The Candy Smell Test in Clinical Routine

Haxel, Boris; Bertz-Duffy, S; Faldum, Andreas; Trellakis, Sokrates; Stein, B.; Renner, Bertold; Kobal, Gerd; Letzel, Stephan; Mann, Wolf J.; Muttray, Axel

doi:10.2500/ajra.2011.25.3611

Cited by 28 publications

(34 citation statements)

References 14 publications

(25 reference statements)

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“…The overall mean TDI (best performing nostril) was 34.3 ± 3.5, with 5 subjects scoring slightly below the cutoff for normosmia. TDI and CST results correlated significantly ( r 30 = 0.391, p = 0.032), similar to previous findings 10,11 . Interestingly, in this small group males performed significantly better on right threshold, TDI and CST than females (all p < 0.020).…”

Section: Resultssupporting

confidence: 89%

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Reversible obstruction of the olfactory cleft: impact on olfactory perception and nasal patency

Besser

Liu

Renner

et al. 2020

Int Forum Allergy Rhinol

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Background: Temporary disruption of sensory input can be studied relatively easily for vision or hearing by covering the eyes or ears. In contrast, closing the nostrils affects not only the sense of smell, but also the ability to breathe through the nose and humidify and warm inhaled air. We hypothesized that filling the olfactory cle (OC) with dissolvable nasal dressing (foam) would temporarily block olfaction while respecting nasal airflow. Methods:In 30 healthy volunteers, the OC was unilaterally obstructed in a back-to-front fashion. Orthonasal and retronasal olfactory function were tested before and after foam application. Ratings of odors and subjective nasal patency (SNP) were collected. Peak nasal inspiratory flow (PNIF) was used to measure nasal patency. Results:Foam was safely applied in every case using minimal instruments. No complications were reported. Orthonasal and retronasal test results decreased significantly in overall participants (all p < 0.0008). Indicating temporary anosmia, 3 subjects reached the lowest possible score for odor-threshold testing, with corresponding drops in retronasal test scores. PNIF values before and a er foam application were not significantly different (p = 0.11). SNP ratings decreased slightly, but not significantly (p = 0.052). Odor-intensity ratings dropped significantly (all p < 0.05). Conclusion:The OC can be safely obstructed with dissolvable nasal dressing, resulting in a decrease in odorintensity and orthonasal and retronasal olfactory function test scores. This procedure may serve as a hyposmia model that maintains normal nasal airflow.

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Section: Resultssupporting

confidence: 89%

“…Retronasal olfactory function was assessed using 27 food‐grade‐quality candies, each 9 mm in diameter and containing 500 mg sorbitol and the target aroma (the candy smell test [CST]) 10‐12 . Candies can be sucked or chewed; after each candy the mouth is rinsed with water.…”

Section: Methodsmentioning

confidence: 99%

Reversible obstruction of the olfactory cleft: impact on olfactory perception and nasal patency

Besser

Liu

Renner

et al. 2020

Int Forum Allergy Rhinol

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“…Retronasal olfactory function was tested using the newly developed, extended CST (CST27), consisting of 27 (instead of 23) white candies with a diameter of 9 mm, each containing 500 mg sorbitol and one targeted aroma. The CST was developed for children and has shown reliable and valid results from the age of 6 upwards . The candies were manufactured in the Division of Pharmaceutics, University Erlangen‐Nürnberg.…”

Section: Methodsmentioning

confidence: 99%

“…Although the majority of patients with loss of olfactory function complain of decreased flavor perception, olfactory function is normally only tested with established orthonasal testing procedures (eg, University of Pennsylvania Smell Identification Test [UPSIT] or the Sniffin’ Sticks Test [TDI]). Retronasal olfactory tests, such as the Candy Smell Test (CST) or the taste powders still need higher acceptance in clinical routine …”

