Jayant M. Pinto

Education is a key predictor of cognitive function and dementia. Sensory impairments and social well-being are underexplored modifiable pathways through which education may influence cognitive function. Using longitudinal data from the National Social Life, Health, and Aging Project, we created a latent measure of global sensory impairment (GSI) encompassing all five “classical” senses. We estimated the indirect influence of education on Montreal Cognitive Assessment (MoCA) scores—our primary measure of cognitive function—through GSI, loneliness, and social isolation. Positive dementia screening was a secondary outcome. GSI accounted for 5.32% and social isolation for 3.79% of college attendance’s influence on MoCA scores. For years of education, GSI accounted for 3.87% and social isolation for 2.85% of its influence on MoCA scores. Loneliness accounted for smaller percentages. Sensory impairments and social isolation may be targets for public health interventions aimed at reducing educational disparities in cognitive function and improving older adults’ quality of life.

Background: Rhinitis is the most common sinonasal condition and poses a significant cost burden. Rhinitis symptom control is associated with exposure to environmental triggers (eg, aeroallergens, pollutants, and irritants). While people spend much of their time at home, studies examining the association of rhinitis symptoms with home environmental exposures, especially in low-income, urban, and racial or ethnic minorities, are limited. Frequently, 3 types of surveys are used in ecological momentary assessment (EMA): a survey conducted at a predetermined rate, an event-triggered survey, and a follow-up survey to gauge behavioral changes in response to the event. Objective: This study aims to determine the feasibility and usability of daily and triggered EMA paired with an indoor air quality monitor to collect exposure and rhinitis symptom data. Methods: Participants were recruited from the Allergy and Ear, Nose, and Throat clinics at 2 academic centers. Participants had to have a rhinitis diagnosis with active symptoms, be 18 years of age or older, self-identify as a racial or ethnic minority, live in the city of Chicago, be able to read and speak English, and have a smartphone. Participants received the Awair Omni air quality monitor to measure volatile organic compounds, particulate matter, and humidity. EMA data were collected using a personal smartphone using the PiLR Health app. Participants were sent daily scheduled surveys, random check-in surveys, and air quality event-triggered survey EMA notifications to assess rhinitis symptoms, environmental exposures, and mitigation strategies for 14 days. After the 14-day data collection period, participants completed the acceptability, appropriateness, and feasibility survey items. Feasibility metrics captured included recruitment and retention, demographics, rhinitis symptoms, and the usability of the PiLR Health App and Awair Omni. Barriers and challenges were identified and captured by the study staff. Descriptive statistics were performed using Excel (Microsoft Corp). Results: A total of 24 participants were approached, 15 participants consented and 12 participants completed the study. Participants received an average of 62.42 (SD 14.26) total surveys during their study period, and of those surveys, an average of 36.83 (SD 22.18; 59%) surveys were completed. All 12 participants met the threshold for successful home air monitoring (11 days of continuous environmental data assessment). The usability of study components and integration into the overall study was high (usability scale≥68), indicating participants considered each of the devices to be usable. Participant feedback on the study was positive; yet, they did identify areas for improvement including getting air quality data in real time, providing more detailed instructions for device setup, and doing more check-ins. Conclusions: A real-time assessment of home environmental exposures and subjective rhinitis symptoms was feasible to conduct. This study will support the development of targeted interventions to address disparities in sinonasal disease care and outcomes.

