Loss of Taste

Taste refers to the ability to sense sweet, salty, bitter and sour characteristics. It is a rudimentary sense and virtually impossible to lose completely. It is often confused with flavour, which is the combination of taste (20%) and smell (80%). When patients complain of a taste disturbance, a smell disorder is very frequently the actual problem.

Diagnostics

UPSIT Olfactory (Smell) Test

Why?

The University of Pennsylvania Smell Inventory Test (UPSIT) is a universally accepted standardised test of olfaction. Smell disturbances are common after head injury and this test is therefore most frequently or used to evaluate these patients, particularly for medico-legal purposes.

How?

This test is carried out by the ENT practice nurse. It consists of four envelope-sized booklets, each containing ten ‘scratch and sniff’ odour strips. The smells are released by scratching the strip with a pencil tip which should be sniffed immediately. The subject is offered 4 possible multiple-choice responses describing what the odour may smell like. Only one is correct. You must mark one of these, even if no smell is perceived.

The responses are analysed and compared to data from sex and age-matched normal population studies. The results are graded as hyposmia when there is a mild reduction in the sense of smell or various degrees of microsmia, when there is a moderate reduction. At the other extreme anosmia indicates a completely absent sense of smell. Even if the subject has a completely absent sense of smell some correct responses will be achieved by the laws of random chance. This can help to identify subjects who may be malingering and exaggerating their smell disability

Mini Olfactory UPSIT

Why?

The full UPSIT test is quite time consuming and the booklets are relatively expensive. Hence the reason this full test is largely confined to the assessment of patients for legal purposes. A mini-UPSIT test is an abbreviated assessment in which only 3 scratch and sniff odours are used on a single small card. It is therefore much cheaper and more straightforward to carry out, but can still give helpful clinical information regarding adjunctive confirmation of a patients sense of smell before medical or surgical treatments.

How?

This test is carried out by the ENT practice nurse. It consists of four envelope-sized booklets, each containing ten ‘scratch and sniff’ odour strips. The smells are released by scratching the strip with a pencil tip which should be sniffed immediately. The subject is offered 4 possible multiple-choice responses describing what the odour may smell like. Only one is correct. You must mark one of these, even if no smell is perceived.