por atividade reduzida durante a saciedade. Essa situação foi mais pronunciada em pacientes com um melhor sentido olfativo. Os neurotransmissores relacionados com o olfato devem ser alvo de um estudo mais aprofundado.

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INTRODUCTION: The olfactory system is affected by the nutritional balance and chemical state of the body, serving as an internal sensor. All bodily functions are affected by energy loss, including olfaction; hunger can alter odour perception. OBJECTIVE: In this study, we investigated the effect of fasting on olfactory perception in humans, and also assessed perceptual changes during satiation. METHODS: The "Sniffin' Sticks" olfactory test was applied after 16h of fasting, and again at least 1h after Ramadan supper during periods of satiation. All participants were informed about the study procedure and provided informed consent. The study protocol was approved by the local Ethics Committee of Gaziosmanpasa Taksim Education and Research Hospital (09/07/2014 no: 60). The study was conducted in accordance with the basic principles of the Declaration of Helsinki. RESULTS: This prospective study included 48 subjects (20 males, 28 females) with a mean age of 33.6±9.7 (range 20-72) years; their mean height was 169.1±7.6 (range 150.0-185.0)cm, mean weight was 71.2±17.6 (range 50.0-85.0)kg, and average BMI was 24.8±5.3 (range 19.5-55.9). Scores were higher on all items pertaining to olfactory identification, thresholds and discrimination during fasting vs. satiation (p<0.05). Identification (I) results: Identification scores were significantly higher during the fasting (median=14.0) vs. satiation period (median=13.0). Threshold (T) results: Threshold scores were significantly higher during the fasting (median=7.3) vs. satiation period (median=6.2). Discrimination (D) results: Discrimination scores were significantly higher during the fasting (median=14.0) vs. satiation period (median=13.0). The total TDI scores were 35.2 (fasting) vs. 32.6 (satiation). When we compared fasting threshold value of >9 and ≤9, the gap between the fasting and satiety thresholds was significantly greater in >9 (p<0.05). CONCLUSION: Olfactory function improved during fasting and declined during satiation. The olfactory system is more sensitive, and more reactive to odours, under starvation conditions, and is characterised by reduced activity during satiation. This situation was more pronounced in patients with a better sense of smell. Olfaction-related neurotransmitters should be the target of further study.

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BACKGROUND AND AIMS: Olfactory testing is useful in the differential diagnosis of age-related pathologies. To provide baseline reference values for clinical use in Mexico City we investigated the relation between olfactory capabilities and the principal population parameters of age, sex, and smoking habits in a large sample of healthy inhabitants. METHODS: We applied the internationally recognized and commercially available Sniffin' Sticks test battery to 916 men and women from across the adult life span. The Sniffin' Sticks test evaluates three key aspects of olfactory function: 1) ability to detect an odor, 2) to discriminate between odors, and 3) to identify odors. RESULTS: We found a significant decline in olfactory function from the 5th decade of age, and that detection threshold was the most sensitive measure of this. We did not find a significant difference between men and women or between smokers and non-smokers. In confirmation of our previous studies of the negative effect of air pollution on olfactory function, Mexico City inhabitants had poorer overall performance than corresponding subjects previously tested in the neighboring but less polluted Mexican state of Tlaxcala. CONCLUSIONS: Although we basically confirm findings on general demographic patterns of olfactory performance from other countries, we also demonstrate the need to take into account local cultural, environmental and demographic factors in the clinical evaluation of olfactory performance of Mexico City inhabitants. The Sniffin' Sticks test battery, with some adjustment of stimuli to correspond to Mexican culture, provides an easily administered means of assessing olfactory health.

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OBJECTIVE: The aim of this study is to determine the usefulness of the University of Pennsylvania smell identification test (UPSIT), sniffin sticks (SS-16) and brief smell identification test (B-SIT) to assess smell identification in the Mexican population and its accuracy in discriminating subjects with Parkinson's disease (PD). METHODS: We included 199 nondemented PD subjects and 199 control subjects matched by gender. Smell identification was tested using the UPSIT and SS-16. Our group obtained B-SIT data from a previous report. RESULTS: The mean number of UPSIT items correctly identified by controls was 27.3±6; the PD group had a mean score of 19.4±6. UPSIT had a sensitivity of 82% with a specificity of 66% for a cut-off score of ≤25 for detection of PD. The mean number of SS-16 items correctly identified by controls was 10.3±2.2, while the PD group had 7.4±2.8 correct answers. For SS-16, sensitivity was 77.8% and specificity of 71.2% when using a cut-off value of ≤9. Lemon, turpentine and rose had an identification rate below the 25th percentile for all three tests. Odors with an identification rate above the 75th percentile include banana for all three tests, and gasoline, onion and chocolate for UPSIT and B-SIT. CONCLUSION: The sensitivity and specificity of the smell tests that were evaluated were lower in comparison to other published reports. Cultural biases and smell familiarity may influence the test results. The development of a true cross-culturally adapted smell identification test is warranted may improve test accuracy.