BACKGROUND Rhinitis is the most common sinonasal condition and poses a significant cost burden. Rhinitis symptom control is associated with exposure to environmental triggers (eg, aeroallergens, pollutants, and irritants). While people spend much of their time at home, studies examining the association of rhinitis symptoms with home environmental exposures, especially in low-income, urban, and racial or ethnic minorities, are limited. Frequently, 3 types of surveys are used in ecological momentary assessment (EMA): a survey conducted at a predetermined rate, an event-triggered survey, and a follow-up survey to gauge behavioral changes in response to the event. OBJECTIVE This study aims to determine the feasibility and usability of daily and triggered EMA paired with an indoor air quality monitor to collect exposure and rhinitis symptom data. METHODS Participants were recruited from the Allergy and Ear, Nose, and Throat clinics at 2 academic centers. Participants had to have a rhinitis diagnosis with active symptoms, be 18 years of age or older, self-identify as a racial or ethnic minority, live in the city of Chicago, be able to read and speak English, and have a smartphone. Participants received the Awair Omni air quality monitor to measure volatile organic compounds, particulate matter, and humidity. EMA data were collected using a personal smartphone using the PiLR Health app. Participants were sent daily scheduled surveys, random check-in surveys, and air quality event-triggered survey EMA notifications to assess rhinitis symptoms, environmental exposures, and mitigation strategies for 14 days. After the 14-day data collection period, participants completed the acceptability, appropriateness, and feasibility survey items. Feasibility metrics captured included recruitment and retention, demographics, rhinitis symptoms, and the usability of the PiLR Health App and Awair Omni. Barriers and challenges were identified and captured by the study staff. Descriptive statistics were performed using Excel (Microsoft Corp). RESULTS A total of 24 participants were approached, 15 participants consented and 12 participants completed the study. Participants received an average of 62.42 (SD 14.26) total surveys during their study period, and of those surveys, an average of 36.83 (SD 22.18; 59%) surveys were completed. All 12 participants met the threshold for successful home air monitoring (11 days of continuous environmental data assessment). The usability of study components and integration into the overall study was high (usability scale≥68), indicating participants considered each of the devices to be usable. Participant feedback on the study was positive; yet, they did identify areas for improvement including getting air quality data in real time, providing more detailed instructions for device setup, and doing more check-ins. CONCLUSIONS A real-time assessment of home environmental exposures and subjective rhinitis symptoms was feasible to conduct. This study will support the development of targeted interventions to address disparities in sinonasal disease care and outcomes.

Gustatory dysfunction (GD), or taste dysfunction, is associated with poor quality of life. Recent literature has demonstrated an association between olfactory dysfunction (OD) and mortality in older adults. However, the association between GD and mortality has not been rigorously studied in a large national cohort. This study helps characterize this relationship and explore underlying mechanisms. Cross-sectional study of the 2013 to 2014 National Health and Nutrition Examination Survey linked to the National Death Index (NDI) through 2019. GD was assessed through self-report and psychometric recognition of quinine and salt, excluding participants with self-reported and psychometric OD. Cox proportional hazards regression models examined associations between GD and mortality, adjusting for demographics, history of cardiovascular comorbidities, diabetes, and malignancy, nutritional status, cognitive function, and depression. Subgroup analysis was also performed based on age and sex. The analytical cohort consisted of 1,136 adults aged 40 and older with complete data, subsequently weighted to create a nationally representative cohort. Isolated psychometric GD is associated with an 87% increased risk of 5-year all-cause mortality after adjusting for all covariates (HR = 1.87, 95% CI = 1.09 to 3.21, P = 0.023). This relationship remains robust among a subgroup of younger participants age 40 to 64 (HR = 18.89, 95% CI = 1.73 to 205.96, P = 0.016) and among male participants (HR = 2.53, 95% CI = 1.34 to 4.76, P = 0.004). Isolated self-reported GD is not statistically significantly associated with mortality. This is one of the first studies to demonstrate an association between GD and mortality, supporting the growing body of literature linking chemosensory dysfunction with unhealthy aging, a finding that warrants more clinical scrutiny.

