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Paediatric Barcelona Olfactory Test-6 (pBOT-6): Validation of a Combined Odour Identification and Threshold Screening Test in Healthy Spanish Children and Adolescents

Mariño-Sánchez F1,2, Valls-Mateus M2,3, Fragola C1, de los Santos G1,4, Aguirre A1, Alonso J1, Valero J5, Santamaría A1, Rojas Lechuga MJ2,3, Cobeta I1,4, Alobid I2,3*, Mullol J2,3*

Unidad de Rinología y Cirugía de Base de Cráneo. Servicio de Otorrinolaringología. Hospital Universitario Ramón y Cajal. Madrid, Spain.
2Immunoal∙lèrgia Respiratòria Clínica i Experimental (IRCE), Institut d’Investigacions Biomédiques August Pi i Sunyer (IDIBAPS). Research Group of Excellence 2017-SGR-1090 (Generalitat de Catalunya). Barcelona, Catalonia, Spain.
3Unitat de Rinologia i Clínica de l’Olfacte, Servei d’Otorinolaringologia, Hospital Clínic, Universitat de Barcelona, CIBERES. Barcelona, Catalonia, Spain.
4Universidad de Alcalá. Alcalá de Henares, Madrid, Spain.
5Departamento de Fisicoquímica. Facultat de Farmàcia. Universitat de Barcelona, Spain.
*Equal contribution to senior responsibilities

J Investig Allergol Clin Immunol 2020; Vol. 30(6)
doi: 10.18176/jiaci.0451

Background: Few odour tests have been created for children.
Objectives: The aim of the present study was to develop and validate a simple and quick olfactory test, suitable for the evaluation of odour identification and threshold in a Spanish paediatric population, the paediatric Barcelona Olfactory Test-6 (pBOT-6).
Methods: The pBOT-6 consisted in a set of 6 odorants for a forced-choice identification test (IT), and a 6 dilutions phenyl ethyl alcohol geometric series for the threshold test (TT). The pBOT-6 was compared with the U-sniff test (a validated international paediatric smell test) in 131 Spanish healthy volunteers aged 6-17 years. A Bland-Altman plot was used to determine the agreement between two tests. Reliability was analyzed in fifteenvolunteers using the intraclass correlation coefficient (ICC). Normative data was obtained and 8 children diagnosed with subjective smell loss were tested for validation.
Results: Bland-Altman analysis demonstrated a minimal bias of -1.71% with upper and lower limit of agreement of -31.1% and 27.6%, respectively. The ICC was 0.83 (95% CI 0.6-0.96) for the IT and 0.73 (95% CI 0.36-0.9) for the TT, showing excellent and good consistency between measurements over time. Mean pBOT-6 scores were significantly higher in healthy volunteers compared with patients with smell loss. Discrimination between normosmia and smell loss was achieved with a sensitivity of 96.9% and a specificity of 100%.
Conclusions: The pBOT-6 offers an effectiveand fast method useful in clinical routine to distinguish, with high sensitivity and specificity, between paediatric patients with normosmia and those with smell dysfunction.

Key words: Olfaction, Smell test, Paediatric, Children, Smell loss