Development and Validation of a Novel At-home Smell Assessment | Olfaction and Taste | JN Learning | AMA Ed Hub [Skip to Content]
[Skip to Content Landing]

Development and Validation of a Novel At-home Smell Assessment

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME
Key Points

Question  Can an olfactory dysfunction be assessed via commonly available household items?

Findings  In this diagnostic study of 115 adults with self-reported olfactory dysfunction, 2 shorter, patient-reported assessments using common household items were easy to use and had high accuracy when detecting olfactory dysfunction.

Meaning  These findings suggest that these novel assessments can be used by people seeking to test their sense of smell and by health care professionals to detect olfactory dysfunction.

Abstract

Importance  Current tools for diagnosis of olfactory dysfunction (OD) are costly, time-consuming, and often require clinician administration.

Objective  To develop and validate a simple screening assessment for OD using common household items.

Design, Setting, and Participants  This fully virtual diagnostic study included adults with self-reported OD from any cause throughout the US. Data were collected from December 2020 to April 2021 and analyzed from May 2021 to July 2021.

Main Outcomes and Measures  Participants with self-reported olfactory dysfunction took a survey assessing smell perception of 45 household items and completed the Clinical Global Impression–Severity (CGI-S) smell questionnaire, the University of Pennsylvania Smell Identification Test (UPSIT), and the 36-item Short Form Survey (SF-36). Psychometric and clinimetric analyses were used to consolidate 45 household items into 2 short Novel Anosmia Screening at Leisure (NASAL) assessments, NASAL-7 (range, 0-14; lower score indicating greater anosmia) and NASAL-3 (range, 0-6; lower score indicating greater anosmia).

Results  A total of 115 participants were included in the study, with a median (range) age of 42 (19-70) years, 92 (80%) women, and 97 (84%) White individuals. There was a moderate correlation between the UPSIT and NASAL-7 scores and NASAL-3 scores (NASAL-7: ρ = 0.484; NASAL-3: ρ = 0.404). Both NASAL-7 and NASAL-3 had moderate accuracy in identifying participants with anosmia as defined by UPSIT (NASAL-7 area under the receiver operating curve [AUC], 0.706; 95% CI, 0.551-0.862; NASAL-3 AUC, 0.658; 95% CI, 0.503-0.814). Scoring 7 or less on the NASAL-7 had 70% (95% CI, 48%-86%) sensitivity and 53% (95% CI, 43%-63%) specificity in discriminating participants with anosmia from participants without. Scoring 2 or less on the NASAL-3 had 57% (95% CI, 36%-76%) sensitivity and 78% (95% CI, 69%-85%) specificity in discriminating participants with anosmia from participants without. There was moderate agreement between UPSIT-defined OD categories and those defined by NASAL-7 (weighted κ = 0.496; 95% CI, 0.343-0.649) and those defined by NASAL-3 (weighted κ = 0.365; 95% CI, 0.187-0.543). The agreement with self-reported severity of olfactory dysfunction as measured by CGI-S and the NASAL-7 and NASAL-3 was moderate, with a weighted κ of 0.590 (95% CI, 0.474-0.707) for the NASAL-7 and 0.597 (95% CI, 0.481-0.712) for the NASAL-3.

Conclusion and Relevance  The findings of this diagnostic study suggest that NASAL-7 and NASAL-3, inexpensive and brief patient-reported assessments, can be used to identify individuals with OD. As the burden of COVID-19–associated OD increases, these assessments may prove beneficial as screening and diagnostic tools. Future work will explore whether the NASAL assessments are sensitive to change and how much of a change is clinically important.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 CME Credit™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: November 15, 2021.

Published Online: January 13, 2022. doi:10.1001/jamaoto.2021.3994

Corresponding Author: Jay F. Piccirillo, MD, Clinical Outcomes Research Office, Department of Otolaryngology–Head & Neck Surgery, Washington University School of Medicine in St. Louis, 660 South Euclid Avenue, Campus Box 8115, St Louis, MO 63110 (piccirij@wustl.edu).

Author Contributions: Ms Gupta and Dr Kallogjeri had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Gupta, Kallogjeri, Smith, Khan, Piccirillo.

Acquisition, analysis, or interpretation of data: Gupta, Kallogjeri, Farrell, Lee, Piccirillo.

Drafting of the manuscript: Gupta.

Critical revision of the manuscript for important intellectual content: All authors.

Statistical analysis: Gupta, Kallogjeri, Smith, Khan.

Obtained funding: Piccirillo.

Administrative, technical, or material support: Gupta, Lee, Piccirillo.

Supervision: Gupta, Farrell, Lee, Piccirillo.

Conflict of Interest Disclosures: Dr Kallogjeri reported owning stock in Potentia Metrics and receiving personal fees for serving as a statistics editor for JAMA Otolaryngology–Head & Neck Surgery outside the submitted work. Dr Piccirillo reported receiving royalty payments for Sino-Nasal Outcome Test, licensed by Washington University. Dr Piccirillo also received fees for serving as the Editor of JAMA Otolaryngology–Head & Neck Surgery. No other disclosures were reported.

