OBJECTIVES: Olfactory dysfunction (OD) is common and carries significant personal and societal burden. Accurate assessment is necessary for good clinical and research practice but is highly dependent on the assessment technique used. Current practice with regards to UK/international clinical assessment is unknown. We aimed to capture current clinical practice, with reference to contemporaneously available guidelines. We further aimed to compare UK to international practice. DESIGN: Anonymous online questionnaire with cross-sectional non-probability sampling. Subgroup analysis according to subspeciality training in rhinology ('rhinologists' and 'non-rhinologists') was performed, with geographical comparisons only made according to subgroup. PARTICIPANTS: ENT surgeons who assess olfaction. RESULTS: Responses were received from 465 clinicians (217 from UK and 17 countries total). Country-specific response rate varied, with the lowest rate being obtained from Japan (1.4%) and highest from Greece (72.5%). Most UK clinicians do not perform psychophysical smell testing during any of the presented clinical scenarios-though rhinologists did so more often than non-rhinologists. The most frequent barriers to testing related to service provision (e.g., time/funding limitations). Whilst there was variability in practice, in general, international respondents performed psychophysical testing more frequently than those from the UK. Approximately 3/4 of all respondents said they would like to receive training in psychophysical smell testing. Patient reported outcome measures were infrequently used in the UK/internationally. More UK respondents performed diagnostic MRI scanning than international respondents. CONCLUSIONS: To our knowledge, this is the most comprehensive UK-based, and only international survey of clinical practice in the assessment of OD. We present recommendations to improve practice, including increased education and funding for psychophysical smell testing. We hope this will promote accurate and reliable olfactory assessment, as is the accepted standard in other sensory systems.

2nd Academic Department Smell and Taste Clinic Aristotle University of Thessaloniki Thessaloniki Greece

Centre for Olfactory Research Applications IP School of Advanced Study London UK

CIBER of Respiratory diseases Health Institute Carlos 3 Madrid Spain

Department of Clinical Medicine Flavour Institute Aarhus University Aarhus Denmark

Department of Otolaryngology Head and Neck Surgery Biruni University School of Medicine Istanbul Turkey

Department of Otolaryngology Newcastle upon Tyne Hospitals NHS Foundation Trust Newcastle upon Tyne UK

Department of Otorhinolaryngology and Head and Neck Surgery Regional Hospital Pardubice Pardubice Czech Republic

Department of Otorhinolaryngology Flavour Clinic University Clinic for Flavour Balance and Sleep Regional Hospital Gødstrup Herning Denmark

Department of Otorhinolaryngology Jikei University School of Medicine Tokyo Japan

ENT Department Cliniques Universitaires Saint Luc Brussels Belgium

ENT Department Guy's and St Thomas' NHS Trust London UK

ENT Department Pinderfields Hospital Mid Yorkshire Hospitals NHS Trust Wakefield UK

Faculty of Health Studies University of Pardubice Pardubice Czech Republic

Fifth Sense London UK

Institut d'Investigacions Biomèdiques August Pi i Sunyer Barcelona Spain

Institute of Neuroscience Université Catholique de Louvain Brussels Belgium

Norwich Medical School Norwich UK

Rhinology Olfactory Unit Department of Otorhinolaryngology Head and Neck Surgery University Hospital of Geneva Medical School Geneva Switzerland

Rhinology Unit and Smell Clinic ENT Department Hospital Clinic University of Barcelona Barcelona Spain

Royal National and ENT Hospital London UK

Skull Base Unit ENT Department Hospital Clinic Barcelona University Barcelona Spain

Smell and Taste Clinic Department of Otolaryngology TU Dresden Dresden Germany

The Norfolk Smell and Taste Clinic Norfolk and Waveney ENT Service James Paget and Norfolk and Norwich University Hospitals Norfolk UK

UCL Ear Institute University College London London UK

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$a OBJECTIVES: Olfactory dysfunction (OD) is common and carries significant personal and societal burden. Accurate assessment is necessary for good clinical and research practice but is highly dependent on the assessment technique used. Current practice with regards to UK/international clinical assessment is unknown. We aimed to capture current clinical practice, with reference to contemporaneously available guidelines. We further aimed to compare UK to international practice. DESIGN: Anonymous online questionnaire with cross-sectional non-probability sampling. Subgroup analysis according to subspeciality training in rhinology ('rhinologists' and 'non-rhinologists') was performed, with geographical comparisons only made according to subgroup. PARTICIPANTS: ENT surgeons who assess olfaction. RESULTS: Responses were received from 465 clinicians (217 from UK and 17 countries total). Country-specific response rate varied, with the lowest rate being obtained from Japan (1.4%) and highest from Greece (72.5%). Most UK clinicians do not perform psychophysical smell testing during any of the presented clinical scenarios-though rhinologists did so more often than non-rhinologists. The most frequent barriers to testing related to service provision (e.g., time/funding limitations). Whilst there was variability in practice, in general, international respondents performed psychophysical testing more frequently than those from the UK. Approximately 3/4 of all respondents said they would like to receive training in psychophysical smell testing. Patient reported outcome measures were infrequently used in the UK/internationally. More UK respondents performed diagnostic MRI scanning than international respondents. CONCLUSIONS: To our knowledge, this is the most comprehensive UK-based, and only international survey of clinical practice in the assessment of OD. We present recommendations to improve practice, including increased education and funding for psychophysical smell testing. We hope this will promote accurate and reliable olfactory assessment, as is the accepted standard in other sensory systems.

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