xRead - Olfactory Disorders (September 2023)

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TABLE II.A.3 AAP-defined strategy for recommendation development

Preponderance of benefit over harm

Balance of benefit and harm

Preponderance of harm over benefit Strong recommendation against

Evidence quality

A. Well-designed RCTs

Strong recommendation

Option

B. RCTs with minor limitations; overwhelmingly consistent evidence from observational studies C. Observational studies (case-control and cohort design) D . Expert opinion, case reports, reasoning from first principles

Recommendation

Recommendation against

Option

No recommendation

AAP = American Academy of Pediatrics; RCT = randomized controlled trial.

III DEFINITIONS A Anosmia and Hyposmia

Anosmia is defined as an absence of olfaction with an inability to detect and correctly identify odors, as mea sured by a validated, standardized olfactory test. 11–13 While anosmia, by definition, describes complete smell loss, functional anosmia refers to the possible existence of trace olfactory function (OF) but at a level not consid ered to be useful or noticeable in daily life. 12,14 Hypos mia or microsmia is defined as partial smell loss. 12,14 Specific anosmia is an inability to detect one or more specific odorants while olfaction of other odorants is intact. 15 As self-assessment of olfactory loss can be unreliable, the diagnosis of anosmia is traditionally confirmed based on the absolute number of correct answers on psychophys ical olfactory testing, with the threshold established from patients with complete loss of smell. 12,13,16 Normosmia (normal OF) for most olfactory tests is based on norma tive data from healthy 16- to 35-year-old patients, although normative data have been collected for all age groups on certain tests, such as the University of Pennsylvania Smell Identification Test (UPSIT R ). 13 Hyposmia is an absolute score below the 10th percentile of that normosmic group. 12,16,17 Hyposmia can be further delineated into mild, moderate, or severe hyposmia. 13 OF should be assessed by validated tests of odor threshold and either odor identifi cation or discrimination. Composite scores may be more reliable than tests of only one component of olfactory ability. 14

FIGURE II.A-1 Stage I of Iterative Review Process

FIGURE II.A-2 Stage II of Iterative Review Process