COVID-19-associated anosmia: Difference between revisions

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__NOTOC__
__NOTOC__
{{COVID-19}}
{{SI}}


{{CMG}}; {{AE}}[[User:MoisesRomo|Moises Romo M.D.]]
{{CMG}}; {{AE}}[[User:MoisesRomo|Moises Romo M.D.]] {{Fs}}


{{SK}}[[anosmia]], olfactory dysfunction, [[SARS-CoV-2]], [[dysgeusia]]  
{{SK}} [[anosmia]], olfactory dysfunction, [[SARS-CoV-2]], [[dysgeusia]]  


==Overview==
==Overview==
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**Genetic susceptibility
**Genetic susceptibility
*Susceptibility to [[COVID-19]] [[infection]] is influenced to some degree by the [[Host (biology)|host]] [[genotype]], making a 47-fold [[heritability]] for [[anosmia]].<ref name="pmid32563019" /><ref name="WilliamsFreydin2020">{{cite journal|last1=Williams|first1=Frances MK|last2=Freydin|first2=Maxim|last3=Mangino|first3=Massimo|last4=Couvreur|first4=Simon|last5=Visconti|first5=Alessia|last6=Bowyer|first6=Ruth CE|last7=Le Roy|first7=Caroline I|last8=Falchi|first8=Mario|last9=Sudre|first9=Carole|last10=Davies|first10=Richard|last11=Hammond|first11=Christopher|last12=Menni|first12=Cristina|last13=Steves|first13=Claire|last14=Spector|first14=Tim|year=2020|doi=10.1101/2020.04.22.20072124}}</ref>
*Susceptibility to [[COVID-19]] [[infection]] is influenced to some degree by the [[Host (biology)|host]] [[genotype]], making a 47-fold [[heritability]] for [[anosmia]].<ref name="pmid32563019" /><ref name="WilliamsFreydin2020">{{cite journal|last1=Williams|first1=Frances MK|last2=Freydin|first2=Maxim|last3=Mangino|first3=Massimo|last4=Couvreur|first4=Simon|last5=Visconti|first5=Alessia|last6=Bowyer|first6=Ruth CE|last7=Le Roy|first7=Caroline I|last8=Falchi|first8=Mario|last9=Sudre|first9=Carole|last10=Davies|first10=Richard|last11=Hammond|first11=Christopher|last12=Menni|first12=Cristina|last13=Steves|first13=Claire|last14=Spector|first14=Tim|year=2020|doi=10.1101/2020.04.22.20072124}}</ref>
*To view the epidemiology and demographics of COVID-19, [[COVID-19 risk factors|click here]].
*To view the risk factors of COVID-19, [[COVID-19 risk factors|click here]].