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Introducción: Para acceder a la región selar, podemos utilizar las técnicas transcraneal, transeptal, o transnasal endoscópica, pudiendo provocar diferentes grados de hiposmia. Se ha descrito menor morbilidad al utilizar la técnica endoscópica, pero faltan estudios dirigidos a los resultados olfatorios. Objetivo: Determinar la presencia de deterioro olfatorio en los pacientes sometidos a un abordaje transnasal endoscópico. Material y método: Se reclutaron 12 pacientes con tumores en la región selar durante 8 meses. Se les realizó un test de olfato preoperatorio, fueron intervenidos mediante abordaje transnasal endoscópico y controlados al mes posoperatorio. Resultados: Se logró seguimiento a 10 pacientes. Seis (60%) presentaron un test de olfato preoperatorio normal. Al mes posoperatorio, se constató mejoría olfatoria en 1 (10%) paciente, 8 (80%) se mantuvieron en la misma categoría y 1 (10%) presentó deterioro olfatorio. En suma, 9 de 10 pacientes (90%) mantienen o mejoran su olfato al mes posoperatorio. Conclusión: Nuestros resultados sugieren que el abordaje transnasal endoscópico utilizado en este estudio no produce deterioro olfatorio. Dado que además es una técnica de abordaje efectiva y relativamente segura, consideramos que constituye una alternativa factible para utilizar en pacientes con patología tumoral en la región selar.

Introduction: To access the sellar region we can use the transcranial, transeptal, or transnasal endoscopic approaches, which may cause different degrees of hyposmia. It has described less morbidity to use the endocopic technique, however, there are few studies directed at olfactory outcomes. Aim: To determine the presence of olfactory impairment secondary to endoscopic transnasal approach. Material and method: 12 patients with tumors in the sellar region were enrolled during 8 months. They were underwent a smell test preoperatively, operated by endoscopic transnasal approach, and controlled with postoperative retesting, after one month. Results: Follow-up was achieved to 10 patients. 6 (60%) presented a normal preoperative smell test. Within one postoperative month, olfactory improvement was found in 1 (10%) patient, 8 (80%) remained in the same category and 1 (10%) had olfactory impairment. In all, 9 out of 10 patients (90%) maintain or improve their sense of smell after surgery. Conclusions: Our results suggest that the transnasal endoscopic approach used in this study, doesn't produce olfactory impairment. Given that is also an effective and relatively safe approach, we believe that is a feasible alternative for use in patients with tumor pathology in the sellar region.

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The idiopathic Parkinson disease (IPD) is traditionally diagnosed by motor signs, but non-motor symptoms and signs are frequent and may help in the clinical diagnosis. PURPOSE: To evaluate the olfactory function in Brazilian healthy subjects, patients with early-onset PD (EOPD) and late-onset PD (LOPD) using the Sniffin' Sticks odor-identification test (SST). METHOD: We studied 70 patients with IPD (19 EOPD and 51 LOPD) and 70 controls matched for gender, age and years of schooling. Subjects with dementia and loss of smell for other reasons were excluded. RESULTS: The SST showed a significant difference (p<0.001) between groups: control groups (12.0±0.3), EOPD (8.3±0.7), and LOPD (6.7±0.4) when the groups were adjusted for gender, age, disease duration, and years of schooling. CONCLUSION: Both groups of IPD patients presented olfactory impairments, but those whose symptoms started before 45 years-old (EOPD) had better sense of smell than the LOPD patients.

A doença de Parkinson idiopática (DPI) tradicionalmente é diagnosticada pelos sinais motores, porém os sinais e sintomas não-motores são freqüentes. OBJETIVO: Avaliar a função olfatória em sujeitos brasileiros saudáveis e em pacientes com doença de Parkinson precoce (DPP) e doença de Parkinson tardia (DPT) utilizando o teste Sniffin' Sticks (TSS) de identificação de odores. MÉTODO: Setenta pacientes com DPI (19 DPP e 51 DPT) e 70 controles pareados para as variáveis gênero, idade e anos de escolaridade foram estudados. Foram excluídos sujeitos com demência e/ou perda de olfato por outros motivos. RESULTADOS: O TSS mostrou uma diferença significativa (p<0,001) entre os grupos controle (12,0±0,3), DPP (8,3±0,7) e DPT (6,7±0,4) quando os grupos foram ajustados para sexo, idade, duração da doença e anos de escolaridade. CONCLUSÃO: Pacientes com DPI apresentam redução do olfato, sendo mais importante entre aqueles com DPT. A disfunção olfatória pode ser uma ferramenta muito útil no diagnóstico de DPI.

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