Olfactory Fluctuation Revisited

Abstract

Objectives Many patients complain about olfactory fluctuation (OF), which is a symptom commonly attributed to sinonasal disease. Data‐based evidence for its association with sinonasal disease is scarce. The aim of the study is to identify explanatory variables associated with OF and to analyze its predictive value regarding sinonasal disease. Study design We performed a retrospective study based on patients with olfactory dysfunction. Methods We analyzed data from 482 patients attending the smell and taste outpatient clinic with full psychophysical workup and structured questions regarding their symptoms. The questionnaire included items on OF and chronic nasal symptoms. Clinical investigators filled out the second part of this questionnaire that included information about nasal endoscopy, psychophysical tests of orthonasal olfaction (Sniffin' Sticks), retronasal olfaction, and putative etiology of olfactory dysfunction. Results OF was more prevalent in sinonasal disease (42.4%) compared to other putative etiologies of olfactory dysfunction such as postinfectious (28%) or posttraumatic (11.7%) (X2 [5, n = 440] = 24.98; P < .0001). OF was strongly associated with Sniffin' Sticks score categories (anosmia, hyposmia, normosmia) (X2 [2, n = 424] = 39.21; P < .0001; Cramer's V = 0.30; P < .0001) and presence of “chronic nasal symptoms” (X2 [1, n = 437] = 22.71; P < .0001; Cramer's V = 0.23; P < .0001). The accuracy in predicting putative sinonasal disease etiology when OF was present depended strongly on the clinical context. Conclusion Olfactory fluctuation is a symptom mostly but not exclusively associated with sinonasal disease, elevated Sniffin' Sticks test scores, and is frequently accompanied by other nasal complaints. Its presence is valuable information for clinicians to be integrated into the clinical context when doing patients' workup. Level of Evidence 4 Laryngoscope, 130:2442–2447, 2020

Assessment of olfactory fluctuations in a clinical context

“…Various hypotheses have been proposed to explain OF; however, the exact mechanism of OF remains unknown. The present study confirms previous findings by Hsieh et al [ 10 ] that self-reported OF is strongly, but not exclusively, associated with sinonasal disorders. In addition to previous studies, our findings show that OF is most frequently observed in sinonasal OD, compared to postviral and idiopathic OD.…”

“…The pathophysiology of sinonasal OD involves an impairment of nasal airflow and inflammation of the olfactory neural pathway [ 10 , 11 , 15 , 16 ]. Airflow to the olfactory region was found to increase when airway patency improved at critical areas, such as the olfactory cleft and the internal nasal valve [ 17 ].…”

“…Although OF is common among patients with OD, very little data-based analysis of OF has been done [ 10 ] and no current structured model of clinical workup for OF assessment exists. Due to the wide range of amplitude, duration, and frequency of symptoms, OF patients can be a clinical challenge.…”

Exploring possibilities for shortening the 22‐item Sino‐Nasal Outcome Test (SNOT‐22) using item response theory

“…CRS is often associated with a fluctuating course of the disease, which can even lead to daily differences in symptom severity. 11 Not surprisingly, daily diaries-"real-life assessment of CRS patients" 12,13 -have been proposed to gain greater insights into the main drivers of CRS symptomatology. However, completing these symptom diaries on a daily basis might impose a significant respondent burden, leading to nonadherence with data collection protocols.…”

“…CRS is often associated with a fluctuating course of the disease, which can even lead to daily differences in symptom severity 11 . Not surprisingly, daily diaries—“real‐life assessment of CRS patients” 12,13 —have been proposed to gain greater insights into the main drivers of CRS symptomatology.…”