==Screening==
==Screening==


*A [[Screening (medicine)|screening]] strategy, duly validated for [[Olfaction|olfactory]] [[disfunction]] in [[COVID-19]], consists of carrying out specific questionnaires, such as the ''Questionnaire for Olfactory Disfunction''.<ref name="pmid32466862" /><ref name="pmid26384780">{{cite journal |vauthors=Nguyen DT, Rumeau C, Gallet P, Jankowski R |title=Olfactory exploration: State of the art |journal=Eur Ann Otorhinolaryngol Head Neck Dis |volume=133 |issue=2 |pages=113–8 |date=April 2016 |pmid=26384780 |doi=10.1016/j.anorl.2015.08.038 |url=}}</ref><ref name="pmid22566102">{{cite journal |vauthors=Simopoulos E, Katotomichelakis M, Gouveris H, Tripsianis G, Livaditis M, Danielides V |title=Olfaction-associated quality of life in chronic rhinosinusitis: adaptation and validation of an olfaction-specific questionnaire |journal=Laryngoscope |volume=122 |issue=7 |pages=1450–4 |date=July 2012 |pmid=22566102 |doi=10.1002/lary.23349 |url=}}</ref>
*A [[Screening (medicine)|screening]] strategy, duly validated for [[Olfaction|olfactory]] [[disfunction]] in [[COVID-19]], consists of carrying out specific questionnaires, such as the ''Questionnaire for Olfactory Disfunction''.<ref name="pmid32466862" /><ref name="pmid26384780">{{cite journal |vauthors=Nguyen DT, Rumeau C, Gallet P, Jankowski R |title=Olfactory exploration: State of the art |journal=Eur Ann Otorhinolaryngol Head Neck Dis |volume=133 |issue=2 |pages=113–8 |date=April 2016 |pmid=26384780 |doi=10.1016/j.anorl.2015.08.038 |url=}}</ref><ref name="pmid22566102">{{cite journal |vauthors=Simopoulos E, Katotomichelakis M, Gouveris H, Tripsianis G, Livaditis M, Danielides V |title=Olfaction-associated quality of life in chronic rhinosinusitis: adaptation and validation of an olfaction-specific questionnaire |journal=Laryngoscope |volume=122 |issue=7 |pages=1450–4 |date=July 2012 |pmid=22566102 |doi=10.1002/lary.23349 |url=}}</ref>
*Several [[ENT]] societies in the United Kingdom and the United States, have advised to treat [[anosmia]] marker of [[SARS-CoV-2]] [[infection]].<ref name=":0">{{Cite journal|last=Robert Pellegrin, Keiland W. Cooper, Antonella Di Pizio, Paule V. Joseph, Surabhi Bhutani, Valentina Parma|first=|date=2020|title=Corona Viruses and the Chemical Senses:
*Several [[ENT]] societies in the United Kingdom and the United States, have advised treating [[anosmia]] marker of [[SARS-CoV-2]] [[infection]].<ref name=":0">{{Cite journal|last=Robert Pellegrin, Keiland W. Cooper, Antonella Di Pizio, Paule V. Joseph, Surabhi Bhutani, Valentina Parma|first=|date=2020|title=Corona Viruses and the Chemical Senses:
Past, Present, and Future|url=|journal=Oxford University|volume=|pages=|via=}}</ref><ref name="urlwww.entuk.org">{{cite web |url=https://www.entuk.org/sites/default/files/files/Loss%20of%20sense%20of%20smell%20as%20marker%20of%20COVID.pdf |title=www.entuk.org |format= |work= |accessdate=}}</ref><ref name="urlAAO-HNSF 2020 Annual Meeting & OTO Experience | American Academy of Otolaryngology-Head and Neck Surgery">{{cite web |url=https://www.entnet.org/content/aao-hnsf-2020-annual-meeting-oto-experience |title=AAO-HNSF 2020 Annual Meeting & OTO Experience &#124; American Academy of Otolaryngology-Head and Neck Surgery |format= |work= |accessdate=}}</ref>
Past, Present, and Future|url=|journal=Oxford University|volume=|pages=|via=}}</ref><ref name="urlwww.entuk.org">{{cite web |url=https://www.entuk.org/sites/default/files/files/Loss%20of%20sense%20of%20smell%20as%20marker%20of%20COVID.pdf |title=www.entuk.org |format= |work= |accessdate=}}</ref><ref name="urlAAO-HNSF 2020 Annual Meeting & OTO Experience | American Academy of Otolaryngology-Head and Neck Surgery">{{cite web |url=https://www.entnet.org/content/aao-hnsf-2020-annual-meeting-oto-experience |title=AAO-HNSF 2020 Annual Meeting & OTO Experience &#124; American Academy of Otolaryngology-Head and Neck Surgery |format= |work= |accessdate=}}</ref>
* The [[American Academy of Otolaryngology]] (AAO) proposed for [[anosmia]], [[hyposmia]], and [[dysgeusia]] to be added to the list of [[Screening test|screening]] tools for [[COVID-19]] in otherwise [[asymptomatic]] individuals.<ref name="urlAAO-HNSF 2020 Annual Meeting & OTO Experience | American Academy of Otolaryngology-Head and Neck Surgery" /><ref name=":0" />
* The [[American Academy of Otolaryngology]] (AAO) proposed for [[anosmia]], [[hyposmia]], and [[dysgeusia]] to be added to the list of [[Screening test|screening]] tools for [[COVID-19]] in otherwise [[asymptomatic]] individuals.<ref name="urlAAO-HNSF 2020 Annual Meeting & OTO Experience | American Academy of Otolaryngology-Head and Neck Surgery" /><ref name=":0" />
*In the absence of available solid data, the recommendation should be to perform nasal swabs on any patient with recent onset [[anosmia]], duly assessed.<ref name="pmid32466862" />
*In the absence of available solid data, the recommendation should be to perform nasal swabs on any patient with recent-onset [[anosmia]], duly assessed.<ref name="pmid32466862" />
*To view screening for COVID-19, [[COVID-19 screening|click here]].<br />
*To view screening for COVID-19, [[COVID-19 screening|click here]].<br />


