Olfactory Dysfunction in COVID-19 Patients: Prevalence and Prognosis for Recovering Sense of Smell
Luca D’Ascanio MD
Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Santa Croce Hospital AORMN, Fano-Pesaro, Italy
These authors contributed equally to this article.
Search for more papers by this authorManlio Pandolfini MD
Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Santa Croce Hospital AORMN, Fano-Pesaro, Italy
Search for more papers by this authorCristina Cingolani MD
Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Santa Croce Hospital AORMN, Fano-Pesaro, Italy
Search for more papers by this authorGino Latini MD
Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Santa Croce Hospital AORMN, Fano-Pesaro, Italy
Search for more papers by this authorPaolo Gradoni MD
Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Santa Croce Hospital AORMN, Fano-Pesaro, Italy
Search for more papers by this authorGabriele Frausini MD
Internal Medicine Department “Santa Croce Hospital” AORMN, Fano, Italy
Search for more papers by this authorMassimo Maranzano
Division of Oral and Maxillofacial and Facial Plastic Surgery, Manchester University Foundation Trust, Manchester, UK
Search for more papers by this authorCorresponding Author
Michael J. Brenner MD
Department of Otolaryngology–Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
These authors contributed equally to this article.
Michael J. Brenner, MD, Department of Otolaryngology–Head & Neck Surgery, University of Michigan Medical School, 1500 E. Medical Center Dr, 1903 Taubman Center SPC 5312, Ann Arbor, MI, 48109-5214, USA. Email: [email protected]Search for more papers by this authorArianna Di Stadio MD, PhD
Arianna Di Stadio, Department of Otolaryngology–Head & Neck Surgery, University of Perugia, Perugia, Italy
These authors contributed equally to this article.
Search for more papers by this authorLuca D’Ascanio MD
Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Santa Croce Hospital AORMN, Fano-Pesaro, Italy
These authors contributed equally to this article.
Search for more papers by this authorManlio Pandolfini MD
Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Santa Croce Hospital AORMN, Fano-Pesaro, Italy
Search for more papers by this authorCristina Cingolani MD
Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Santa Croce Hospital AORMN, Fano-Pesaro, Italy
Search for more papers by this authorGino Latini MD
Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Santa Croce Hospital AORMN, Fano-Pesaro, Italy
Search for more papers by this authorPaolo Gradoni MD
Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Santa Croce Hospital AORMN, Fano-Pesaro, Italy
Search for more papers by this authorGabriele Frausini MD
Internal Medicine Department “Santa Croce Hospital” AORMN, Fano, Italy
Search for more papers by this authorMassimo Maranzano
Division of Oral and Maxillofacial and Facial Plastic Surgery, Manchester University Foundation Trust, Manchester, UK
Search for more papers by this authorCorresponding Author
Michael J. Brenner MD
Department of Otolaryngology–Head & Neck Surgery, University of Michigan Medical School, Ann Arbor, Michigan, USA
These authors contributed equally to this article.
Michael J. Brenner, MD, Department of Otolaryngology–Head & Neck Surgery, University of Michigan Medical School, 1500 E. Medical Center Dr, 1903 Taubman Center SPC 5312, Ann Arbor, MI, 48109-5214, USA. Email: [email protected]Search for more papers by this authorArianna Di Stadio MD, PhD
Arianna Di Stadio, Department of Otolaryngology–Head & Neck Surgery, University of Perugia, Perugia, Italy
These authors contributed equally to this article.
Search for more papers by this authorAbstract
While olfactory dysfunction associated with coronavirus disease 2019 (COVID-19) has attracted considerable interest, few studies have tracked outcomes at serial time points or beyond 2 weeks. Furthermore, data are conflicting regarding whether COVID-19 severity correlates with degree of olfactory dysfunction. This prospective case-control study analyzed prevalence and severity of subjective loss of smell in outpatients (n = 23) and inpatients (n = 20) with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection vs healthy controls (n = 25). Olfactory dysfunction was reported more commonly in COVID-19 patients than in healthy controls (P <. 001), and outpatients paradoxically reported loss of smell more commonly than inpatients (P =. 02). Headaches were present in 52% of patients with olfactory dysfunction. Anosmia or hyposmia persisted beyond 5 days but most of the patients recovered by 30 days, suggesting favorable prognosis for olfaction. Differences between inpatients and outpatients are potentially reflective of timeline of olfactory symptoms and contextual factors, underscoring the importance of corroborative objective testing, coupled with careful tracking of temporal relationships.
References
- 1Hu Z, Song C, Xu C, et al. Clinical characteristics of 24 asymptomatic infections with COVID-19 screened among close contacts in Nanjing, China. Sci China Life Sci. 2020; 63(5): 706–711.
- 2Li LQ, Huang T, Wang YQ, et al. COVID-19 patients’ clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 2020; 92(6): 577–583.
- 3Mizumoto K, Kagaya K, Zarebski A, Chowell G. Estimating the asymptomatic proportion of coronavirus disease 2019 (COVID-19) cases on board the Diamond Princess cruise ship, Yokohama, Japan, 2020. Euro Surveill. 2020; 25(10): 2000180.
- 4Ralli M, Di Stadio A, Greco A, de Vincentiis M, Polimeni A. Defining the burden of olfactory dysfunction in COVID-19 patients. Eur Rev Med Pharmacol Sci. 2020; 24(7): 3440–3441.
- 5Printza A, Constantinidis J. The role of self-reported smell and taste disorders in suspected COVID-19 [published online May 23, 2020]. Eur Arch Otorhinolaryngol.
