Applicability of the University of Pennsylvania Smell Identification Test (SIT) in Brazilians: pilot study

O teste de identificação do olfato da Universidade da Pensilvânia (SIT) é o exame olfatório mais citado na literatura devido a sua fácil aplicação e alta confiabilidade teste-reteste. Ainda não foram normatizados seus valores de olfação normal para a população brasileira. OBJETIVO: Verificar o escore no SIT alcançado por um grupo de brasileiros e o nível de dificuldade encontrado para a execução do teste. FORMA DE ESTUDO: Transversal. MATERIAL E MÉTODO: O SIT foi aplicado a 25 voluntários brasileiros de diversas classes econômicas, sem queixas olfatórias prévias. Após a aplicação do teste, todos preencheram um questionário com uma escala visual analógica (VAS) referente ao nível de dificuldade encontrado na realização do teste. RESULTADOS: O escore médio da amostra de brasileiros foi 32,5 (desvio-padrão:3,48) de 40, abaixo do considerado normal para a população americana. O nível de dificuldade médio encontrado foi 26mm (desvio padrão: 24,68) segundo a VAS, tendendo a facilidade, e 4(16%) participantes não conheciam algum dos odores escritos nas alternativas. CONCLUSÃO: Nesse estudo piloto, houve indícios de boa aplicabilidade do teste, com o escore dos brasileiros pouco abaixo da normosmia. São necessários estudos futuros para confirmar a existência de diferença de pontuação entre pessoas de diferente classe econômica.The University of Pennsylvania Smell Identification Test (SIT) is the most cited olfactory test in the literature because it is easy to perform and there is high test-retest reliability. There were no standardized olfaction values in a normal Brazilian population. AIM: To measure the SIT score in a group of Brazilians, and to assess the level of difficulty when implementing the test. STUDY DESIGN: A cross-sectional study. MATERIALS AND METHODS: The SIT was applied in 25 Brazilian volunteers of various income levels who presented no olfactory complaints. Following the test, subjects answered a questionnaire with a visual analog scale (VAS) for the level of difficulty. RESULTS: The mean in the sample of Brazilians was 32.5 (SD: 3.48) our of 40; this is below what is considered normal for US citizens. The level of difficulty was on average 26 mm (SD: 24.68) in the VAS, but it trended towards easy; 4(16%) participants did not recognize some of the odors under 'alternatives'. CONCLUSION: In this pilot study, there was evidence of good test applicability; the score of the sample of Brazilians was just below normosmia. Further studies are needed to confirm the existence of differences between people of different income levels

A new cultural adaptation of the University of Pennsylvania Smell Identification Test

OBJECTIVES: The University of Pennsylvania Smell Identification Test, a test of olfactory function that is widely used by otolaryngologists, geriatricians, and neurologists, has been translated into more than a dozen languages. In some instances, cultural and socioeconomic factors have necessitated changes in the odorant items or the response alternatives to make the test scores congruent with North American norms. The objective of this study was to compare the performance of Brazilian subjects on a new Portuguese language version of the University of Pennsylvania Smell Identification Test with their performance on an earlier Portuguese language version of the test, as well as to assess the influences of gender, age, ethnicity, and economic status on the test scores. METHODS: Based on pilot data, several response alternatives of the earlier Portuguese language version of the test were altered in an effort to improve test performance. Forty-nine healthy Brazilian volunteers, who represented several economic classes, were tested. The test scores of the study cohort who received the newer version of the test were compared with those of a group of 25 subjects who received the earlier version of the test. RESULTS: The mean score for the new version [35 (2.1)] was significantly (p = 0.002) higher than that for the earlier version [32.5 (3.5)]. Although no apparent influence of socioeconomic status was observed, the female participants outperformed the male participants in the current subject cohort. CONCLUSION: The changes made in the new cultural adaptation of the Portuguese version of the University of Pennsylvania Smell Identification Test were effective in increasing the average test scores of the participants. Overall, the female subjects outperformed the male subjects on the test