Funding/Support: Research reported in this publication was supported by grant T32DC000022 from the Development of Clinician/Researchers in Academic ENT of the National Institute of Deafness and Other Communication Disorders (Ms Gupta, Mr Smith, and Dr Lee) and grant TL1TR002344 from the National Center For Advancing Translational Sciences of the National Institutes of Health (Mr Khan). Recruitment for this study was supported by ResearchMatch and the Recruitment Enhancement Core (Volunteers for Health). ResearchMatch is a national health volunteer registry that was created by several academic institutions and supported by the National Institutes of Health as part of the Clinical Translational Science Award program. ResearchMatch has a large population of volunteers who have consented to be contacted by researchers about health studies for which they may be eligible. The Recruitment Enhancement Core in the Regulatory Support Center of the Institute of Clinical and Translational Sciences, Washington University School of Medicine, is supported by grant UL1TR002345 from the National Center For Advancing Translational Sciences of the National Institutes of Health. Recruitment was also supported by the group AbScent, led by Chrissi Kelly.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: Drs Kallogjeri and Piccirillo are Statistics Editor and Editor, respectively, of JAMA Otolaryngology–Head & Neck Surgery, but they were not involved in any of the decisions regarding review of the manuscript or its acceptance. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Additional Contributions: Thanks to Amber Perrin, BS, and Zach Jaeger, BS, of the Washington University School of Medicine for their support throughout this project. Ms Perrin received additional compensation.

