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Protocol - Smell and Taste

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Description:

The Modified Pocket Smell Test (M-PST) is an eight-item self-administered "scratch-and-sniff" test contained in two 4-Item Pocket Smell Tests, which will be used in parallel. The test odorants are embedded in microcapsules positioned on scent strips at the bottom and top of each page of the test cards. The stimuli to be smelled are released by scratching the strips with a plastic stylus tip.

Eleven questions from the NHANES Chemical Senses - Taste & Smell Questionnaire determine whether the subject has had difficulty with taste or smell over the past 12 months.

Specific Instructions:

Administration requires use of the NHANES 4-Item Pocket Smell Test (cards A and B), which can be purchased here:

https://sensonics.com/smell-products/pocket-smell-test-49.html

Notes on administration:

Prepare the room for the examination before the individual enters the room. Confirm that the M-PST cards are available and accessible. The taste and smell exam does not require a formal, standard script. However, the examiner will provide a brief introduction to the examination using the following talking points provided.

The stimuli to be smelled are released by scratching the strips with a plastic stylus tip. When performing the odor testing identification, the windows must be closed and any fans in the room turned off. The air conditioning can stay on. Also, there should be no other things in the room that would give off a strong odor such as coffee, food, or flowers, and the examiners should not wear strong perfume or cologne.

To ensure that both the computer screen and the booklet are on the correct odorant, the application screen should follow the same order as the cards. Once the individual has completed the card, retrieve it and discard it appropriately.

Pregnant and lactating women should be excluded from this smell examination.

Note: "SP" represents sample person or person under assessment.

Protocol:

Before beginning the taste and smell exams, the individual will be asked a short series of questions to screen him or her for exclusion criteria and then additional questions are asked to identify any conditions he or she may currently have, such as a head cold or sinus problem, that may alter or influence the interpretation of the exam results at the time it is performed. The questions are as follows:

1. Are you currently pregnant or breastfeeding a baby?

2. Today, do you have any of the following problems with your nose? Mark all that apply. ?

  • Sneeze frequently;
  • Green, yellow, or brown mucus discharge;
  • Completely blocked-up nose;
  • Sinus pain; or
  • A head cold or runny nose from the flu.

3. Is your nose blocked-up on both sides, or on just one side?

If the individual answers "Yes," "Dont Know," or "Refused" to questions 2, she will be excluded from the entire exam.

(INTERVIEWER INSTRUCTION: Blocked up nose is when you cant breathe air in and out of the nose. Sinus pain is pain, pressure or fullness in the area of the face behind the cheeks or forehead.)

The smell test does not require a formal, standard script. However, the examiner will provide a brief introduction to the examination using the following talking points provided (Appendix B): ?

  • Purpose - To see how well you can identify some common smells
  • Two cards: 
  • Each card has 4 smells;
  • Each smell has 4 choices;
  • Look at the four choices while I read them to you; and
  • Tell me which choice is what you smelled.
  • If not sure, pick the closest; and
  • If no smell, guess.

Open the first card and show the individual the different scent strips. Explain that you will scratch the brown rectangle left to right in a "z" pattern to properly release the test odor. The Modified Pocket Smell Test should be folded one page at a time as the health techs (HTs) proceed with the test. This is done so that individuals only smell one scent of the booklet at a time, and not previously scratched odors as well. After scratching the scent strip, ask the individual to hold the card under his or her nose and sniff the odor. The individual should be encouraged to sniff the label immediately after it has been scratched to ensure that the odor has not significantly dissipated. Ask the individual to identify the scent after reading all answer choices from the computer screen, and record the individuals answer on the application.

In order for the test to be valid, you must read all the answer choices even if the individual selects one right away. This is especially important in situations where the correct response might be the first choice. If the odor the individual smells is not represented by one of the four choices provided, the individual needs to choose the answer closest to his or her experience. If the individual smells nothing, he or she must guess the best answer.

The M-PST is designed as a forced-choice test, so it is essential that individuals choose one of the four possible responses even if they smell nothing at all. The overall test score cant be calculated unless all eight items are completed. It is known that people with loss of smell may have some remaining ability to smell even if they are not aware of it. This is the reason for prompting them to guess an answer even if they believe they smell nothing. The M-PST is scored by the overall number of items that are correctly identified so there must be an answer for each test scent for the test to be valid.

Once the individual has completed one scent, go immediately to the next scent, and so on, until all eight odorants are completed. There is no need to pause or wait between scents. In some cases, the individuals may request HTs to re-scratch an odor strip. In most cases, it is unnecessary and does not help with identification. The odorants are as follows:

M-PST Items:

  • Chocolate
  • Strawberry
  • Smoke
  • Leather
  • Soap
  • Grape
  • Onion
  • Natural Gas

This section includes one screen per odor and will contain a place to indicate what the odor smells most. Please choose one of the four alternative smells from each screen.

