{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T21:45:16Z","timestamp":1785534316569,"version":"3.56.0"},"reference-count":75,"publisher":"American Medical Association (AMA)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Otolaryngol Head Neck Surg"],"published-print":{"date-parts":[[2023,9,1]]},"abstract":"<jats:sec id=\"ab-ooi230041-4\"><jats:title>Importance<\/jats:title><jats:p>Olfactory dysfunction (OD) is increasingly recognized as a robust marker of frailty and mortality. Despite broad recognition of frailty as a critical component of head and neck cancer (HNC) care, there is no standardized frailty assessment.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230041-5\"><jats:title>Objective<\/jats:title><jats:p>To assess the prevalence of OD and its association with frailty and postoperative outcomes in HNC.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230041-6\"><jats:title>Design, Setting, and Participants<\/jats:title><jats:p>In this prospective cohort study with enrollment between February 17, 2021, to September 29, 2021, at a tertiary academic medical center, 85 eligible adult patients with primary, treatment-naive HNC of mucosal or cutaneous origin were included. Patients with a history of COVID-19, neurocognitive, or primary smell\/taste disorders were excluded.<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230041-7\"><jats:title>Exposures<\/jats:title><jats:p>Prospective olfactory assessments (self-reported, visual analog scale [VAS] and psychophysical, University of Pennsylvania Smell Identification Test [UPSIT]) with concurrent frailty assessment (Risk Analysis Index [RAI]) were used. Olfactory-specific quality of life (QOL) was examined with brief Questionnaire of Olfactory Disorders\u2013Negative Statements (QOD-NS).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230041-8\"><jats:title>Main Outcome(s) and Measure(s)<\/jats:title><jats:p>The primary outcome was the prevalence of OD as assessed by VAS (0-10, no to normal smell) and UPSIT (0-40, higher scores reflect better olfaction) and its association with frailty (RAI, 0-81, higher scores indicate greater frailty). For surgical patients, secondary outcomes were associations between OD and postoperative length of stay (LOS), 30-day postoperative outcomes, and QOD-NS (0-21, higher scores indicate worse QOL).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230041-9\"><jats:title>Results<\/jats:title><jats:p>Among 51 patients with HNC (mean [SD] age, 63 [10] years; 39 [77%] male participants; 41 [80%] White participants), 24 (47%) were frail, and 4 (8%) were very frail. Despite median (IQR) self-reported olfaction by VAS of 9 (8-10), 30 (59%) patients demonstrated measured OD with psychophysical testing. No meaningful association was found between self-reported and psychophysical testing (Hodges-Lehmann, &amp;amp;lt;0.001; 95% CI, \u22122 to 1); a total of 46 (90%) patients did not report decreased olfaction-specific QOL. Median UPSIT scores were lower in frail patients (Hodges-Lehmann, 6; 95% CI, 2-12). Multivariate modeling demonstrated severe microsmia\/anosmia was associated with 1.75 (95% CI, 1.09-2.80) times odds of being frail\/very frail and approximately 3 days increased LOS (\u03b2, 2.96; 95% CI, 0.29-5.62).<\/jats:p><\/jats:sec><jats:sec id=\"ab-ooi230041-10\"><jats:title>Conclusions and Relevance<\/jats:title><jats:p>Although patients with HNC are unaware of olfactory changes, OD is common and may serve as a bellwether of frailty. In this prospective cohort study, a dose-dependent association was demonstrated between increasing degrees of OD and frailty, and the potential utility of olfaction was highlighted as a touchstone in the assessment of HNC frailty.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamaoto.2023.1935","type":"journal-article","created":{"date-parts":[[2023,7,27]],"date-time":"2023-07-27T15:32:05Z","timestamp":1690471925000},"page":"828","source":"Crossref","is-referenced-by-count":15,"title":["Exploring Olfactory Dysfunction as a Marker of Frailty and Postoperative Outcomes in Head and Neck Cancer"],"prefix":"10.1001","volume":"149","author":[{"given":"Leila J.","family":"Mady","sequence":"first","affiliation":[{"name":"Department of Otolaryngology\u2013Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"De Ravin","sequence":"additional","affiliation":[{"name":"Department of 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