Paediatric Barcelona Olfactory Test-6 (pBOT-6): Validation of a Combined Odour Identification and Threshold Screening Test in Healthy Spanish Children and Adolescents

Background: Few odour tests have been created for children. Objectives: The aim of the present study was to develop and validate a simple and quick olfactory test, suitable for the evaluation of odour identification and threshold in a Spanish paediatric population, the paediatric Barcelona Olfactory Test-6 (pBOT-6).The pBOT-6 consisted in a set of 6 odorants for a forced-choice identification test (IT), and a 6 dilutions phenyl ethyl alcohol geometric series for the threshold test (TT). The pBOT-6 was compared with the U-sniff test (a validated international paediatric smell test) in 131 Spanish healthy volunteers aged 6-17 years. A Bland-Altman plot was used to determine the agreement between two tests. Reliability was analyzed in fifteenvolunteers using the intraclass correlation coefficient (ICC). Normative data was obtained and 8 children diagnosed with subjective smell loss were tested for validation.Bland-Altman analysis demonstrated a minimal bias of -1.71% with upper and lower limit of agreement of -31.1% and 27.6%, respectively. The ICC was 0.83 (95% CI 0.6-0.96) for the IT and 0.73 (95% CI 0.36-0.9) for the TT, showing excellent and good consistency between measurements over time. Mean pBOT-6 scores were significantly higher in healthy volunteers compared with patients with smell loss. Discrimination between normosmia and smell loss was achieved with a sensitivity of 96.9% and a specificity of 100%.The pBOT-6 offers an effectiveand fast method useful in clinical routine to distinguish, with high sensitivity and specificity, between paediatric patients with normosmia and those with smell dysfunction

Pérdida del sentido del olfato: profundizando en su epidemiología, causas rinosinusales y posibilidades terapéuticas