Cross-Cultural Adaptation and Validation of SNOT-20 in Portuguese

Introduction. Chronic rhinosinusitis is a highly prevalent disease, so it is necessary to create valid instruments to assess the quality of life of these patients. The SNOT-20 questionnaire was developed for this purpose as a specific test to evaluate the quality of life related to chronic rhinosinusitis. It was validated in the English language, and it has been used in most studies on this subject. Currently, there is no validated instrument for assessing this disease in Portuguese. Objective. Cross-cultural adaptation and validation of SNOT-20 in Portuguese. Patients and Methods. The SNOT-20 questionnaire underwent a meticulous process of cross-cultural adaptation and was evaluated by assessing its sensitivity, reliability, and validity. Results. The process resulted in an intelligible version of the questionnaire, the SNOT-20p. Internal consistency (Cronbach's alpha = 0.91, P < .001), reliability testing-retesting (r = 0.994, P < .001), content validity, validity of discrimination of patients without chronic rhinosinusitis (U = 44, P < .0001) and assessment of sensitivity to change (SRM = 1.53 and 1.09) were evaluated. Conclusion. We conducted a successful process of cross-cultural adaptation and validation of the SNOT-20 questionnaire into Portuguese

Intensive Olfactory Training in Post-COVID Patients: A Randomized Multicenter Clinical Trial

Introduction: Olfactory dysfunction (OD) is one of the most reported symptoms of COVID -19. Previous studies have identified olfactory training (OT) as an important treatment for postinfectious OD, but little is known about its effect after SARS-CoV-2 infection and how it can be optimized. Objective: To assess whether OT can be optimized if performed intensively, with more fragrances over a shorter period in patients with persistent OD after COVID -19. Also, to determine the presence of other variables related to OD and treatment response in this population. Method: This multicenter randomized clinical trial recruited 80 patients with persistent OD with previous COVID-19 for less than three months. The patients were divided into two groups, who received treatment with 4 and 8 essences over four weeks. Subjective assessments and the University of Pennsylvania Smell Identification Test (UPSIT) were performed before and after treatment. Results: A significant improvement in olfaction was measured subjectively and on UPSIT in both groups, but without significant differences between groups. In addition, the presence of olfactory fluctuation was associated with higher UPSIT scores. Conclusion: These data suggest that intensifying the training by increasing the number of essences for 4 weeks does not show superiority over the classical method. Moreover, a fluctuating olfactory ability seems to be related to a better score in the UPSIT

Giant cell bone lesions in the craniofacial region: a diagnostic and therapeutic challenge

Background: Giant cell tumors of bone (GCTs) are common in the long bones, but rare in the craniofacial region, with only 1% of cases occurring in the latter. Clinical, radiological, and anatomical diagnosis of this locally aggressive disease, which occurs in response to trauma or neoplastic transformation, poses a major challenge in clinical practice. Methods: The present study describes a series of 4 cases and highlights the main features of the differential diagnosis and treatment of these lesions: GCT, giant cell reparative granuloma (GCRG), and the brown tumor of hyperparathyroidism. Results: GCT presents as a benign neoplasm, most typically affecting the knees, and rarely in the temporal and sphenoid bones. It is radiologically indistinguishable from GCRG due to its lytic, poorly defined appearance. The distinction can only be made microscopically, as the presence of multinucleated giant cells scattered throughout the stroma and the absence of a history of trauma favor a diagnosis of GCT. The brown tumor of hyperparathyroidism occurs with rapid, localized osteoclast activity secondary to the effects of increased parathyroid hormone (PTH) levels; parathyroid examination is indispensable. Conclusion: The diagnosis and treatment of these lesions poses a major challenge due to their similar clinical presentation and radiological appearance. Accurate diagnosis is essential for definition of appropriate management, as complete resection is the goal in GCT and GCRG to avoid recurrence, whereas the brown tumor often yields to treatment of the underlying hyperparathyroidism

