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Original Investigation |

Risk Factors for Hazardous Events in Olfactory-Impaired Patients

Taylor S. Pence, BS1; Evan R. Reiter, MD2; Laurence J. DiNardo, MD2; Richard M. Costanzo, PhD1,2
[+] Author Affiliations
1Department of Physiology and Biophysics, Virginia Commonwealth University, Richmond
2Department of Otolaryngology–Head and Neck Surgery, Virginia Commonwealth University, Richmond
JAMA Otolaryngol Head Neck Surg. 2014;140(10):951-955. doi:10.1001/jamaoto.2014.1675.
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Importance  Normal olfaction provides essential cues to allow early detection and avoidance of potentially hazardous situations. Thus, patients with impaired olfaction may be at increased risk of experiencing certain hazardous events such as cooking or house fires, delayed detection of gas leaks, and exposure to or ingestion of toxic substances.

Objective  To identify risk factors and potential trends over time in olfactory-related hazardous events in patients with impaired olfactory function.

Design, Setting, and Participants  Retrospective cohort study of 1047 patients presenting to a university smell and taste clinic between 1983 and 2013. A total of 704 patients had both clinical olfactory testing and a hazard interview and were studied. On the basis of olfactory function testing results, patients were categorized as normosmic (n = 161), mildly hyposmic (n = 99), moderately hyposmic (n = 93), severely hyposmic (n = 142), and anosmic (n = 209).

Interventions  Patient evaluation including interview, examination, and olfactory testing.

Main Outcomes and Measures  Incidence of specific olfaction-related hazardous events (ie, burning pots and/or pans, starting a fire while cooking, inability to detect gas leaks, inability to detect smoke, and ingestion of toxic substances or spoiled foods) by degree of olfactory impairment.

Results  The incidence of having experienced any hazardous event progressively increased with degree of impairment: normosmic (18.0%), mildly hyposmic (22.2%), moderately hyposmic (31.2%), severely hyposmic (32.4%), and anosmic (39.2%). Over 3 decades there was no significant change in the overall incidence of hazardous events. Analysis of demographic data (age, sex, race, smoking status, and etiology) revealed significant differences in the incidence of hazardous events based on age (among 397 patients <65 years, 148 [37.3%] with hazardous event, vs 31 of 146 patients ≥65 years [21.3%]; P < .001), sex (among 278 women, 106 [38.1%] with hazardous event, vs 73 of 265 men [27.6%]; P = .009), and race (among 98 African Americans, 41 [41.8%] with hazardous event, vs 134 of 434 whites [30.9%]; P = .04).

Conclusions and Relevance  Increased level of olfactory impairment portends an increased risk of experiencing a hazardous event. Risk is further impacted by individuals’ age, sex, and race. These results may assist health care practitioners in counseling patients on the risks associated with olfactory impairment.

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Figure.
Incidence of Events and Hazardous Events

A, Percentage of patients at each level of olfactory function who experienced at least 1 hazardous event. The blue bars represent different degrees of olfactory impairment, from complete loss of smell (anosmic [darkest blue]) to normosmia (lightest blue). B, The incidence of hazardous events in olfactory-impaired patients (n = 543).

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