References
1.
Menni  C , Valdes  AM , Freidin  MB ,  et al.  Real-time tracking of self-reported symptoms to predict potential COVID-19.   Nat Med. 2020;26(7):1037-1040. doi:10.1038/s41591-020-0916-2PubMedGoogle ScholarCrossref
2.
Mercante  G , Ferreli  F , De Virgilio  A ,  et al.  Prevalence of taste and smell dysfunction in coronavirus disease 2019.   JAMA Otolaryngol Head Neck Surg. 2020;146(8):723-728. doi:10.1001/jamaoto.2020.1155PubMedGoogle ScholarCrossref
3.
Boscolo-Rizzo  P , Borsetto  D , Fabbris  C ,  et al.  Evolution of altered sense of smell or taste in patients with mildly symptomatic COVID-19.   JAMA Otolaryngol Head Neck Surg. 2020;146(8):729-732. doi:10.1001/jamaoto.2020.1379PubMedGoogle ScholarCrossref
4.
Kaye  R , Chang  CWD , Kazahaya  K , Brereton  J , Denneny  JC  III .  COVID-19 anosmia reporting tool: initial findings.   Otolaryngol Head Neck Surg. 2020;163(1):132-134. doi:10.1177/0194599820922992PubMedGoogle ScholarCrossref
5.
Lechien  JR , Chiesa-Estomba  CM , De Siati  DR ,  et al.  Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study.   Eur Arch Otorhinolaryngol. 2020;277(8):2251-2261. doi:10.1007/s00405-020-05965-1PubMedGoogle ScholarCrossref
6.
Walker  A , Pottinger  G , Scott  A , Hopkins  C .  Anosmia and loss of smell in the era of COVID-19.   BMJ. 2020;370:m2808. doi:10.1136/bmj.m2808PubMedGoogle Scholar
7.
Speth  MM , Singer-Cornelius  T , Oberle  M , Gengler  I , Brockmeier  SJ , Sedaghat  AR .  Mood, anxiety and olfactory dysfunction in COVID-19: evidence of central nervous system involvement?   Laryngoscope. 2020;130(11):2520-2525. doi:10.1002/lary.28964PubMedGoogle ScholarCrossref
8.
Benarroch  EE .  Olfactory system: functional organization and involvement in neurodegenerative disease.   Neurology. 2010;75(12):1104-1109. doi:10.1212/WNL.0b013e3181f3db84PubMedGoogle ScholarCrossref
9.
Saiz-Sanchez  D , Flores-Cuadrado  A , Ubeda-Bañon  I , de la Rosa-Prieto  C , Martinez-Marcos  A .  Interneurons in the human olfactory system in Alzheimer’s disease.   Exp Neurol. 2016;276:13-21. doi:10.1016/j.expneurol.2015.11.009PubMedGoogle ScholarCrossref
10.
Alves  J , Petrosyan  A , Magalhães  R .  Olfactory dysfunction in dementia.   World J Clin Cases. 2014;2(11):661-667. doi:10.12998/wjcc.v2.i11.661PubMedGoogle ScholarCrossref
11.
Kotecha  AM , Corrêa  ADC , Fisher  KM , Rushworth  JV .  Olfactory dysfunction as a global biomarker for sniffing out Alzheimer’s disease: a meta-analysis.   Biosensors (Basel). 2018;8(2):E41. doi:10.3390/bios8020041PubMedGoogle Scholar
12.
Pinto  JM , Wroblewski  KE , Kern  DW , Schumm  LP , McClintock  MK .  Olfactory dysfunction predicts 5-year mortality in older adults.   PLoS One. 2014;9(10):e107541. doi:10.1371/journal.pone.0107541PubMedGoogle Scholar
13.
Choi  JS , Jang  SS , Kim  J , Hur  K , Ference  E , Wrobel  B .  Association between olfactory dysfunction and mortality in US adults.   JAMA Otolaryngol Head Neck Surg. 2021;147(1):49-55. doi:10.1001/jamaoto.2020.3502PubMedGoogle ScholarCrossref
14.
Jiramongkolchai  P , Jones  MS , Peterson  A ,  et al.  Association of olfactory training with neural connectivity in adults with postviral olfactory dysfunction.   JAMA Otolaryngol Head Neck Surg. 2021;147(6):502-509. doi:10.1001/jamaoto.2021.0086PubMedGoogle ScholarCrossref
15.
Whitcroft  KL , Hummel  T .  Clinical diagnosis and current management strategies for olfactory dysfunction: a review.   JAMA Otolaryngol Head Neck Surg. 2019;145(9):846-853. doi:10.1001/jamaoto.2019.1728PubMedGoogle ScholarCrossref
16.
Pekala  K , Chandra  RK , Turner  JH .  Efficacy of olfactory training in patients with olfactory loss: a systematic review and meta-analysis.   Int Forum Allergy Rhinol. 2016;6(3):299-307. doi:10.1002/alr.21669PubMedGoogle ScholarCrossref
17.
Nguyen  TP , Patel  ZM .  Budesonide irrigation with olfactory training improves outcomes compared with olfactory training alone in patients with olfactory loss.   Int Forum Allergy Rhinol. 2018;8(9):977-981. doi:10.1002/alr.22140PubMedGoogle ScholarCrossref
18.
Doty  RL , Shaman  P , Dann  M .  Development of the University of Pennsylvania Smell Identification Test: a standardized microencapsulated test of olfactory function.   Physiol Behav. 1984;32(3):489-502. doi:10.1016/0031-9384(84)90269-5PubMedGoogle ScholarCrossref
19.
Doty  RL , Shaman  P , Kimmelman  CP , Dann  MS .  University of Pennsylvania Smell Identification Test: a rapid quantitative olfactory function test for the clinic.   Laryngoscope. 1984;94(2 Pt 1):176-178. doi:10.1288/00005537-198402000-00004PubMedGoogle Scholar
20.
Deems  DA , Doty  RL , Settle  RG ,  et al.  Smell and taste disorders, a study of 750 patients from the University of Pennsylvania Smell and Taste Center.   Arch Otolaryngol Head Neck Surg. 1991;117(5):519-528. doi:10.1001/archotol.1991.01870170065015PubMedGoogle ScholarCrossref
21.
Hummel  T , Sekinger  B , Wolf  SR , Pauli  E , Kobal  G .  ‘Sniffin’ sticks’: olfactory performance assessed by the combined testing of odor identification, odor discrimination and olfactory threshold.   Chem Senses. 1997;22(1):39-52. doi:10.1093/chemse/22.1.39PubMedGoogle ScholarCrossref
22.
Dravnieks  A .  Atlas of Odor Character Profiles. ASTM International; 1985.
23.
Castro  JB , Ramanathan  A , Chennubhotla  CS .  Categorical dimensions of human odor descriptor space revealed by non-negative matrix factorization.   PLoS One. 2013;8(9):e73289. doi:10.1371/journal.pone.0073289PubMedGoogle Scholar
24.
Patnaik  B , Batch  A , Elmqvist  N .  Information olfactation: harnessing scent to convey data.   IEEE Trans Vis Comput Graph. 2018;25(1):726-736. doi:10.1109/TVCG.2018.2865237PubMedGoogle ScholarCrossref
25.
Busner  J , Targum  SD .  The clinical global impressions scale: applying a research tool in clinical practice.   Psychiatry (Edgmont). 2007;4(7):28-37.PubMedGoogle Scholar
26.
Dunlop  BW , Gray  J , Rapaport  MH .  Transdiagnostic clinical global impression scoring for routine clinical settings.   Behav Sci (Basel). 2017;7(3):E40. doi:10.3390/bs7030040PubMedGoogle Scholar
27.
Ware  JE  Jr , Sherbourne  CD .  The MOS 36-item short-form health survey (SF-36): I. conceptual framework and item selection.   Med Care. 1992;30(6):473-483. doi:10.1097/00005650-199206000-00002PubMedGoogle ScholarCrossref
28.
Ware  JE , Kosinski  M , Keller  SD .  SF-36 Physical and Mental Health Summary Scales. A User's Manual. Health Assessment Lab, 1994.
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close

Name Your Search

Save Search
Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Close

Lookup An Activity

or

Close

My Saved Searches

You currently have no searches saved.

Close

My Saved Courses

You currently have no courses saved.

Close
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right
Close