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Stefan Heilmann, MD; Gundel Strehle; Kati Rosenheim; Michael Damm, MD; Thomas Hummel, MD

Arch Otolaryngol Head Neck Surg. 2002;128:414-418.

Objectives  To develop a test kit for the simple assessment of retronasal olfactory function and to compare orthonasal and retronasal olfactory function in healthy subjects and patients with olfactory disorders.

Design and Patients  We tested 230 individuals with normosmia, hyposmia, and anosmia using grocery-available powders. Initially, 30 different substances were investigated. Subjects identified each substance using a list with 4 verbal items (forced choice). After preliminary experiments, 20 items were selected according to the degree to which they were identified by normosmic and anosmic subjects. Orthonasal olfactory function was assessed psychophysically using "sniffin' sticks," which includes tests for odor identification, discrimination, and butanol odor thresholds. In addition, anosmia was confirmed electrophysiologically by means of olfactory-evoked potentials.

Results  In healthy subjects, there was a test-retest reliability correlation of r₂₇ = 0.76 for retronasal olfactory function, which is similar to other odor identification tests. Retronasal testing in normosmic subjects allowed for the discrimination of sex-related differences, with women scoring higher than men (P = .007), and the identification of a slight decrease with age (r₁₂₀ = -0.20; P = .03). Orthonasal and retronasal identification of odors was found to correlate (r₈₆ = 0.78; P<.001). Retronasal testing allowed for the discrimination between normosmia, hyposmia, and anosmia (P<.001). In addition, retronasal performance of anosmic patients appeared to improve with duration of anosmia (P = .03). No difference was found between patients with anosmia of different origin.

Conclusion  Results of the present investigation indicate that the assessment of retronasal olfactory function is possible using oral stimulus presentation.

From the Department of Otorhinolaryngology, University of Dresden Medical School, Dresden, Germany (Drs Heilmann and Hummel and Mss Strehle and Rosenheim); and the Department of Otorhinolaryngology, University of Cologne, Köln, Germany (Dr Damm).

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