Proposed Topic (Most preferred): :
HA Young Investigators Session (Projects to be presented by HA staff who had joined HA for 10 years or less)
Authors (including presenting author) :
Ng NT, Fok KM
Affiliation :
Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong
Introduction :
The COVID-19 pandemic has shown us how vulnerable we are to diseases that find an entry point in the olfactory system. Despite the sudden onset of smell loss that is common in people with COVID-19, the sense of smell is rarely evaluated in routine medical care, an omission can often be accompanied by symptoms of head trauma, post endoscopic surgery and brain mass cases. Unless it is measured directly, many people do not realize their sense of smell is partially reduced, thus, hint the overall importance of a validated olfactory testing as well as a proactive and multi-disciplinary care plan.
Objectives :
Early recognition of smell impairment with the use of a comprehensive and accurate olfactory test is crucial in clinical practice, together with a proactive multi-disciplinary care plan, aiming to strengthen patients’ awareness in their affected ADL and provide them with a better hospitalization experience.
Methodology :
PICOS criteria were utilized. [Problem: patients with hyposmia or anosmia; Intervention: established comprehensive smell test ; Comparison: assessing the validity of various smell tests between anosmics and normosmics; Outcome:To provide a comprehensive care with more reliable and objective assessment tool for those patients].
A literature search on three online database (PUDMED, COCHRANE and EMBASE) was performed for relevant publications, beginning after 2013 through 2023 using keywords “diagnosis of anosmia/hyposmia/smelling disorder” and “ orthonasal test” or “smell test”. Relevant articles were screened manually and randomized control trials written in English were recruited. The literature review was analyzed by Critical Appraisal skills Program (CASP). After removing duplicates in literature search and papers do not relate to diagnosis specifically, 11 full text articles were screened according to eligibility criteria.
The identified literatures suggested that an ideal smell test should consider the diversity and uniformity for the delivery of odorants and answering with forced multiple choices with rating system to indicate the severity of smell deficits. Considering the simplicity and inadequately of coffee beans test in current use, “4-Items Pocket Smell test” was implemented and piloted in neurological unit in July 2023. Convenience sampling of patients who were diagnosed with head trauma, brain tumor and post-nasal surgery were recruited while excluding patient with psychiatric disease or not fully conscious. Total 24 patients were recruited.
Result & Outcome :
The “4-Items Pocket Smell test” revealed that the recruited patients (60% in frontal head injury, 20% in brain tumor, 20% in trans-sphenoidal surgery) suffered from different degree of ipsilateral or bilateral smell disorder, which has been consistent with the clinical pathophysiology of the disease, indicating a higher test sensitivity compared with the traditional coffee beans test.
Satisfactory survey was conducted about patients’ experience for nursing care during hospitalization and upon discharge. With the implementation of our all-round multidisciplinary care plan, their recognition of smell deficit and related safety concerns were enhanced as well as a higher satisfactory level upon discharge.
Staff’s knowledge in caring patients with smell impairment was evaluated by pre and post-test, which demonstrate significant improvement in competency and confidence in caring those patients with the means of score increased from 60% to 90%.
