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Alcohol Sniff Test (AST): An Important Tool for Screening Post-Viral Olfactory Loss in Acute Flu-Like Dysfunction

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Abstract

Olfactory disorders have a significant impact on patients' quality of life but are often underestimated in clinical practice. Upper respiratory tract infections (URTIs) are a common cause of olfactory loss. While most cases of olfactory loss due to URTIs are conductive and reversible, post-viral olfactory dysfunction (PVOD) persists despite symptom improvement. PVOD is attributed to damage to the olfactory epithelium and nerves or central olfactory pathway lesions. The Alcohol Sniff Test (AST) has been proposed as a tool to assess olfactory function in the acute phase and aid in differentiating PVOD from conductive disorders. This study aims to evaluate the effectiveness of the AST as a predictor of post-viral olfactory loss in patients with flu-like syndrome. An observational cross-sectional study was conducted among employees with flu-like syndrome at a tertiary hospital. Three groups were formed: flu-like syndrome with conductive disorder without COVID-19 (PVOD-), flu-like syndrome with neurosensory and/or central disorder due to COVID-19 (PVOD +), and an asymptomatic control group. The Alcohol Sniff Test was performed to assess olfactory function. Statistical analysis was conducted to evaluate the AST's performance. For a cut off of 10 cm, 88.57% of PVOD + patients and 60.53% of PVOD – patients showed AST alteration, respectively (p = 0.013, OR = 5.05, 95% CI [1.48–17.25]). There was a statistically significant difference in the mean distance between the PVOD + group (4.35 ± 4.1 cm) and the control group (20 ± 4.33 cm) (p < 0.05). This relationship was also observed between the PVOD + and PVOD- groups (9 cm ± 7.5) (p < 0.05) and between the PVOD- and control groups (p < 0.05). For a cut off of 10 cm, the AST showed a sensitivity of 88% and specificity of 41%, resulting in an Odds Ratio of 9.7 (95% CI 3.3–28.1) (p < 0.001) and a Positive Predictive Value of 69.4% for PVOD. PVOD, including cases associated with COVID-19, is a prevalent cause of olfactory loss. The Alcohol Sniff Test demonstrated promising results in identifying PVOD in patients with flu-like syndrome. The test's simplicity and accessibility make it a valuable tool for early screening and identifying individuals who may benefit from prompt treatment. The Alcohol Sniff Test (AST) shows potential as an effective tool for screening post-viral olfactory loss in patients with flu-like syndrome. It can aid in early identification of PVOD cases and facilitate timely interventions to reduce the likelihood of persistent hyposmia.

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Funding

The research did not receive any external funding, and all the materials used in the study were financed by the researchers themselves.

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Authors and Affiliations

  1. Departamento de Otorrinolaringologia, Hospital Do Servidor Público Estadual Francisco Morato de Oliveira, Rua Loefgren, 1543, Apt 34, Sao Paulo, SP, 04040-032, Brazil

    Domenico Seabra Modesto, Hugo Machado Silva Neto, Felipe Carvalho Leão, José Arruda Mendes Neto & Fábio Akira Suzuki

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  1. Domenico Seabra Modesto
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  2. Hugo Machado Silva Neto
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  3. Felipe Carvalho Leão
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  4. José Arruda Mendes Neto
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Correspondence to Domenico Seabra Modesto.

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This manuscript has not been published or presented elsewhere in part or in entirety and is not under consideration by another journal. All authors have approved the manuscript and agree with submission. The article is in compliance with ethical standards.

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The study was approved by the ethics committee under the number 37266520.0.0000.5463, and all participants signed an informed consent form. The individuals were selected through non-probabilistic judgment sampling.

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Modesto, D.S., Silva Neto, H.M., Leão, F.C. et al. Alcohol Sniff Test (AST): An Important Tool for Screening Post-Viral Olfactory Loss in Acute Flu-Like Dysfunction. Indian J Otolaryngol Head Neck Surg 76, 604–610 (2024). https://doi.org/10.1007/s12070-023-04224-z

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