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Pediatric Barcelona Olfactory Test ̶ 6 (pBOT-6): Validation of a Combined Odor 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,*

1Unidad 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 Clinica de l’Olfacte, Servei d’Otorinolaringologia, Hospital Clínic, Universitat de Barcelona, CIBERES. Barcelona, Spain
4Universidad de Alcalá, Alcalá de Henares, Madrid, Spain
5Departamento de Fisicoquímica, Facultat de Farmàcia, Universitat de Barcelona, Spain
*Both authors contributed equally to the manuscript with senior responsibilities.

J Investig Allergol Clin Immunol 2020; Vol 30(6) : 439-447
doi: 10.18176/jiaci.0451

Background: Few odor tests have been developed for children.
Objectives: The aim of the present study was to develop and validate a simple and quick olfactory test to evaluate odor identification and threshold in a Spanish pediatric population.
Methods: The Pediatric Barcelona Olfactory Test-6 (pBOT-6) consisted of a set of 6 odorants for a forced choice identification test and a 6-dilution phenyl ethyl alcohol geometric series for the threshold test. The pBOT-6 was compared with the Universal Sniff test (a validated international pediatric smell test) in 131 healthy Spanish volunteers aged 6-17 years. A Bland-Altman plot was used to determine the agreement between the 2 tests. Reliability was analyzed in 15 volunteers using the intraclass correlation coefficient. Normative data were obtained, and 8 children diagnosed with subjective loss of smell were tested for validation.
Results: The Bland-Altman analysis demonstrated a minimal bias of –1.71% with upper and lower limits of agreement of –31.1% and 27.6%, respectively. The intraclass correlation coefficient was 0.83 (95%CI, 0.6-0.96) for the identification test and 0.73 (95%CI, 0.36-0.9) for the threshold test, with excellent and good consistency between measurements over time. Mean pBOT-6 scores were significantly higher in healthy volunteers than in patients with loss of smell. Discrimination between normosmia and loss of smell was achieved with a sensitivity of 96.9% and a specificity of 100%.
Conclusions: pBOT-6 offers an effective and fast method that is useful in clinical routine to distinguish, with high sensitivity and specificity, between pediatric patients with normosmia and those with loss of smell.

Key words: Olfaction, Smell test, Pediatric, Children, Loss of smell