- 6Speth MM, Singer-Cornelius T, Obere M, Gengler I, Brockmeier SJ, Sedaghat AR. Olfactory dysfunction and sinonasal symptomatology in COVID-19: prevalence, severity, timing, and associated characteristics. Otolaryngol Head Neck Surg. 2020; 163(1): 114–120.
- 7Coelho DH, Kons ZA, Costanzo RM, Reiter ER. Subjective changes in smell and taste during the COVID-19 pandemic: a national survey-preliminary results [published online May 19, 2020]. Otolaryngol Head Neck Surg.
- 8Vaira LA, Hopkins C, Salzano G, et al. Olfactory and gustatory function impairment in COVID-19 patients: Italian objective multicenter-study [published online May 21, 2020]. Head Neck.
- 9Wang Y, Kang H, Liu X, Tong Z. Combination of RT-qPCR testing and clinical features for diagnosis of COVID-19 facilitates management of SARS-CoV-2 outbreak. J Med Virol. 2020; 92(6): 538–539.
- 10Spinato G, Fabbris C, Polesel J, et al. Alterations in smell or taste in mildly symptomatic outpatients with SARS-CoV-2 infection. JAMA. 2020; 323(20): 2089–2090.
- 11Vaira LA, Deiana G, Fois AG, et al. Objective evaluation of anosmia and ageusia in COVID-19 patients: single-center experience on 72 cases. Head Neck. 2020; 42(6): 1252–1258.
- 12Panuganti BA, Jafari A, MacDonald B, DeConde AS. Predicting COVID-19 incidence using anosmia and other COVID-19 symptomatology: preliminary analysis using Google and Twitter [published online June 2, 2020]. Otolaryngol Head Neck Surg.
- 13 World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected: interim guidance. Published January 2020. Accessed February 5, 2020. https://www.who.int/internal-publications-detail/clinical-management-of-severeacute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
- 14Howard BE, Lal D. Protective rhinologic practice special considerations during COVID-19: visit planning, personal equipment, testing, and environmental controls [published online June 2, 2020]. Otolaryngol Head Neck Surg.
- 15Mark ME, LoSavio P, Husain I, Papagiannopoulos P, Batra PS, Tajudeen BA. Effect of implementing simulation education on health care worker comfort with nasopharyngeal swabbing for COVID-19 [published online June 2, 2020]. Otolaryngol Head Neck Surg.
- 16Piras A, Rizzo D, Uzzau S, De Riu G, Rubino S, Bussu F. Inappropriate nasopharyngeal sampling for SARS-CoV-2 detection is a relevant cause of false-negative reports [published online May 26, 2020]. Otolaryngol Head Neck Surg.
- 17Kaye R, Chang CWD, Kazahaya K, Brereton J, Denneny JC. COVID-19 Anosmia Reporting Tool: initial findings. Otolaryngol Head Neck Surg. 2020; 163(1): 132–134.
- 18Krouse HJ. Whatever happened to evidence-based practice during COVID-19 [published online May 19, 2020]? Otolaryngol Head Neck Surg.
- 19Tong JY, Wong A, Zhu D, Fastenberg JH, Tham T. The prevalence of olfactory and gustatory dysfunction in COVID-19 patients: a systematic review and meta-analysis [published online May 5, 2020]. Otolaryngol Head Neck Surg.
- 20Lechien JR, Chiesa-Estomba CM, De Siati DR, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol. 2020; 277(8): 2251–2261.
- 21Kaye R, Chang CWD, Kazahaya K, Brereton J, Denneny JCIII. COVID-19 anosmia reporting tool: initial findings [published online April 28, 2020]. Otolaryngol Head Neck Surg.
- 22Eliezer M, Hautefort C, Hamel AL, et al. Sudden and complete olfactory loss function as a possible symptom of COVID-19 [published online April 8, 2020]. JAMA Otolaryngol Head Neck Surg.
- 23Karimi-Galougahi M, Raad N, Mikaniki N. Anosmia and the need for COVID-19 screening during the pandemic [published online May 5, 2020]. Otolaryngol Head Neck Surg.
- 24Ralli M, Di Stadio A, Greco A, de Vincentiis M, Polimeni A. Defining the burden of olfactory dysfunction in COVID-19 patients. Eur Rev Med Pharmacol Sci. 2020; 24(7): 3440–3441.
- 25Wu Y, Xu X, Chen Z, et al. Nervous system involvement after infection with COVID-19 and other coronaviruses [published online March 30, 2020]. Brain Behav Immun.
- 26Garavello W, Galluzzi F. Olfactory dysfunction in COVID-19 [published online May 5, 2020]. Otolaryngol Head Neck Surg.
- 27Sedaghat AR, Gengler I, Speth MM. Olfactory dysfunction: a highly prevalent symptom of COVID-19 with public health significance [published online May 5, 2020]. Otolaryngol Head Neck Surg.
- 28Hatton CF, Duncan CJA. Microglia are essential to protective antiviral immunity: lessons from mouse models of viral encephalitis. Front Immunol. 2019; 10: 2656.
- 29Kosugi EM, Lavinsky J, Romano FR, et al. Incomplete and late recovery of sudden olfactory dysfunction in COVID-19 [published online May 25, 2020]. Braz J Otorhinolaryngol.
- 30Di Stadio A, Della Volpe A, Ralli M, Ricci G. Gender differences in COVID-19 infection: the estrogen effect on upper and lower airways. Can it help to figure out a treatment? Eur Rev Med Pharmacol Sci. 2020; 24(10): 5195–5196.
- 31Moulton VR. Sex hormones in acquired immunity and autoimmune disease. Front Immunol. 2018; 9: 2279.