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* Approximately 82% of patients with [[anosmia]] related to [[COVID-19]] recover within 2 weeks and 98% of them within 28 days.<ref name="pmid32563019" /><ref name="pmid323055632" /><ref name="pmid32279441">{{cite journal |vauthors=Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS |title=Association of chemosensory dysfunction and COVID-19 in patients presenting with influenza-like symptoms |journal=Int Forum Allergy Rhinol |volume= |issue= |pages= |date=April 2020 |pmid=32279441 |pmc=7262089 |doi=10.1002/alr.22579 |url=}}</ref>
* Approximately 82% of patients with [[anosmia]] related to [[COVID-19]] recover within 2 weeks and 98% of them within 28 days.<ref name="pmid32563019" /><ref name="pmid323055632" /><ref name="pmid32279441">{{cite journal |vauthors=Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS |title=Association of chemosensory dysfunction and COVID-19 in patients presenting with influenza-like symptoms |journal=Int Forum Allergy Rhinol |volume= |issue= |pages= |date=April 2020 |pmid=32279441 |pmc=7262089 |doi=10.1002/alr.22579 |url=}}</ref>
*The intensity and duration of the [[Olfaction|olfactory]] [[disfunction]] associated to [[COVID-19]], is highly variable depending on the capacity and rate of regeneration of the neuroepitielium.<ref name="pmid32466862" />
*The intensity and duration of the [[Olfaction|olfactory]] [[disfunction]] associated to [[COVID-19]], is highly variable depending on the capacity and rate of regeneration of the neuroepitielium.<ref name="pmid32466862" />
*A recent review by JAMA showed that 96% of the patients recover from [[anosmia]] within one year of its onset. At 6 months, 85% of the patients recovered from [[anosmia]]. [[Parosmia]] was not evaluated, and it can be potentially more debilitating for patients.<ref name="pmid34165581">{{cite journal| author=Renaud M, Thibault C, Le Normand F, Mcdonald EG, Gallix B, Debry C | display-authors=etal| title=Clinical Outcomes for Patients With Anosmia 1 Year After COVID-19 Diagnosis. | journal=JAMA Netw Open | year= 2021 | volume= 4 | issue= 6 | pages= e2115352 | pmid=34165581 | doi=10.1001/jamanetworkopen.2021.15352 | pmc=8226421 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=34165581  }} </ref>
*To view natural history, complications, and prognosis of COVID-19, [[COVID-19 natural history, complications and prognosis|click here]].
*To view natural history, complications, and prognosis of COVID-19, [[COVID-19 natural history, complications and prognosis|click here]].


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*[[Anosmia]] occurs more commonly after the onset of other [[symptoms]]. In a study involving 1325 participants with [[anosmia]] (with no confirmatory [[COVID-19 diagnostic study of choice|COVID-19 test]]), 13% reported [[anosmia]] before their onset, 38.4% at the same time, and in 48.6% after the onset of [[symptoms]].<ref name="pmid32277751" />
*[[Anosmia]] occurs more commonly after the onset of other [[symptoms]]. In a study involving 1325 participants with [[anosmia]] (with no confirmatory [[COVID-19 diagnostic study of choice|COVID-19 test]]), 13% reported [[anosmia]] before their onset, 38.4% at the same time, and in 48.6% after the onset of [[symptoms]].<ref name="pmid32277751" />
* A study reports that [[anosmia]] typically developes after 4.4 days of [[COVID-19]] [[infection]].<ref name="pmid323055632">{{cite journal |vauthors=Klopfenstein T, Kadiane-Oussou NJ, Toko L, Royer PY, Lepiller Q, Gendrin V, Zayet S |title=Features of anosmia in COVID-19 |journal=Med Mal Infect |volume= |issue= |pages= |date=April 2020 |pmid=32305563 |pmc=7162775 |doi=10.1016/j.medmal.2020.04.006 |url=}}</ref><ref name="pmid32563019" />
* A study reports that [[anosmia]] typically developes after 4.4 days of [[COVID-19]] [[infection]].<ref name="pmid323055632">{{cite journal |vauthors=Klopfenstein T, Kadiane-Oussou NJ, Toko L, Royer PY, Lepiller Q, Gendrin V, Zayet S |title=Features of anosmia in COVID-19 |journal=Med Mal Infect |volume= |issue= |pages= |date=April 2020 |pmid=32305563 |pmc=7162775 |doi=10.1016/j.medmal.2020.04.006 |url=}}</ref><ref name="pmid32563019" />
'''Common Symptoms'''
* Common symptoms accompanying [[anosmia]] related to [[COVID-19]] are:
** [[Fever]]
** [[Headache]]
** [[Nausea]]/ [[vomiting]]
** [[Irritability]]
** [[Malaise]]
** [[Neck stiffness]]
** Light sensitivity/ [[photophobia]]
'''Less Common Symptoms'''
* Less common symptoms accompanying [[anosmia]] related to [[COVID-19]] are:
** [[Myalgias]]
** [[Confusion]]
** [[Seizures]] (with concomitant [[encephalitis]])
*To view the history and symptoms of COVID-19, [[COVID-19 history and symptoms|click here]].
*To view the history and symptoms of COVID-19, [[COVID-19 history and symptoms|click here]].