Recent smell loss is the best predictor of COVID-19 among individuals with recent respiratory symptoms

In a preregistered, cross-sectional study we investigated whether olfactory loss is a reliable predictor of COVID-19 using a crowdsourced questionnaire in 23 languages to assess symptoms in individuals self-reporting recent respiratory illness. We quantified changes in chemosensory abilities during the course of the respiratory illness using 0-100 visual analog scales (VAS) for participants reporting a positive (C19+; n=4148) or negative (C19-; n=546) COVID-19 laboratory test outcome. Logistic regression models identified univariate and multivariate predictors of COVID-19 status and post-COVID-19 olfactory recovery. Both C19+ and C19- groups exhibited smell loss, but it was significantly larger in C19+ participants (mean±SD, C19+: -82.5±27.2 points; C19-: -59.8±37.7). Smell loss during illness was the best predictor of COVID-19 in both univariate and multivariate models (ROC AUC=0.72). Additional variables provide negligible model improvement. VAS ratings of smell loss were more predictive than binary chemosensory yes/no-questions or other cardinal symptoms (e.g., fever). Olfactory recovery within 40 days of respiratory symptom onset was reported for ~50% of participants and was best predicted by time since respiratory symptom onset. We find that quantified smell loss is the best predictor of COVID-19 amongst those with symptoms of respiratory illness. To aid clinicians and contact tracers in identifying individuals with a high likelihood of having COVID-19, we propose a novel 0-10 scale to screen for recent olfactory loss, the ODoR-19. We find that numeric ratings ≤2 indicate high odds of symptomatic COVID-19 (4&lt;10). Once independently validated, this tool could be deployed when viral lab tests are impractical or unavailable

Validation of the University of Pennsylvania Smell Identification Test (UPSIT) for Brazilians

INTRODUÇÃO: Apesar da fundamental importância da olfação para avaliação dos sabores dos alimentos ingeridos, percepção de vazamento de gases e de incêndios, sua avaliação clínica ainda não se encontra padronizada no Brasil. O Teste de Identificação do Olfato da Universidade da Pensilvânia (UPSIT) é um teste mundialmente utilizado e considerado por muitos como o padrão-ouro da avaliação olfatória. Originalmente em inglês, já foi traduzido para mais de 12 línguas. Esse trabalho se propôs a validar de forma inédita o UPSIT para outra cultura. O UPSIT versão em português foi validado para a população brasileira e tabelas normativas foram elaboradas para comparação do escore obtido segundo o sexo e idade do indivíduo. Secundariamente, procurou-se os fatores preditores de um melhor escore no teste. CASUÍSTICA E MÉTODOS: Estudo transversal realizado de dezembro de 2011 a agosto de 2012. A amostra utilizada foi não-probabilística por quotas e constituída por indivíduos presentes em uma instituição de atendimento público (Poupatempo São Paulo), de forma consecutiva, sem queixas olfatórias no dia do exame. Foi determinada a quota de 60 brasileiros(as) em cada faixa etária de cada sexo, a saber: 20-24, 25-30, 31-34, 35-40, 41-44, 45-50, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79 e >= 80 anos. Após responderem questionário referente a dados demográficos e critérios de inclusão e exclusão do estudo, fizeram o UPSIT 782 indivíduos do sexo masculino e 796 do sexo feminino. Nos pacientes com idade igual ou superior a 65 anos foi realizado o Mini Exame do Estado Mental e se excluíram aqueles pacientes com escore inferior a 24 pontos pela possibilidade de quadro demencial. A versão do UPSIT aplicada nesse estudo foi resultado de dois estudos prévios para melhorar a aplicabilidade desse teste para a população brasileira. RESULTADOS: 1820 voluntários participaram do estudo, 1578 foram incluídos nas tabelas normativas. 242 foram excluídos no dia da entrevista por estarem com infecção das vias aéreas superiores, terem história de trauma crânio-encefálico, queixa de perda de olfato ou paladar e um escore menor de 24 no Mini Exame do Estado Mental. Verificou-se que entre os 1578 indivíduos analisados, o escore de UPSIT variou de 9 a 40, obtendo-se escore médio de 32,1 (desvio padrão: 5,3) e escore mediano igual a 33. Pela análise univariada (p = 80 years. After answering a questionnaire about demographics and inclusion and exclusion criteria of the study, 782 males and 796 females did the UPSIT. In patients aged over 65 years was held the Mini Mental State Examination and excluded those patients with a score less than 24 points for the possibility of dementia. The version of the UPSIT applied in this study was the result of two previous studies to enhance the applicability of this test for the Brazilian population. RESULTS: 1820 volunteers participated in the study, 1578 were included in the normative tables. 242 were excluded on the day of the interview for being with upper airway infection, having an history of head trauma, complaining of smell or taste losses and a score below 24 on the Mini Mental State Examination. It was found that among the 1578 subjects analyzed, the UPSIT scores ranged from 9 to 40, yielding a mean score of 32.1 (SD: 5.3) and a median 33. By univariate analysis (p < 0.01) and multivariate analysis - multiple linear regression-(p < 0.05), it was observed that the age, sex, years of schooling and family monthly income influenced the test scores. CONCLUSIONS: UPSIT is now validated for use in the Brazilian population. Normative tables for olfactory assessment and a fast way to obtain them were demonstrated. Correction factors are needed for a perfect equivalence between norms of all continents, using as gold standard norms of the country where the original version of the test was developed. Worse economic and educational status interfered negatively in olfactory performanc

