Assessment of patients with taste and smell disorders.

The evaluation of patients with taste and smell complaints is difficult without standardized quantitative methods of assessment. This paper summarizes recent developments in the evaluation of chemosensory patients. Evaluation must begin with a careful medical history, since certain questions can help in establishing an etiology. Several recent advances have been made in the development of standardized tests for the assessment of taste and olfactory function. Smell can be evaluated with a combination of butanol threshold and odor identification (University of Connecticut test battery) and with the University of Pennsylvania Smell Identification Test (UPSIT). Scores obtained from 91 patients show good correlation between these two testing procedures. Both tests provide normative data for comparison, with the UPSIT including both age- and sex-related norms. Traditional evaluation of taste deficits with threshold procedures has been questioned. Measures of suprathreshold taste intensity require the anchoring of taste judgements to another, presumably normal, modality. This has been approached using magnitude matching, in which taste and auditory loudness are judged on the same scale. Spatial testing of the tongue and soft palate can reveal pathology of the gustatory nerves or their central connections. Further understanding of taste and olfactory dysfunction will be facilitated by the development of standardized methods of evaluation.