Item 1

The odor smells most like

  • Lemon 
  • Chocolate
  • Smoke
  • Black Pepper

Item 2

The odor smells most like

  • Strawberry
  • Garlic
  • Leather
  • Gasoline

Item 3

The odor smells most like

  • Garlic
  • Grass
  • Smoke
  • Peach

Item 4

The odor smells most like

  • Mint
  • A flower
  • Leather
  • Apple

Item 5

The odor smells most like

  • Soap 
  • Black Pepper
  • Leather
  • Peanut

Item 6

The odor smells most like

  • Gasoline
  • Grape 
  • Rose
  • Peanut

Item 7

The odor smells most like

  • Chocolate
  • Strawberry
  • Onion 
  • Fruit Punch

Item 8

The odor smells most like

  • Orange
  • Cinnamon
  • Cola
  • Natural Gas

Participant Evaluation

This section is to provide information to help determine if the individual had any problems with the entire exam.

Rate the individuals overall understanding of the entire test as very good, good, fair, poor, or unable to cooperate. ___________________

Additional Smell and Taste Questions

1. The next questions are about {your/SPs} sense of smell. During the past 12 months, {have you/has he/has she} had a problem with {your/his/her} ability to smell, such as not being able to smell things or things not smelling the way they are supposed to?

1[ ]YES

2[ ]NO

7[ ]REFUSED

9[ ]DONT KNOW

2. How would {you/SP} rate {your/his/her} ability to smell now as compared to when {you were/he was/she was} 25 years old? Is it better, worse or is there no change?

1[ ]BETTER NOW

2[ ]WORSE NOW

3[ ]NO CHANGE

7[ ]REFUSED

9[ ]DONT KNOW

3. Do some smells bother {you/SP} although they do not bother other people?

1[ ]YES

2[ ]NO

7[ ]REFUSED

9[ ]DONT KNOW

4. {Do you/Does SP} sometimes smell an unpleasant, bad or burning odor when nothing is there?

1[ ]YES

2[ ]NO

7[ ]REFUSED

9[ ]DONT KNOW

IF Q.1 = 1 OR Q.2 = 2 OR Q.4 = 1, THEN CONTINUE, OTHERWISE, GO TO Q.6.

5. Is the problem with {your/SPs} ability to smell always there or does it come and go?

INTERVIEWER INSTRUCTION: PLEASE INCLUDE TEMPORARY PROBLEMS WITH THE SPS SENSE OF SMELL DUE TO ALLERGIES BUT DO NOT INCLUDE ANY PROBLEMS WITH SMELL DUE TO A HEAD COLD.

1[ ]IT IS ALWAYS THERE .............................................................. 1

2[ ]IT COMES AND GOES.............................................................. 2

3[ ]I HAVE A PROBLEM ONLY WITH A COLD ............................. 3

7[ ]REFUSED.................................................................................. 7

9[ ]DONT KNOW............................................................................ 9

CAPI INSTRUCTION:

DISPLAY REASON GOT TO THIS QUESTION ABOVE QUESTION TEXT FOR INTERVIEWER REFERENCE.

IF Q.2 = 2 DISPLAY "SMELL WORSE THAN WHEN 25"

IF Q.4 = 1 DISPLAY "SMELL ODOR WHEN NOT THERE"

6. The next questions are about {your/SPs} sense of taste. During the past 12 months, {have you/has he/has she} had a problem with {your/his/her} ability to taste sweet, sour, salty or bitter foods and drinks?

1[ ]YES

2[ ]NO

7[ ]REFUSED

9[ ]DONT KNOW

7. I am going to read you a list of tastes in everyday foods. How {is your/is SPs} ability to taste each one of these now compared to when {you were/he was/she was} 25 years old? Would you say it is better, worse, or is there no change?

INTERVIEWER INSTRUCTION: PLEASE DO NOT INCLUDE TEMPORARY PROBLEMS WITH THE SPs SENSE OF SMELL DUE TO A HEAD COLD.

RESPONSES: BETTER = 1, WORSE = 2, NO CHANGE = 3, REFUSED = 7, DONT KNOW = 9

a. salt in foods like potato chips or pretzels

1[ ]Better

2[ ]Worse

3[ ]No Change

7[ ]Refused

9[ ]Dont Know

b. sourness in foods like lemons or vinegar

1[ ]Better

2[ ]Worse

3[ ]No Change

7[ ]Refused

9[ ]Dont Know

c. sweetness in foods like peaches or ice cream

1[ ]Better

2[ ]Worse

3[ ]No Change

7[ ]Refused

9[ ]Dont Know

d. bitterness in drinks like unsweetened black coffee

1[ ]Better

2[ ]Worse

3[ ]No Change

7[ ]Refused

9[ ]Dont Know

8. Is {your/SPs} ability to taste food flavors such as chocolate, vanilla or strawberry as good as when {you were/he was/she was} 25 years old?

