The 8-Odorant Barcelona Olfactory Test (BOT-8): Validation of a New Test in the Spanish Population During the COVID-19 Pandemic

COVID-19; Pèrdua d'olfacte; Prova de l'olfacteCOVID-19; Loss of smell; Smell testCOVID-19; Pérdida de olfato; Prueba del olfatoBackground and objective: Most smell tests are difficult to implement in daily clinical practice owing to their long duration. The aim of the present study was to develop and validate a short, easy-to-perform, and reusable smell test to be implemented during the COVID-19 pandemic. Methods: The study population comprised 120 healthy adults and 195 patients with self-reported olfactory dysfunction (OD). The 8-Odorant Barcelona Olfactory Test (BOT-8) was used for detection, memory/recognition, and forced-choice identification. In addition, a rose threshold test was performed, and a visual analog scale was applied. The Smell Diskettes Olfaction Test (SDOT) was used for correlation in healthy volunteers, and the University of Pennsylvania Smell Identification Test (UPSIT) was used for patients with OD to establish cut-offs for anosmia and hyposmia. In order to take account of the COVID-19 pandemic, disposable cotton swabs with odorants were compared with the original test. Results: In healthy persons, the mean (SD) BOT-8 score was 100% for detection, 94.5% (1.07) for memory/recognition, and 89.6% (0.86) for identification. In patients with OD, the equivalent values were 86% (32.8), 73.2% (37.9), and 77.1% (34.2), respectively. BOT-8 demonstrated good test-retest reliability, with agreement of 96.7% and a quadratic k of 0.84 (P<.001). A strong correlation was observed between BOT-8 and SDOT (r=0.67, P<.001) and UPSIT (r=0.86, P<.001). Agreement was excellent for disposable cotton swabs, with a k of 0.79 compared with the original test. The cut-off point for anosmia was ≤3 (area under the curve, 0.83; sensitivity, 0.673; specificity, 0.993). Conclusion: BOT-8 offers an efficient and fast method for assessment of smell threshold, detection, memory, and identification in daily clinical practice. Disposable cotton swabs with odorants proved to be useful and safe during the COVID-19 pandemic

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

Impacte de les alteracions anatòmiques intranasals sobre els símptomes, la resposta al tractament mèdic i la qualitat de vida en nens i adolescents amb rinitis al·lèrgica persistent

