xRead - Olfactory Disorders (September 2023)

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347

PATEL et al.

TABLE IV.3 (Continued) Study Year

LOE Study design

Population

Outcome

Conclusions

Nordin et al

2011

4

Case series

50 patients with NPs

Survey completion 38% perceived risk of failure to detect smoke/fire, 15% rancid food, 6% dangers at work, chemicals/gases

Pence et al

2014

3

Retrospective cohort 704 smell clinic–tested patients with varying levels of impairment (643) and without (161) Retrospective cohort 445 smell clinic–tested patients with varying levels of impairment (340) and without (105)

Reported

Increasing likelihood of experiencing hazardous event with increasing OD Increasing likelihood of experiencing hazardous event with increasing OD No differences in odor detection, suggesting no sensory compensation in patients who are vision or hearing impaired

occurrence of hazardous events

Reported

Santos et al

2004

3

occurrence of hazardous events

Sorokowska et al

2020

3

Cohort

100 blind and 100 sighted controls, 74 deaf and 99 hearing controls

Threshold for detection of

rotten food odor

Temmel et al

2020

4

Case series

278 patients with OD Survey completion Decreased QOL; 50% ate spoiled foods, 30% burned foods; younger

and female patients were more likely to have complaints/issues HCs = healthy controls; LOE = level of evidence; NP = nasal polyp; OD = olfactory dysfunction; QOL = quality of life; TBI = traumatic brain injury.

humans, while much attention is directed toward the impact of OD on feeding behaviors and QOL, 24,61,62 the critical importance of olfaction on personal safety—most notably the avoidance of injury from fires, ingestion of spoiled food, and inhalation of noxious chemicals— cannot be disregarded. 24 Objective data directly linking smell loss to such potential harms are lacking. An early study attempted to explore causes of the disproportionate number of deaths in persons aged > 60 years in England caused by “coal-gas poisoning,” demonstrating that 33% of those aged > 65 years, compared with 7% aged < 65 years, were unable to recognize the odor of “town gas.” 63 Another study reporting on the demographics of fire victims in New Jersey showed an overrepresentation of the very young and elderly among fire victims, when compared with state demographics, arguing that this might be explained, in part, by reduced olfaction in the latter group. 64 Studies employing patient reports of having experienced OD-related safety events showed significant differences between anosmic, hyposmic, and normosmic populations for both acquired 65–67 and congenital 57 olfac tory deficits. The odds ratio of experiencing “hazardous events” compared with controls was 2.94 for anosmics

and 1.30 to 2.18 for hyposmics of varying degrees, while increased risk was also noted in patients aged < 65 years and women, potentially related to differing risks of exposure during work and home activities. 67 However, difficulties exist in normalizing data for frequency of exposure to such events, as well as length or nature (quantitative versus qualitative) of OD. Many studies have explored the QOL impact of OD. Those including safety-related issues have indicated increased incidence of fear or concern for gas leaks (49%–60% 20,61,62,68 ), smoke/fires (30%–50% 20,36,62,69,70 ), chemical exposures (6%–40% 62,70 ), and eating spoiled foods (15%– 71% 20,36,61,68–70 ). However, only two of these studies employed some form of olfactory-intact control popu lation, with one relying on patient-report of function, 62 and the other using objective testing. 61 Most authors advocate the importance of counseling olfactory-impaired patients on these hazards and compensatory strategies for risk mitigation. The Individual Importance of Olfaction Questionnaire has been used to compare the importance of olfaction in daily life, showing lower scores in anosmic compared with hyposmic or control patients, 71 suggesting compensation among afflicted individuals. However,