1[ ]YES

2[ ]NO

7[ ]REFUSED

9[ ]DONT KNOW

9. During the past 12 months {have you/has SP} had a taste or other sensation in {your/his/her} mouth that does not go away?

1[ ]YES

2[ ]NO

7[ ]REFUSED

9[ ]DONT KNOW

IF Q.6 = 1 OR Q.7 (ANY) = 2 OR Q.8 = 2 OR Q.9 = 1, THEN CONTINUE, OTHERWISE, GO TO END

10. Please describe the taste or other sensation in {your/SPs} mouth that does not go away. Would {you/he/she} say it is:

CODE ALL THAT APPLY.

1[ ]sweet

2[ ]sour

3[ ]salty

4[ ]bitter

5[ ]metallic

6[ ]burning or tingling

7[ ]bad or foul

[ ] 8 or something else

77[ ]REFUSED

99[ ]DONT KNOW

11. During the past 12 months, {have you/has SP} experienced a problem with {your/his/her} general health, work or {your/his/her} enjoyment of life because of a problem with {your/his/her) ability to taste or smell?

INTERVIEWER INSTRUCTION: INCLUDE PROBLEMS WITH DIET AND WEIGHT AS HEALTH PROBLEMS.

1[ ]YES

2[ ]NO

7[ ]REFUSED

9[ ]DONT KNOW

Protocol Name from Source:

National Health and Nutrition Examination Survey (NHANES), Taste and Smell Examination Component Manual, 2013. National Health and Nutrition Examination Survey (NHANES) Chemical Senses - Taste & Smell Questionnaire

Availability:

Publicly available

Personnel and Training Required

The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a "dont know" response is provided.

Equipment Needs
The PhenX Working Group acknowledges that these questions can be administered in a computerized or noncomputerized format (i.e., paper-and-pencil instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer/handheld computer to administer a computer-assisted questionnaire. The M-PST is an eight-odor, forced-choice screening test. (Sensonics International, Haddon Heights, New Jersey, USA)Plastic stylus used to scratch the odor test patches on the smell test.
Requirements
Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered questionnaire

Life Stage:

Adult, Senior

Participants:

40 years of age and older

Selection Rationale

The National Health and Nutrition Examination Survey (NHANES) Smell Test and the Taste and Smell questions are well-validated and used in large ongoing national studies and clinical trials.

Language

English, Spanish

Standards
StandardNameIDSource
Common Data Elements (CDE) Taste and Smell Questionnaire Assessment Score 6360532 CDE Browser
Derived Variables

None

Process and Review

Not applicable

Source

Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey (NHANES) Taste and Smell Examination Component Manual. January 2013.

Centers for Disease Control and Prevention, National Center for Health Statistics, National Health and Nutrition Examination Survey (NHANES) Chemical Senses - Taste & Smell Questionnaire, Questions CSQ.010, CSQ.020, CSQ.030, CSQ.040, CSQ.070, CSQ.080, CSQ.090, CSQ.100, CSQ.110, CSQ.120, CSQ.190, (corresponding to Questions 1-11), 2012

General References

Doty, R. L. (2015). Olfactory dysfunction and its measurement in the clinic. World Journal of Otorhinolaryngology-Head and Neck Surgery, 1(1), 28-33.

Liu, G., Zong, G., Doty, R. L., &Sun, Q. (2016). Prevalence and risk factors of taste and smell impairment in a nationwide representative sample of the US population: a cross-sectional study. Epidemiology Research, 6(11), e013246.

Rawal, S., Hoffman, H. J., Honda, M., Huedo-Medin, T. B., & Duffy, V. B. (2015). The Taste and Smell Protocol in the 2011-2014 US National Health and Nutrition Examination Survey (NHANES): Test-Retest Reliability and Validity Testing. Chemosensory Perception, 8(3), 138-148.