[cat] En la pràctica clínica habitual no és infreqüent trobar pacients pediàtrics amb rinitis al·lèrgica persistent (PER) que són derivats al servei d’ Otorrinolaringologia per manca de resposta al tractament mèdic. Per aquest motiu, es va decidir estudiar els factors de risc associats a la manca de resposta al tractament mèdic en nens i adolescents amb PER moderada i greu, especialment les alteracions anatòmiques intranasals. Segons la resposta al tractament mèdic es van avaluar i comparar dos grups de pacients, els responedors (R) i els no responedors (NR). Els pacients pediàtrics amb PER van ser estudiats prospectivament després de rebre tractament amb corticoides intranasals (fluticasona o mometasona) durant almenys 2 mesos consecutius. La gravetat de la PER va ser estratificada amb la classificació ARIA-m. Segons l'edat, els pacients es van estratificar en nens (6-11 anys) i adolescents (12-17 anys). Els símptomes nasals es van avaluar mitjançant una EVA (0-10 cm) i l’EVA total dels símptomes nasals es va utilitzar per definir la resposta (EVA ≤5 cm) o la resistència (EVA >5 cm) al tractament mèdic. Les alteraciones anatòmiques nasals van ser evaluades mitjançant un endoscopi flexible de 2,4 milímetres i van ser classificades en obstructives o no obstructives. El grup NR va presentar una major prevalença de dismòrfia septal obstructiva (45,3% vs. 11,4%; p=0,0002) i d’hiperplàsia de cornets obstructiva (64,0% vs. 0%; p=0,00001) que el grup R. L’exploració mitjançant endoscòpia nasal demostra que gairebé el 90% dels pacients pediàtrics amb PER que no responen al tractament mèdic tenen algun dels 7 tipus de dismòrfia septal (DS). Les DS anteriors unilaterals i bilaterals estan fortament associades amb una mala resposta al tractament mèdic, una major gravetat de la rinitis i una puntuació superior en EVA d’obstrucció nasal. A més, prevalença de PER greu va ser major en el grup NR que en el grup R i el bon control de l'asma es va associar amb una probabilitat de millora de la PER amb el tractament mèdic. La qualitat de vida (QdV) es va evaluar mitjançant qüestionaris específics per RA, el PRQLQ per als nens i el AdolQRLQ per adolescents. Els pacients NR van presentar una major afectació de la QdV que els responedors tant en adolescents com en nens. Així mateix, la presència d'una dismòrfia septal obstructiva, d'una hiperplàsia de cornets obstructiva i de totes dues alhora es va associar amb una pitjor qualitat de vida en els adolescents. Respecte a les comorbilitats, la presència de conjuntivitis va afectar negativament la QdV dels nens i dels adolescents. Addicionalment, vam trobar una forta correlació entre els símptomes mesurats amb l’EVA i la puntuació global de QdV dels dos grups d’edat. Per últim, la presència d’hipòsmia es va associar amb un major risc de patir PER greu i de resistència al tractament mèdic. D'altra banda, el bon control de la RA es va associar inversament amb la hipòsmia. L’EVA d'olfacte va ser pitjor en els NR o en aquells pacients amb hiperplàsia de cornets obstructiva i amb PER greu. Com a conclusió final, considerem que cal incloure l'endoscòpia nasal, l’escala visual analògica de símptomes nasals, sobretot la pèrdua de l’olfacte, i la classificació de gravetat ARIA modificada tant en la pràctica clínica diària com en els futurs protocols d’estudi clínic de la rinitis al·lèrgica en pediatria així com en les guies nacionals i internacionals. Són eines senzilles, ràpides de fer i molt valuoses per al maneig dels pacients pediàtrics amb rinitis al·lèrgica ja que permeten donar un millor diagnòstic, avaluar la millor opció terapèutica (mèdica i/o quirúrgica) i, en conseqüència, millorar la seva qualitat de vida.[eng] In clinical practice it is common to find pediatric patients with persistent allergic rhinitis (PER) who are referred to Otorhinolaryngology due to lack of response to medical treatment. Our objective was to assess the risk factors associated with the lack of response to medical treatment in children and adolescents with moderate and severe PER, especially nasal obstructive disorders (NOD). According to the response to medical treatment, two groups of patients, the responders (R) and the non-responders (NR), were evaluated and compared. The patients were studied prospectively after receiving treatment with intranasal corticosteroids for at least 2 consecutive months. The severity of the PER was stratified by the ARIA-m classification. According to age, patients were divided into two groups: children (6-11 years) and adolescents (12-17 years). Nasal symptoms were assessed by the visual analogue scale (VAS), and the total VAS of nasal symptoms was used to define the response (VAS ≤5 cm) or resistance (> 5 cm) to medical treatment. NOD were evaluated by flexible endoscopy. The NR group presented a higher prevalence of obstructive septal deformity and severe inferior turbinate enlargement when compared with the R group. Higher septal deformity and turbinate enlargement scores were strongly associated with treatment refractoriness. The prevalence of severe PER was also higher for the NR group. Higher asthma control scores were associated with the probability of treatment-induced improvement. Quality of life (QoL) was assessed using specific questionnaires for RA, the PRQLQ for children and the AdolQRLQ for adolescents. The NR patients presented a greater involvement of the QOL than the R patients in both adolescents and children. Likewise, the presence of obstructive DS, obstructive turbinates hyperplasia and both at the same time was associated with a worse QOL in adolescents. Finally, the presence of hyposmia was associated with an increased risk of severe PER, turbinate hyperplasia and resistance to medical treatment. On the other hand, good control of RA was inversely associated with hyposmia. In conclusion, medical therapy refractoriness in pediatric PER patients was associated with the presence of nasal obstructive disorders, impaired QoL and hyposmia. In those patients, ENT examination will facilitate an early NOD diagnosis in order to indicate potential corrective surgery

Modified nasal floor and inferior meatus flap for septal perforation repair. Extension and limits

BACKGROUND: The nasal floor and inferior meatus (NFIM) flap represents an available option for the reconstruction of a septal perforation (SP). This study explores the feasibility of repairing SPs using a modified simple and extended (including inferior turbinate) NFIM flap. METHODS: An anatomic study was achieved in fresh frozen cadaveric specimens to measure the area and lengths of NFIM flap. The repair of SP with simple and extended NIFM flaps was performed in some of these cadaveric specimens. Preoperative radiological evaluation of CT scans allowed studying the reconstruction limits of the simple or extended NFIM flap. A cohort of patients with SP who underwent reconstruction with an NFIM flap was also included. RESULTS: Complete SP repair with NFIM was achieved in all specimens (n=10). In 38 fresh cadaveric specimens, coronal and sagittal lengths and area of simple NFIM flaps were smaller than in extended NFIM flaps. The radiological analysis of 75 CT scans revealed that the septal height could be reconstructed with a simple and extended NFIM flap. Complete SP repair wasachieved in 5 patients (4 male, mean age 57.4 years) using modified NFIM flaps. CONCLUSION: The simple or expanded NFIM flap represents a feasible option to repair small or medium-sized perforations located at the lower 1/3 or 3/4 of the nasal septum.status: publishe