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Sniffin' Sticks Test
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Supplemental: Parkinson's disease (PD)
Short Description of Instrument
The Sniffin' Sticks test was developed in 1997, primarily for European populations, and has subsequently been validated in several countries and disease states. It has the advantage of providing complete olfactory assessment by applying a perception threshold test, an odor discrimination test, and an odor identification test.
The standard Sniffin' Sticks test has 16 odor identification items, where each item has one correct answer and three incorrect answers or "distractors" in a forced choice paradigm. There is also a Sniffin' 12 item version which is a subset of the 16 item version.
Comments/Special Instructions
The test must be performed in a quiet, well-ventilated room to avoid the presence of any residual odors. Ideally, the examiner also wears odorless cotton gloves or must wash his/her hands in water without using soap. The test subject must not have smoked, eaten, or drunk anything other than water for fifteen minutes prior to the test. Each pen must be presented only once, for 3 to 4 seconds, about 2 cm from the edge of the nostril. The subject is asked to sniff no more than twice following a simple verbal command, and then the cap is immediately replaced on the pen. The pen must not touch the subject's skin. In the event of accidental contact, the response will be excluded from the results and the condition will need to be retested. The test is classically performed with both nostrils, but a single nostril test can also be performed. The examiner must not provide any information about the results or express any comments during the test. An interval of 3 to 5 minutes must be observed between each subtest.
Scoring and Psychometric Properties
Scoring: A Sniffin' result is scored out of 16 where a higher score indicates better olfaction.
Psychometric Properties: Strong correlation with University of Pennsylvania Smell Identification Test (UPSIT): r = 0.81-0.85. High test-retest reliability:  r = 0.80 (odor discrimination), r = 0.88 (odor identification), and r = 0.92 (odor threshold). Excellent discrimination of patients with PD from controls (areas under the curve =0.90; sensitivities =83.3%; specificities =82.0%). Performance may discriminate PD from atypical parkinsonian conditions, namely multiple system atrophy: 76.7% (sensitivity) and 95.7% (specificity).
Conversion calculations between scores on UPSIT to Brief Smell Identification Test (B-SIT) to Sniffin' 16, and Sniffin' 12 to 16 scores, have been developed and validated. This can facilitate direct comparison between tests aiding future collaborative analyses and evidence synthesis.
Strengths: Semi-objective testing of olfactory sensation, validated in Parkinson's disease populations, validated in multiple countries, and cross-cultural appropriateness.
Weaknesses: Time consuming, expensive ($250 for one kit), strict testing guidelines for testing conditions. Published normative data stratified age as 5-15; 16-35; 36-55; and >55, with limited stratification in older age groups.
Key References:
Rumeau C, Nguyen DT, Jankowski R. How to assess olfactory performance with the Sniffin' Sticks test(®). Eur Ann Otorhinolaryngol Head Neck Dis. 2016 Jun;133(3):203-6.
Hummel T, Kobal G, Gudziol H, Mackay-Sim A. Normative data for the "Sniffin' Sticks" including tests of odor identification, odor discrimination, and olfactory thresholds: an upgrade based on a group of more than 3,000 subjects. Eur Arch Otorhinolaryngol. 2007 Mar;264(3):237-43.
Additional References:
Haehner A, Mayer AM, Landis BN, Pournaras I, Lill K, Gudziol V, Hummel T. High test-retest reliability of the extended version of the "Sniffin' Sticks" test. Chem Senses. 2009 Oct;34(8):705-11.
Krismer F, Pinter B, Mueller C, Mahlknecht P, Nocker M, Reiter E, Djamshidian-Tehrani A, Boesch SM, Wenning GK, Scherfler C, Poewe W, Seppi K. Sniffing the diagnosis: Olfactory testing in neurodegenerative parkinsonism. Parkinsonism Relat Disord. 2017 Feb;35:36-41.
Lawton M, Hu MT, Baig F, Ruffmann C, Barron E, Swallow DM, Malek N, Grosset KA, Bajaj N, Barker RA, Williams N, Burn DJ, Foltynie T, Morris HR, Wood NW, May MT, Grosset DG, Ben-Shlomo Y. Equating scores of the University of Pennsylvania Smell Identification Test and Sniffin' Sticks test in patients with Parkinson's disease. Parkinsonism Relat Disord. 2016 Dec;33:96-101.
Mahlknecht P, Pechlaner R, Boesveldt S, Volc D, Pinter B, Reiter E, Müller C, Krismer F, Berendse HW, van Hilten JJ, Wuschitz A, Schimetta W, HÖgl B, Djamshidian A, Nocker M, GÖbel G, Gasperi A, Kiechl S, Willeit J, Poewe W, Seppi K. Optimizing odor identification testing as quick and accurate diagnostic tool for Parkinson's disease. Mov Disord. 2016 Sep;31(9):1408-13.
Pinkhardt EH, Liu H, Ma D, Chen J, Pachollek A, Kunz MS, Kassubek J, Ludolph AC, Huang Y, Chen H, Landwehrmeyer GB, Wang Z, Su W. Olfactory screening of Parkinson's Disease patients and healthy subjects in China and Germany: A study of cross-cultural adaptation of the Sniffin' Sticks 12-identification test. PLoS One. 2019 Nov 8;14(11):e0224331.
Document last updated August 2022