Standardization of Latency and Amplitude Values of Short, Middle and Long Latency Auditory Evoked Potentials in Adults

Introduction Auditory processing refers to the efficiency and effectiveness with which the central auditory nervous system uses auditory information. Middle- and long-latency auditory evoked potentials are objective electrophysiological tests that can complement the diagnosis of alterations involving central auditory processing. Objective To standardize latency and amplitude values for short-, middle-, and long-latency auditory evoked potentials in adults with normal hearing thresholds. Methods This is a cross-sectional study. Thirty-three adults with normal hearing thresholds, without hearing complaints, and with normal central auditory processing were evaluated. All underwent basic audiological evaluation, central auditory processing assessment, and short-, middle-, and long-latency auditory evoked potentials. Results Absolute latency and interpeak values for middle- and long-latency auditory evoked potentials were lower than internationally suggested. However, for the brainstem auditory evoked potential, the means were within the range considered as normal, as suggested in the equipment. Conclusion The present study provided measurements of normal latencies and amplitudes for short-, middle-, and long-latency auditory evoked potentials in adults

Changes in Auditory Evoked Potentials Increase the Chances of Adults Having Central Auditory Processing Disorder

Introduction Auditory evoked potentials are widely used in clinical practice to complement the assessment of central auditory processing. However, it is necessary to understand whether these potentials are highly accurate, to assist in the diagnosis of auditory processing disorder

Perforation of nasal septum: etiology and diagnosis

Introduction: The nasal septum perforation is an occasional finding of rhinoscopy and most patients are asymptomatic. However, there are several possible etiologies of this condition, making necessary a thorough investigation. Objective: To review the literature the main causes of septal perforation and describe the diagnostic tests currently used. Method: A systematic literature review of journals indexed identifiable until December 2008. Final Comments: The main causes are the traumatic / iatrogenic nasal drug use, exposure to toxic gases, inflammatory and infectious diseases and neoplasms. The diagnosis is based on detailed medical history, focusing on occupation and origin of the patient, observation of the characteristics of mucosal injury on biopsy and collection of additional tests such as ANCA, guided by the main suspect