Sensitivity and Specificity of Self-Reported Olfactory Function in a Home-Based Study of Independent-Living, Healthy...

The 2011-14 US National Health and Nutrition Examination Survey chemosensory protocol asks adults to self-rate their orthonasal (via nostrils) and retronasal (via mouth) smell abilities for subsequent odor identification testing. From data collected with a similar protocol, we aimed to identify a self-reported olfactory index that showed the best sensitivity (correctly identifying dysfunction) and specificity (correctly indentifying normosmia) with measured olfaction.

In home-based testing, 121 independent-living older women (age 73±7 years) reported their olfactory function by interviewer-administered survey. Olfactory function was measured orthonasally via composite (odor threshold, identification task) or identification task alone.

Only 16 % of women self-rated "below average" smell function. More women perceived loss of smell (38 %) or flavor (30 %) with aging. The rate of measured dysfunction was 30 % by composite (threshold and identification) and 21.5 % by identification task, the latter misclassifying some mild dysfunction as normosmia. An index of self-rated smell function and perceived loss yielded the most favorable sensitivity (65 %) and specificity (77 %) to measured function. Self-rated olfaction showed better agreement with severe measured dysfunction; mild dysfunction was less noticed.

Self-reported indices that query about current and perceived changes in smell and flavor with aging showed better sensitivity estimates than those previously reported. Specificity was somewhat lower-some older adults may correctly perceive loss unidentified in a single assessment, or have a retronasal impairment that was undetected by an orthonasal measure.

Our findings should inform self-rated measures that screen for severe olfactory dysfunction in clinical/community settings where testing is not routine.