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Validation of Visual Analogue Scale for loss of smell as a quick test in chronic rhinosinusitis with nasal polyps

Alobid I1,2,3,*, Calvo-Henríquez C4,5,*, Viveros-Díez P6, López-Chacón M1,2,3, Rojas-Lechuga MJ2,7, Langdon C1,2,3, Marin C2,3, Mullol J2,3,7

1Skull Base Unit, ENT Department, Hospital Clinic Barcelona, IDIBAPS, CIBERES, Barcelona University, Barcelona, Catalonia, Spain
2INGENIO, IRCE, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBERES, Barcelona, Catalonia, Spain
3CIBER of Respiratory Diseases (CIBERES), Institute of Health Carlos III
4Rhinology Unit, ENT Department, Hospital Complex of Santiago de Compostela, Spain
5Young-Otolaryngologists of the International Federations of Oto-rhino-laryngological Societies (YO-IFOS) study group
6ENT department, University Hospital of Valladolid, Valladolid, Spain
7Rhinology Unit & Smell Clinic, ENT Department, Hospital Clinic Barcelona, IDIBAPS, CIBERES, Barcelona, Catalonia, Spain

*These authors share first-author responsibilities.

J Investig Allergol Clin Immunol 2024; Vol. 34(6)
doi: 10.18176/jiaci.0937

INTRODUCTION/OBJECTIVE: Diagnostic criteria of chronic rhinosinusitis with nasal polyps (CRSwNP) include, among others, olfactory dysfunction (OD). We hypothesize that patients suffering with CRSwNP are good at self-assessing their sense of smell through visual analogue scale (VAS) compared to smell tests.
METHODS: A controlled cross-sectional study was planned. Adults diagnosed with severe CRSwNP waiting for endoscopic sinus surgery were included. A cohort of healthy controls was also studied. All participants performed Barcelona smell test (BAST-24), sinonasal outcomes test 22 (SNOT-22), and VAS for loss of smell. CRSwNP underwent blood test (eosinophils count, total serum IgE), CT scan (Lund-Mackay Score), and nasal endoscopy.
RESULTS: 138 severe CRSwNP and 40 controls subjects were included. The BAST-24 identification score was strongly correlated with the VAS score in the CRSwNP group (rho=-0.79, p<0.001) but not in the control group (rho=-0.14; p=0.39), this difference between groups being statistically significant (p<0.001). A significant correlation of SNOT-22 item 21 (loss of smell) was also found with BAST-24 identification (rho=-0.65, p<0.001), this difference being statistically significant (Z=-2.43; p=0.015). In the ROC curve, the area under the curve (AUC) was 0.85 with 72.5% sensitivity and 93.1% specificity.
CONCLUSION: This study demonstrates a potential role of the VAS score for the screening of OD in severe CRSwNP in daily clinical practice. 

Key words: Polyposis, CRSwNP, Rhinosinusitis, BAST-24, Smell