Protocol ID:

251501

Variables:
Export Variables
Variable NameVariable IDVariable DescriptionVersiondbGaP Mapping
PX251501_Smell_Taste_Ability_Compared_Twenty_Five PX251501020800 Is {your/SP's} ability to taste food flavors more
such as chocolate, vanilla or strawberry as good as when {you were/he was/she was} 25 years old? show less
N/A
PX251501_Smell_Taste_Bitter PX251501020704 How {is your/is SP's} ability to taste more
bitterness in drinks like unsweetened black coffee now compared to when {you were/he was/she was} 25 years old? Would you say it is better, worse, or is there no change? show less
N/A
PX251501_Smell_Taste_Breastfeeding PX251501010100 Are you currently pregnant or breastfeeding more
a baby? show less
N/A
PX251501_Smell_Taste_Describe PX251501021000 Please describe the taste or other sensation more
in {your/SP's} mouth that does not go away. Would {you/he/she} say it is? show less
N/A
PX251501_Smell_Taste_Item_Eight PX251501011100 The odor Item 8 smells most like N/A
PX251501_Smell_Taste_Item_Five PX251501010800 The odor Item 5 smells most like N/A
PX251501_Smell_Taste_Item_Four PX251501010700 The odor Item 4 smells most like N/A
PX251501_Smell_Taste_Item_One PX251501010400 The odor Item 1 smells most like N/A
PX251501_Smell_Taste_Item_Seven PX251501011000 The odor Item 7 smells most like N/A
PX251501_Smell_Taste_Item_Six PX251501010900 The odor Item 6 smells most like N/A
PX251501_Smell_Taste_Item_Three PX251501010600 The odor Item 3 smells most like N/A
PX251501_Smell_Taste_Item_Two PX251501010500 The odor Item 2 smells most like N/A
PX251501_Smell_Taste_Nose_Blocked_Side PX251501010300 Is your nose blocked-up on both sides, or on more
just one side? show less
N/A
PX251501_Smell_Taste_Problems_Nose PX251501010200 Today, do you have any of the following more
problems with your nose? show less
N/A
PX251501_Smell_Taste_Salt PX251501020701 How {is your/is SP's} ability to taste salt more
in foods like potato chips or pretzels now compared to when {you were/he was/she was} 25 years old? Would you say it is better, worse, or is there no change? show less
N/A
PX251501_Smell_Taste_Smells_Bother PX251501020300 Do some smells bother {you/SP} although they more
do not bother other people? show less
N/A
PX251501_Smell_Taste_Smell_Always_Come_Go PX251501020500 Is the problem with {your/SP's} ability to more
smell always there or does it come and go? show less
N/A
PX251501_Smell_Taste_Smell_Compare PX251501020200 How would {you/SP} rate {your/his/her} more
ability to smell now as compared to when {you were/he was/she was} 25 years old? Is it better, worse or is there no change? show less
N/A
PX251501_Smell_Taste_Sour PX251501020702 How {is your/is SP's} ability to taste more
sourness in foods like lemons or vinegar now compared to when {you were/he was/she was} 25 years old? Would you say it is better, worse, or is there no change? show less
N/A
PX251501_Smell_Taste_Sweet PX251501020703 How {is your/is SP's} ability to taste more
sweetness in foods like peaches or ice cream now compared to when {you were/he was/she was} 25 years old? Would you say it is better, worse, or is there no change? show less
N/A
PX251501_Smell_Taste_Twelve_Months_Problem_Life PX251501021100 During the past 12 months, {have you/has SP} more
experienced a problem with {your/his/her} general health, work or {your/his/her} enjoyment of life because of a problem with {your/his/her) ability to taste or smell? show less
N/A
PX251501_Smell_Taste_Twelve_Months_Smell PX251501020100 The next questions are about {your/SP's} more
sense of smell. During the past 12 months, {have you/has he/has she} had a problem with {your/his/her} ability to smell, such as not being able to smell things or things not smelling the way they are supposed to? show less
N/A
PX251501_Smell_Taste_Twelve_Months_Taste PX251501020600 The next questions are about {your/SP's} more
sense of taste. During the past 12 months, {have you/has he/has she} had a problem with {your/his/her} ability to taste sweet, sour, salty or bitter foods and drinks? show less
N/A
PX251501_Smell_Taste_Twelve_Months_Taste_Not_Go_Away PX251501020900 During the past 12 months {have you/has SP} more
had a taste or other sensation in {your/his/her} mouth that does not go away? show less
N/A
PX251501_Smell_Taste_Unpleasent PX251501020400 {Do you/Does SP} sometimes smell an more
unpleasant, bad or burning odor when nothing is there? show less
N/A
Geriatrics
Measure Name:

Smell and Taste

Release Date:

July 2, 2018

Definition

A scratch-and-sniff smell test of eight odorants followed by a series of questions about the subject's ability to smell and taste over the past 12 months.

Purpose

With age comes a decline in and impairment of olfactory and gustation function. This sensory dysfunction may cause minor impairment or could be life-threatening in the elderly.

Keywords

Odor, scratch-and-sniff, sensory, sensory dysfunction, geriatrics, olfactory, gustation, taste disorders, National Health and Nutrition Examination Survey (NHANES), National Center for Health Statistics, gerontology, aging