Tools for measuring olfactory function in adults have been well established. Although studies have shown that olfactory impairment in children may occur as a consequence of a number of diseases or head trauma, until today no consensus on how to evaluate the sense of smell in children exists in Europe. Aim of the study was to develop a modified “Sniffin' Sticks” odor identification test, the “Sniffin' Kids” test for the use in children. In this study 537 children between 6-17 years of age were included. Fourteen odors, which were identified at a high rate by children, were selected from the “Sniffin' Sticks” 16-item odor identification test. Normative date for the 14-item “Sniffin' Kids” odor identification test was obtained. The test was validated by including a group of congenital anosmic children. Results show that the “Sniffin' Kids” test is able to discriminate between normosmia and anosmia with a cutoff value of >7 points on the odor identification test. In addition the test-retest reliability was investigated in a group of 31 healthy children and shown to be ρ = 0.44. With the 14-item odor identification “Sniffin' Kids” test we present a valid and reliable test for measuring olfactory function in children between ages 6–17 years.

The objective of the present study was to investigate the usefulness of time-frequency analysis (TFA) of olfactory-induced EEG change with a low-cost, portable olfactometer in the clinical investigation of smell function. A total of 78 volunteers participated. The study was composed of three parts where olfactory stimuli were presented using a custom-built olfactometer. Part I was designed to optimize the stimulus as well as the recording conditions. In part II EEG-power changes after olfactory/trigeminal stimulation were compared between healthy participants and patients with olfactory impairment. In Part III the test-retest reliability of the method was evaluated in healthy subjects. Part I indicated that the most effective paradigm for stimulus presentation was cued stimulus, with an interstimulus interval of 18-20s at a stimulus duration of 1000ms with each stimulus quality presented 60 times in blocks of 20 stimuli each. In Part II we found that central processing of olfactory stimuli analyzed by TFA differed significantly between healthy controls and patients even when controlling for age. It was possible to reliably distinguish patients with olfactory impairment from healthy individuals at a high degree of accuracy (healthy controls vs anosmic patients: sensitivity 75%; specificity 89%). In addition we could show a good test-retest reliability of TFA of chemosensory induced EEG-power changes in Part III. Central processing of olfactory stimuli analyzed by TFA reliably distinguishes patients with olfactory impairment from healthy individuals at a high degree of accuracy. Importantly this can be achieved with a simple olfactometer.

The clinical diagnostics of olfactory dysfunction in children turns out to be challenging due to low attention span, insufficient linguistic development and lack of odor experiences. Several smell tests have been developed for adults. Most of these examinations take a relatively long time and require a high level of concentration. Therefore, the aim of the current study was to evaluate an odor discrimination and olfactory threshold test using the frequently used “Sniffin’ Sticks” in children and adolescents in a simplified two-alternative-forced-choice version (2AFC) and compare it to the original three-alternative-forced-choice test (3AFC). One-hundred-twenty-one healthy participants aged between 5 and 17 years took part in this study. Within each of the two sessions participants underwent olfactory testing using the modified 2AFC as well as the standard 3AFC method. A better test-retest reliability was achieved using the original 3AFC method compared to the modified 2AFC. This was true for the odor discrimination as well as the olfactory threshold. Age had a significant influence on both tests, which should be considered when testing young children. We discuss these findings with relation to the existing norms and recommend using the 3AFC version due to a better test-retest reliability to measure olfactory function in children.

Olfactory function can be influenced by many factors and olfactory dysfunction is associated with several diseases. But even considering this, the causes of acquired olfactory dysfunction in children are not well understood. This review was conducted to gain an overview of the etiologies of acquired olfactory dysfunction in a pediatric population. Studies were identified using a predefined literature search, including studies if patients were ≤18 years of age and results of psychophysical olfactory testing were reported. A total of 44 articles met the inclusion criteria for this review and were included in the qualitative analysis. The influence of 6 disease groups on olfactory function in children was observed (otorhinolaryngology, traumatic brain injury, oncology, psychiatric diseases, environmental factors, and other diseases). The current literature is convincing that diseases in the otorhinolaryngology group and traumatic brain injury can lead to acquired olfactory dysfunction, whereas according to the current literature, the role of other influencing factors such as most psychiatric disorders remains uncertain. A number of diseases and circumstances affect olfactory function in children and may cause acquired olfactory dysfunction in this age group. Nevertheless, more research is needed to better understand the causes of acquired olfactory dysfunction in children. Future research should have the goal of early diagnosis and, if possible, early treatment of the condition to prevent a negative impact of olfactory dysfunction on children and adolescents.

Although the brain structures involved in integrating odorant and trigeminal stimuli are well-documented, there is still a need to clarify (1) how emotional response is represented in the human brain during cross-modal interaction between odors and trigeminal stimuli, and (2) whether the degree of congruency between the two types of stimuli influences these emotional responses and their neural processing. These questions were explored combining psychophysics, event-related potentials (ERP) and fMRI in the same group of 17 subjects under a “congruent condition” (intranasal carbon dioxide mixed with the smell of orange, a combination found in soda drinks, for example), and an “incongruent condition” (intranasal carbon dioxide mixed with the smell of rose, a combination not encountered in everyday life). Responses to the 3 constituent stimuli (carbon dioxide, orange, and rose) were also measured. Hedonic and intensity ratings were collected for all stimulations. The congruent bimodal stimulus was rated as more pleasant than the incongruent. This behavioral effect was associated with enhanced neural activity in the hippocampus and anterior cingulate gyrus, indicating that these brain areas mediate reactivation of pleasant and congruent olfactory-trigeminal associations.