Department of Neurology, University of Pennsylvania Perelman School of Medicine, Philadelphia.
Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia.
JAMA Otolaryngol Head Neck Surg. 2022 Sep 1;148(9):840-848. doi: 10.1001/jamaoto.2022.1920.
Traumatic brain injury has been associated with short-term olfactory dysfunction, but the association of number of prior head injuries and head injury severity with both subjective and objective long-term olfactory function is less clear.
To investigate the associations of prior head injury, number of prior head injuries, and head injury severity with subjective and psychophysical (objective) olfactory function in older adults and to examine concordance between subjective and objective olfactory function among individuals with and without head injury.
DESIGN, SETTING, AND PARTICIPANTS: This prospective cohort study included 5951 participants who attended Atherosclerosis Risk in Communities (ARIC) Study visit 5 (2011 through 2013). Data analysis was performed between November 2021 and May 2022.
Head injury was defined by self-report and International Classification of Diseases codes.
Self-reported subjective olfactory dysfunction was assessed by the question, "Do you suffer from smell loss or a significantly decreased sense of smell?" Objective olfactory performance was assessed using the 12-item Sniffin' Sticks odor identification test.
Overall, the 5951 participants were a mean (SD) age of 75.6 (5.2) years, 3501 (58.8%) were female, 1356 (22.8%) were of Black race, and 1666 (28.0%) had a history of head injury. Participants with prior head injury were more likely than individuals without prior head injury to report subjective olfactory dysfunction (24% vs 20%; difference, 4%; 95% CI, 1% to 6%) and have objective anosmia (15% vs 13%; difference, 2%; 95% CI, 0.1% to 4%) but had lower concordance between subjective and objective assessment (72% vs 77%; difference, -5%; 95% CI, -8% to -3%). In logistic regression models adjusted for sociodemographics and medical comorbidities including cognitive status, participants with a history of prior head injury, particularly individuals with 2 or more prior head injuries and more severe head injuries, were more likely to self-report subjective olfactory dysfunction and were more likely to be found to have objective anosmia compared with participants with no history of head injury.
Findings of this cohort study provide evidence supporting the association between head injury and olfactory dysfunction, particularly among individuals who experienced multiple prior head injuries and among individuals with more severe head injury. The findings also suggest that individuals with prior head injury were more likely to both under-self-report and over-self-report deficits compared with objective olfactory testing; therefore, it may be important to consider objective olfactory testing in this patient population.
外伤性脑损伤与短期嗅觉功能障碍有关，但先前头部受伤的次数和头部受伤的严重程度与主观和客观的长期嗅觉功能之间的关联则不太明确。
本研究旨在调查先前头部受伤、先前头部受伤次数和头部受伤严重程度与老年人的主观和心理物理学（客观）嗅觉功能之间的关联，并检验有和无头部受伤者之间的主观和客观嗅觉功能的一致性。
设计、地点和参与者：这是一项前瞻性队列研究，纳入了参加动脉粥样硬化风险社区（ARIC）研究 5 期（2011 年至 2013 年）的 5951 名参与者。数据分析于 2021 年 11 月至 2022 年 5 月进行。
头部受伤通过自我报告和国际疾病分类代码来定义。
主观嗅觉功能障碍通过以下问题进行评估：“你是否有嗅觉丧失或嗅觉明显减退？”客观嗅觉表现使用 12 项嗅觉识别测试（Sniffin' Sticks）进行评估。
总体而言，5951 名参与者的平均（SD）年龄为 75.6（5.2）岁，3501 名（58.8%）为女性，1356 名（22.8%）为黑种人，1666 名（28.0%）有头部受伤史。与无先前头部受伤史的参与者相比，有先前头部受伤史的参与者更有可能报告主观嗅觉功能障碍（24%比 20%；差异，4%；95%CI，1%至 6%）和客观嗅觉丧失（15%比 13%；差异，2%；95%CI，0.1%至 4%），但主观和客观评估之间的一致性较低（72%比 77%；差异，-5%；95%CI，-8%至-3%）。在校正了社会人口统计学和包括认知状态在内的医疗合并症后，在逻辑回归模型中，有先前头部受伤史的参与者，特别是有 2 次或更多次先前头部受伤史和更严重头部受伤史的参与者，更有可能报告主观嗅觉功能障碍，并且更有可能被发现有客观嗅觉丧失，而与无头部受伤史的参与者相比。
这项队列研究的结果提供了证据，支持头部受伤与嗅觉功能障碍之间的关联，特别是在经历多次先前头部受伤和更严重头部受伤的个体中。研究结果还表明，与客观嗅觉测试相比，有先前头部受伤史的个体更有可能过度自我报告和低估缺陷；因此，在该患者群体中，可能需要考虑进行客观嗅觉测试。
