xRead - Olfactory Disorders (September 2023)

20426984, 2022, 4, Downloaded from https://onlinelibrary.wiley.com/doi/10.1002/alr.22929, Wiley Online Library on [04/09/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License

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INTERNATIONAL CONSENSUS ON OLFACTION

allergy. 1250,1256 Deficits on the QOD-NS have been asso ciated with worse economic and productivity metrics in patients with CRS. 1257 Patients who underwent both surgi cal and medical treatment of CRS have reported improve ments in QOD-NS scores. 1250,1252,1256 Many studies on OD during the COVID-19 pandemic have been conducted. The majority of these studies at the time of writing utilize VAS or nonvalidated ques tionnaires when assessing patient-reported OD, although some employ the QOD. A prospective study of 81 patients with COVID-19 demonstrated that self-reported olfac tory loss assessed via VAS was predictive of abnormal quantitative OF. 1258 An international series employed the QOD along with VAS and concluded that olfactory or gustatory dysfunction may represent early symptoms of infection. 1259 A series of patients with mild COVID-19 infection demonstrated elevated QOD scores, which cor related with impaired psychophysical olfactory testing and gustatory dysfunction. 1260 Validated olfactory QOL questionnaires have been applied to other populations with OD. In a cohort study of adult patients without otolaryngologic complaints, QOD scores were elevated and associated with metrics of loneliness. 1254 Patients with anosmia and hyposmia had impairments on the MCSTQ-Sc. 36 A multinational study of patients from smell and taste clinics demon strated that those with postinfection OD and PTOD had worse olfactory-specific QOL than those with sinonasal and IOD. 1255 The impact of OD is broad and extends beyond olfactory specific realms. Patients with OD often describe anhedo nia, frustration, sadness, and isolation. 30 In addition to olfactory-specific QOL deficits, individuals with OD from both CRS and non-CRS causes have impairments in areas including general health-related QOL, depression, loneli ness, and productivity loss. 1254,1256,1257 Use of a validated measure of QOL in the assessment of patients with OD Aggregate grade of evidence : C (Level 3: nine studies; Level 4: three studies). Benefit : In patients with CRS, using a validated mea sure of olfactory QOL correlates with quantitative OD at baseline, may potentially serve as a screening tool, and gen erally associates with improvements in OD after treatment. The utility of an olfactory QOL survey in individuals with out sinonasal disease is less clear, but reports suggest there may be value in this approach. Harm : None anticipated. Cost : Minimal time to complete survey. Benefit-harm assessment : Benefit for use over nonuse of surveys. Value judgments : The advantage of using an olfactory QOL survey is greater in individuals with known sinonasal

encouraged for research studies in which subtle effects are expected or cultural factors may impact study outcomes.

D Use of validated survey QOL testing Olfactory-specific QOL can be assessed by multiple methods including survey responses, symptom scores, and VAS. 1243 Often, these patient-reported methods supplement quantitative olfactory testing. Several instru ments have been described and validated, including the Questionnaire of Olfactory Disorders (QOD), 32 the Assessment of Self-Reported Olfactory Function and Olfaction-Related QOL (ASOF), 1244 the Multi-Clinic Smell and Taste Questionnaire-Scandanavian (MCSTQ-Sc), 1245 and other QOL-based surveys. 62 These surveys gener ally provide information regarding the degree to which patients experience OD. The QOD is the most commonly used metric, of which the most frequently employed version incorporates 17 negative statements (QOD NS). 1243 The QOD has high consistency, reliability, and validity. 1243 Thresholds of clinical relevance exist for this instrument. 1246 Beyond validated questionnaires, nonvalidated means have been employed to ascertain olfactory QOL. Studies in various fields including CRS, biologics, septorhinoplasty, and skull base surgery have used the single question from the 22-item Sino-Nasal Outcome Test (SNOT-22) survey on “Decreased sense of smell/taste.” 507,1247–1249 While the intent of this is admirable, caution should be applied when interpreting results from this approach, as factors such as the “halo effect” can lead to spurious findings. In patients with CRS, olfactory QOL and quantitative olfactory testing results generally correlate, although this association is mixed among populations without sinonasal disease and potentially in those treated with medical ther apy for CRS. A prospective study of 121 patients with CRS identified a moderate correlation between QOD and 40 question Smell Identification Test findings ( r = 0.40). 1250 OD identified via the SS test is associated with worse QOD NS scores among patients with CRS, with receiver oper ating characteristic analysis yielding a sensitivity of 60.9% and specificity of 81.8% for the QOD-NS to detect quan titative OD. 1251 Alternatively, after medical treatment of CRS, improvement in SS was not associated with QOD NS scores ( r = –0.016) on short-term follow-up. 1252 In a community-based sample of 7267 individuals, negligible associations were identified between SS results and general health QOL surveys. 1253 However, other studies in dysos mic adults and in patients with PIOD, PTOD, sinonasal OD, and IOD show that QOD scores were generally asso ciated with SS findings. 1254,1255 Among patients with CRS, olfactory-specific QOL is further impaired in patients with NPs and comorbid