Millions of people in the United States experience a reduced or distorted ability to smell or taste. Chemosensory disorders such as anosmia (the inability to smell), parosmia (distorted smell), or dysgeusia (altered taste) have major impacts on health and quality of life including difficulty sensing dangers such as fire or spoilage, a diminished palatability of food and drink that can negatively influence diet and nutrition, feelings of social isolation, and an increased incidence of frailty, anxiety, and depression. Smell or taste dysfunction can also be symptoms of other health issues, including sinonasal disease, cancer, or neurodegenerative disease. Aging adults are disproportionately affected. However, smell and taste function are not regularly assessed as a part of routine healthcare despite their prevalence and impact. This is a lost opportunity, as early detection of a chemosensory disorder would enable patients to obtain needed validation, education and support for their health challenge, could direct both patient and provider to treatment options, and may suggest underlying health issues that should be addressed. To better understand the current barriers to including chemosensory testing as a regular component of health care and to identify opportunities to overcome those barriers, the conference “Towards Universal Chemosensory Testing” was convened on November 5–7, 2023, in Philadelphia, PA. This conference brought together scientists, clinicians, patients, and other experts to discuss these issues and identify collective ways to overcome barriers to testing. This white paper—which is focused primarily on the US healthcare system—is the result of those discussions.

Background: Definitions are essential for effective communication and discourse, particularly in science. They allow the shared understanding of a thought or idea, generalization of knowledge, and comparison across scientific investigation. The current terms describing olfactory dysfunction are vague and overlapping. Summary: As a group of clinical olfactory researchers, we propose the standardization of the terms “dysosmia,” “anosmia,” “hyposmia,” “normosmia,” “hyperosmia,” “olfactory intolerance,” “parosmia,” and “phantosmia” (or “olfactory hallucination”) in olfaction-related communication, with specific definitions in this text. Key Messages: The words included in this paper were determined as those which are most frequently used in the context of olfactory function and dysfunction, in both clinical and research settings. Despite widespread use in publications, however, there still exists some disagreement in the literature regarding the definitions of terms related to olfaction. Multiple overlapping and imprecise terms that are currently in use are confusing and hinder clarity and universal understanding of these concepts. There is a pressing need to have a unified agreement on the definitions of these olfactory terms by researchers working in the field of chemosensory sciences. With the increased interest in olfaction, precise use of these terms will improve the ability to integrate and advance knowledge in this field.

Objective Exposure to particulate matter of 10 μm or less in diameter (PM₁₀) has been implicated in pulmonary and cardiovascular diseases. However, the effect of PM₁₀ on olfaction has not been well established. We estimated individual acute and chronic PM₁₀ exposure levels in a large Brazilian cohort and related them to the ability to identify odors. Methods Adults from São Paulo (n = 1358) were recruited from areas with different levels of air pollution. To verify individual exposure to air pollution, the averages of 30, 60, 90, 180 and 364 days of PM₁₀ were interpolated to subjects’ zip codes using the kriging method. Olfactory identification performance was tested using the University of Pennsylvania Smell Identification Test (UPSIT®). Multiple linear regressions were used to calculate the effect of air pollution on olfactory identification performance, controlling for demographic and other variables that affect the sense of smell. Results Acute exposures to PM₁₀ were related to worse UPSIT® scores, including 30- (β = – 0.94, 95% Confidence Interval [CI] – 0.98, – 0.89), 60- (β = – 1.09, 95% CI = – 1.13, – 1.04) and 90-day intervals (β = – 1.06, 95% CI – 1.10, – 1.02) (reference for β: 1 µm/m³ increase in PM10 exposure per point decrease in UPSIT® score). Chronic exposures were also associated with worse olfaction for both 180- (β = – 1.06, 95% CI – 1.10, – 1.03) and 364-day (β = – 0.87, 95% CI – 0.90, – 0.84) intervals. As in prior work, men, older, low-income, and low-schooling people demonstrated worse olfactory performance. Conclusion Acute and chronic exposure to PM₁₀ is strongly associated with olfactory identification performance in Brazilian adults. Understanding the mechanisms which underlie these relationships could help to improve chemosensory function with a large public health impact.