Section: Introductionmentioning

confidence: 99%

Retronasal olfactory function in patients with smell loss but subjectively normal flavor perception

et al. 2019

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Objectives The human sense of smell constitutes the main part of flavor perception. Typically, patients with loss of olfactory function complain of diminished perception during eating and drinking. However, some patients with smell loss still report normal enjoyment of foods. The aim of the present study was to compare orthonasal and retronasal olfactory function in patients with non‐sinonasal smell loss and subjectively normal flavor perception. Methods Nineteen patients (mean age [range] 52.0 [8–83 years]) with self‐reported olfactory impairment but subjective normal flavor perception were included. Olfactory performance was assessed using the Sniffin’ Sticks (TDI) for orthonasal and the Candy Smell Test (CST) for retronasal function. Visual analogue scales were used for self‐assessment of odor (SOP), taste (STP), and flavor perception (SFP), ranging from 0 (no perception) to 10 (excellent perception). Results Mean (SD) SFP was 8.0 (1.8). Mean (SD) orthonasal TDI‐score of all patients was 14.4 (5.3, range 6–25.3) with 11 patients classified as anosmic and eight as hyposmic. Mean/SD retronasal CST‐score was 8.8 (2.7, range 3–13) within the range of anosmia/hyposmia. No correlation was found between SFP and the CST (P = .62). Conclusion The present results showed that despite claiming normal flavor perception, our patients were ortho‐ and retronasally dysosmic using standard tests for olfactory function. Although other explanations could be possible, we suggest that this subjective flavor perception might be due to unconscious memory recall from previously experienced cross‐modal sensory interactions. Level of Evidence 4 Laryngoscope, 130:1629–1633, 2020

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“…In contrast to the cause of OD, retronasal olfactory function may be significantly predictive for quality of life [9]. Educative lessons on the flavor system and routine retronasal olfactory testing (as various tools have been published [10][11][12][13][14][15]) therefore seem to be valuable and should be implemented whenever possible.…”

Section: Introductionmentioning

confidence: 99%

Flavor education and training in olfactory dysfunction: a pilot study

Besser

Oswald

Liu

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Olfactory training is recommended in olfactory dysfunction (OD) showing promising results. OD patients frequently ask for training modifications in the hope of a better outcome. Also, a lack of knowledge of the flavor system is evident. This investigation sought to implement flavor education (FE) and encourage patients to experience flavors in terms of a flavor training (FT). Methods In included patients (n = 30), OD was either of postinfectious (86.7%) or posttraumatic (13.3%) cause. Chemosensory abilities were tested orthonasally (using Sniffin Sticks = TDI) and retronasally (using the Candy Smell Test = CST). Key points of flavor perception were demonstrated in an educative session. Subjects were instructed to consciously experience flavors out of a list of 50. Effects of FT were explored in two groups (group A and B), with group B starting FT 17 weeks later. Results FE was appreciated and drop-out rate stayed very low (one participant). Compliance was high and 30.4 ± 12.9 flavors were tried. Overall TDI scores improved in 10 patients (6 group A, 4 group B) in a clinically significant way (> 5.5). For group A (starting FT earlier) rm-ANOVA showed a significant effect of session (timepoint) on CST (p < 0.01). Conclusion Flavor education is demonstrated as feasible and appreciated in a clinical setting. FT seems to be a welcomed second-line therapy in patients with olfactory dysfunction. This study shows beneficial trends of FT; however, further studies with larger sample sizes and standardized training protocols are needed.

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The Candy Smell Test in Clinical Routine

Abstract: The CST is an easy-to-handle reliable tool to investigate retronasal olfaction suited for clinical determination of normosmia, hyposmia, and ansomia. In addition, it can be used for investigation where self-application is necessary such as in large survey studies.

Cited by 28 publications

References 14 publications

Reversible obstruction of the olfactory cleft: impact on olfactory perception and nasal patency

Reversible obstruction of the olfactory cleft: impact on olfactory perception and nasal patency

Retronasal olfactory function in patients with smell loss but subjectively normal flavor perception

Flavor education and training in olfactory dysfunction: a pilot study

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