[spa] FUNDAMENTO: A pesar de la importancia del olfato para la nutrición, seguridad y calidad de vida, la prevalencia y factores de riesgo del deterioro olfativo en nuestra población no han sido bien estudiados. La patología inflamatoria nasosinusal (rinitis/rinosinusitis) causa disfunción olfatoria y, aunque existe asociación entre patología nasosinusal y bronquial, se desconoce si la pérdida del olfato puede constituir un factor diagnóstico. También se desconoce si el tratamiento médico mejora el olfato de los pacientes con rinitis alérgica persistente, si el entrenamiento olfativo puede mejorar el sentido del olfato o si la resección del neuroepitelio olfatorio en la cirugía de base de cráneo puede alterarlo. HIPÓTESIS: Existe alta prevalencia de pérdida olfativa en la población general, a veces asociada a enfermedades inflamatorias nasales asociadas a patología broncopulmonar y a la cirugía endoscópica nasosinusal de base de cráneo. El tratamiento médico y el entrenamiento olfativo pueden mejorar las aptitudes olfatorias. OBJETIVOS: 1º) Determinar la prevalencia de pérdida del olfato y los factores de riesgo asociados en la población general. 2º) Estudiar la pérdida del olfato como factor diagnóstico de la patología nasal y broncopulmonar asociada, y como efecto adverso de la cirugía de base de cráneo. 3º) Analizar el efecto del tratamiento de la patología nasal y del entrenamiento olfativo sobre la función olfatoria. METODOLOGÍA: Correspondiente a 5 estudios: 1º) dos cuestionarios (olfato y demografía) y 4 olores microencapsulados distribuidos en población general mediante un periódico (250.000 ejemplares). 2º) Olfatometría comparando enólogos y controles. 3º) Función olfatoria comparando pacientes con bronquiectasias y controles. 4º) Síntomas nasales y olfatometría en pacientes con rinitis alérgica persistente antes y después del tratamiento con levocetirizina. 5º) Síntomas nasales y olfatometría en pacientes intervenidos de tumores de base de cráneo por abordaje endoscópico nasosinusal. RESULTADOS: Extensos resultados publicados en 5 artículos: BMJ Open 2012, Rhinology 2010, RespMed 2011, Int Arch Allergy Immunol 2012, Neurosurgery 2012. CONCLUSIONES: 1º) Existe una alta prevalencia de hiposmia (19%) y anosmia (0,3%) en la población general, aunque sólo el 7% de los sujetos considera tener un sentido del olfato pobre. 2º) La capacidad de detección olfativa se deteriora progresivamente a lo largo de la vida, pero las habilidades cognitivas olfativas se incrementan con la experiencia adquirida en las primeras décadas de la vida para posteriormente decaer a partir de la sexta década de vida. 3º) El sentido del olfato de las mujeres es superior al de los hombres para todas las edades.4º) El embarazo, el sexo masculino, la mala auto-valoración del olfato, un bajo nivel educativo y el envejecimiento son factores de riesgo para la pérdida del sentido del olfato; mientras que la exposición a sustancias tóxicas y fumar son factores protectores moderados. 5º Gracias al entrenamiento y la experiencia, los enólogos poseen una mayor capacidad de identificación. pero no de detección, olfativa que las personas no entrenadas. 6º Existe un claro deterioro de la función olfativa en los pacientes con bronquiectasias en comparación con controles sanos, particularmente en los pacientes afectos de rinosinusitis crónica, poliposis nasal e inmunodeficiencia humoral primaria. 7º) La levocetirizina mejora la pérdida del olfato medida por EVA en pacientes con rinitis alérgica persistente después de 7 días de tratamiento gracias a la disminución de la inflamación nasal. 8º) El abordaje endonasal extendido, pero no el abordaje transnasal transesfenoidal endosópico, tiene un impacto negativo a corto plazo (3 meses) en el sentido del olfato de los pacientes sometidos a cirugía de base de cráneo.[eng] INTRODUCTION: Despite the importance of smell for nutrition, safety and quality of life, the prevalence and risk factors of olfactory impairment in our population have not been well studied. Although there is an association between sinus and bronchial disease, it is not known whether hyposmia can be a diagnostic factor or not. It is also unknown if medical treatment improves smell loss in patients with persistent allergic rhinitis, if olfactory training can improve smell function or if skull base surgery can alter it. HYPOTHESIS: There is a high prevalence of olfactory loss in general population, sometimes associated with bronchopulmonary pathology and endoscopic skull base surgery. Medical treatment and olfactory training can improve smell skills. OBJECTIVES: 1)To report the prevalence of loss of smell and associated risk factors in the general population. 2)To study the loss of smell as a diagnostic tool in the sinonasal and bronchial associated disease, and as a side effect of skull base surgery. 3)To analyze the effect of treatment of nasal inflammatory conditions and training on olfactory function. METHODOLOGY: Corresponding to 5 studies: 1)Two questionnaires (smell and demography) and 4 smells microencapsulated odorants distributed through a newspaper (250,000 copies). 2)Olfactometry in enologists and untrained subjects. 3)Olfactory function in patients with bronchiectasis and controls. 4)Nasal Symptoms and olfactometry in patients with persistent allergic rhinitis before and after treatment with levocetirizine. 5)Nasal Symptoms and olfactometry in patients undergoing skull base tumors by endoscopic sinus approach. RESULTS AND CONCLUSIONS: 1)There is a high prevalence of hyposmia (19%) and anosmia (0.3%) in the general population 2)Smell detection deteriorates throughout life. 3)Women are superior to men in smell abilities. 4)Pregnancy, male gender, poor self-reported sense of smell, low educational level and aging are risk factors for loss of smell; while exposure to toxic substances and smoking are moderate protective factors. 5) Enologists have a superior smell identification than untrained subjects. 6)Patients with bronchiectasis have a deteriorated sense of smell compared to healthy controls. 7)Levocetirizine improves olfactory loss in patients with persistent allergic rhinitis 8)Expanded endonasal approach has a short term negative impact in smell function of patients undergoing skull base surgery

Ethyl alcohol threshold test: a fast, reliable and affordable olfactory Assessment tool for COVID-19 patients

International audienceObjective: COVID-19 patients may present mild symptoms. The identification of paucisymptomatic patients is paramount in order to interrupt the transmission chain of the virus. Olfactory loss could be one of those early symptoms which might help in the diagnosis of COVID-19 patients. In this study, we aim to develop and validate a fast, inexpensive, reliable and easy-to-perform olfactory test for the screening of suspected COVID-19 patients. Study design: Phase I was a case–control study and Phase II a transversal descriptive study. Subjects and methods: Olfaction was assessed with the ethyl alcohol threshold test and symptoms with visual analogue scales. The study was designed in two phases: In Phase I, we compared confirmed COVID-19 patients and healthy controls. In Phase II, patients with suspected COVID-19 infection referred for testing were studied. Results: 275 participants were included in Phase I, 135 in Phase II. The ROC curve showed an AUC of 0.749 in Phase I, 0.737 in Phase II. The cutoff value which offered the highest amount of correctly classified patients was ≥ 2 (10% alcohol) for all age intervals. The odds ratio was 8.19 in Phase I, 6.56 in Phase II with a 75% sensitivity. When cases report normal sense of smell (VAS < 4), it misdiagnoses 57.89% of patients detected by the alcohol threshold test. Conclusion: The olfactory loss assessed with the alcohol threshold test has shown high sensitivity and odds ratio in both patients with confirmed COVID-19 illness and participants with suspected SARS-CoV-2 infection