Olfactory Fluctuation Presence Is Significant Within a Clinical Context

by Linda Kossoff •

Based on available data, what are the explanatory variables associated with olfactory fluctuation (OF), and what is the predictive value of this evidence regarding sinonasal disease?

Bottom line: OF is mostly associated with sinonasal disease and elevated Sniffin’ Sticks scores, and its presence is valuable information when used in clinical context in a patient workup.

BACKGROUND: Olfactory dysfunction (OD) is most frequently caused by sinonasal disease, head trauma, impairment after respiratory tract infections, and other less frequent causes. Authors acknowledge that OF is a clinical presentation of OD that points toward sinonasal disease; however, there has been little data-based analysis on the disorder.

STUDY DESIGN: Retrospective study.

SETTING: The Inner Ear and Olfaction Lab, University of Geneva Faculty of Medicine, Geneva, Switzerland.

SYNOPSIS: Researchers conducted a retrospective analysis of questionnaire data provided by 482 patients who visited a single smell and taste outpatient clinic between 2003 and 2012. The questionnaire focused on smell and taste symptoms, timing, cause, accompanying nasal symptoms, and evolution of the olfactory complaint. Information was compared to clinical data, including Sniffin’ Sticks and retronasal olfaction test scores, and physician’s putative diagnosis for OD. Data analysis showed that reported OF is mostly, but not exclusively, associated with sinonasal disease; patients with OF show higher ortho and retronasal olfactory scores than patients without OF and are more likely to have chronic nasal symptoms indicating sinonasal disease. Findings underscored that OF is not exclusively present in sinonasal disease and showed low predictive value of OF alone to detect sinonasal disease. Data did show an association between OF and elevated olfactory function and chronic nasal symptoms and demonstrated that OF does occur in other putative etiologies. Taken together, study results indicate that OF warrants a thorough patient history assessment, endoscopic examination, and possible imaging or oral steroid trial to seek, confirm, or exclude a sinonasal condition.

CITATION: Hsieh JW, Daskalou D, Detroux V, et al. Olfactory fluctuation revisited. Laryngoscope. 2020;130:2442-2447.