Evaluating the Prevalence of Olfactory Dysfunction in a Pediatric Population

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Evaluating the Prevalence of Olfactory
Dysfunction in a Pediatric Population

• ISOT 2008 Symposium
• Epidemiological Studies of Taste and Smell
• Pamela Dalton, PhD MPH
• Monell Chemical Senses Center
• Philadelphia, PA USA

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The NIH Toolbox for Assessment of Neurological
and Behavioral Function

• A brief, but comprehensive measurement tool for
  assessment of cognitive function, emotional
  health, sensory and motor function.  
• Responsive to the needs of researchers in a
  variety of settings
• Particular emphasis on measuring outcomes in
  clinical trials and functional status in large
  epidemiological and longitudinal studies
• Appropriate for individuals from age 3-85

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Toolbox Instrument Criteria

• Selection criteria (based on RFP, RFI results,
  consensus meeting)
• Applicable across the age span
• No intellectual property issues
• Psychometrically sound
• Brief, easy to use, applicable in variety of
  settings and with different subgroups
• Minimal cost

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NIH Toolbox Pediatric Evaluation Rationale for
Development of Pediatric Specific Tests

• There is a paucity of instruments to assess
  normal children for Motor and Sensory Function
• In many of these domains there is a general
  reliance on proxy reporting
• National norms, if they exist, are typically
  based upon Caucasian, English speaking samples

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Pediatric Populations at Risk for Olfactory
Deficits

• Head injury
• Performance on odor id tests can discriminate
  children with head injury and TBI, incidence and
  severity (Sandford et al, Intl J Ped
  Otorhinolaryngol, 2006 Simcox, Appl
  Neuropsychol, 1996)
• Adenoid hypertrophy
• Performance on odor id test shows improvement
  following adenoidectomy (Konstantinidis et al,
  Ped. Otorhinolaryngol, 2005)
• Allergies??
• Lead or other metal poisoning??
• Olfactory learning may be particularly robust
  during childhood thus, identifying deficits in
  this age group could be important for normal
  development

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Issues Among Many Olfactory Measures

• Little validation/norms for children 3-5 yrs of
  age
• Cognitive linguistic demands of many tests
  confound results from young children
• Measures with highest reliability are not brief
• Reliability/specificity of odor id increases with
  of items
• Cultural experiential specificity of items in
  many odor id tests limit use across diverse
  populations

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Considerations for Testing Children

• Age appropriate, game-like tasks that are fun for
  children and minimize impact of language and
  cognitive development
• Matching odors to pictures is widely used task
• Hedonic judgments disguised as a game (i.e. give
  odors you like to Big Bird, odors you dont like
  to Oscar) has also been shown to be reliable
  method for children as young as three years of
  age.

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Fortunately, several olfactory assessment tools
have been developed with these considerations in
mind

• Match-to-sample odor discrimination task
  (Richman, 1995)
• 5 common items presented in microencapsulated
  form
• Each trial consists of 1 probe, 1 match 1
  distractor
• Cross-cultural Odor ID Test (R. Doty 1996)
• 12 item scratch-n-sniff (subset of UPSIT having
  broader cross-cultural familiarity) with 4 AFC
  response
• San Diego Odor ID Test (C. Murphy)
• 8 common items presented in opaque bottles
• Matched to appropriate line drawing (out of 20
  possible)
• However, most data come from children 5 and up
  in some tests performance for children 5-9 is
  similar to adults in their 8th decade.

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Goals of the Current Study

• Based on the existing tests and methodologies, we
  aim to refine a child-specific test that can be
• administered in lt5 minutes
• uses pictures words
• maintains good reliablity, sensitivity
  specificity

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Odor Stimuli Micro-encapsulated
scratch-n-sniff

• Set A
• Banana2
• Lemon1,2
• Play Doh1
• Coffee1
• Cinnamon1,2
• Bubble Gum1

• Set B
• Peanut Butter1
• Chocolate1,2
• Flower2
• Mint1
• Play Doh1
• Grape

1 Odorant used in SDOIT 2 Odorant used in B-SIT
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Familiarity
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Chocolate
Lemon
Odor 6
Play Doh
Bread
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Olfactory Assessment

• All children over 3 years old will be tested
• To determine familiarity with stimuli,
  accompanying parent or guardian will also take
  test and answer questionnaire about their and
  their childs familiarity with the food or odor
  items on the test
• Parent/guardian will also complete short health
  screening for child focusing on
• Allergy status
• Frequency of colds
• Prior head injury

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Pre-Test Phase Study Site 1Monell Chemical
Senses CenterPhiladelphia, PA

• Children are drawn from Philadelphia metro area
• 600 children tested annually in other studies to
  which this can be appended
• Additional children can be recruited as necessary
• Less time constraints for testing at Monell than
  other test site

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Pre-Test Phase Study Site 2Nemours-duPont
Hospital for ChildrenPre-Op Outpatient Facility
Wilmington, DE

• Patients drawn from the Delaware Valley region
  with pediatric population of 2.2 children under
  age 18
• 14,000 children undergo procedures and 12,500 of
  those go through pre-op outpatient facility,
  where testing will take place
• 35 have ENT-related surgery
• 50 children and their parent/guardian can be
  evaluated per week
• Within the hospital network, additional sites can
  be recruited

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Timeline for Toolbox

• Data collection in progress
• Development/pre-test/validation phase will
  continue through January 2009
• Following that, test/item selection will be
  finalized
• Norming phase will begin in early-mid 2009 and
  continue through 2010
• Norming will take place at multiple sites

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Summary

• Numerous commercial non-commercial olfactory
  tests are available, but may have limitations for
  Toolbox
• Ease of use, storage, transport
• Cultural specificity
• Cognitive/linguistic demands
• Time
• Cost
• Bottom Line Refinement of olfactory tests
  suitable for children through adults provides an
  opportunity for widespread incorporation of
  olfactory assessment in population studies

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Acknowledgments

• PEDIATRIC STUDY TEAM
• Julie Mennella Beverly Cowart
• Monell Chemical Senses Center
• Edward Pribitkin Kyle Fisher
• Dept of Otorhinolaryngology
• Thomas Jefferson University
• James Reilly Carly Jornlin
• Department of Surgery
• A.I. duPont Nemours Hospital for Children

• TOOLBOX OLFACTION TEAM
• Julie Menella
• Monell Chemical Senses Center
• Claire Murphy
• San Diego State University
• Richard Doty
• University of Pennsylvania
• Robert Frank
• University of Cincinnati

Supported by Blueprint for Neuroscience Research,
NIH Contract No HHS-N-260-2006-00007-Cand by
Nemours A.I. duPont Hospital