===Physical Examination===
===Physical Examination===
===== HEENT =====


*[[Physical examination]] using kits of different [[Olfaction|olfactory]] stimuli may disclose conductive, sensorineural, or mixed [[Olfaction|olfactory]] disfunction.<ref name="pmid32466862" />
*[[Physical examination]] using kits of different [[Olfaction|olfactory]] stimuli may disclose conductive, sensorineural, or mixed [[Olfaction|olfactory]] disfunction.<ref name="pmid32466862" />
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===X-ray===
===X-ray===


*[[X-ray]] imaging to the [[nasal cavity]] and [[sinus]] (Cadwell and Waters projections) does not demonstrate any typical finidings in patients with [[anosmia]] due to [[COVID-19]], but may be used to exclude other causes
*[[X-ray]] imaging to the [[nasal cavity]] and [[sinus]] (Cadwell and Waters projections) does not demonstrate any typical findings in patients with [[anosmia]] due to [[COVID-19]], but may be used to exclude other causes
* To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]].<br />
* To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]].<br />


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===MRI===
===MRI===


*[[MRI]] imaging to the [[nasal cavity]] and [[sinus]] does not demonstrate any typical finidings in patients with anosmia due to COVID-19, but may be used to exclude other causes.
*[[MRI]] imaging to the [[nasal cavity]] and [[sinus]] does not demonstrate any typical findings in patients with anosmia due to COVID-19 but may be used to exclude other causes.
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]].<br />
* To view the MRI findings on COVID-19, [[COVID-19 MRI|click here]].<br />


===Other Imaging Findings===
===Other Imaging Findings===


*[[Ultrasound]] imaging to the [[nasal cavity]] and [[sinus]] does not demonstrate any typical finidings in patients with anosmia due to [[COVID-19]], but may be used to exclude other causes.
*[[Ultrasound]] imaging to the [[nasal cavity]] and [[sinus]] does not demonstrate any typical findings in patients with anosmia due to [[COVID-19]] but may be used to exclude other causes.
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]].<br />
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]].<br />


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===Medical Therapy===
===Medical Therapy===


* [[Oral steroids]] may be useful in patients with [[anosmia]] related to [[COVID-19]] after careful discusion of [[risks]] and benefits, when duration exceeds 2 weeks.<ref name="pmid322777512" /> However, current [[World Health Organization|World Health Organization (WHO)]] guidelines advice to avoid the use of [[Oral steroids|systemic steroids]] when possible.<ref name="urlCoronavirus disease (COVID-19)">{{cite web |url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019 |title=Coronavirus disease (COVID-19) |format= |work= |accessdate=}}</ref><ref name="pmid322777512" /> [[Dosage]] has not been clarified by the source, but [[doses]] of 40–60 mg/day for 10–14 days of oral [[prednisolone]] have been shown to improve the mean [[Olfaction|olfactory]] recognition threshold in other causes of [[viral]] [[anosmia]].<ref name="pmid8560170">{{cite journal |vauthors=Ikeda K, Sakurada T, Suzaki Y, Takasaka T |title=Efficacy of systemic corticosteroid treatment for anosmia with nasal and paranasal sinus disease |journal=Rhinology |volume=33 |issue=3 |pages=162–5 |date=September 1995 |pmid=8560170 |doi= |url=}}</ref>
* [[Oral steroids]] may be useful in patients with [[anosmia]] related to [[COVID-19]] after careful evaluation of [[risks]] and benefits, when duration exceeds 2 weeks. However, current [[World Health Organization|World Health Organization (WHO)]] guidelines advice to avoid the use of [[Oral steroids|systemic steroids]] when possible.<ref name="urlCoronavirus disease (COVID-19)">{{cite web |url=https://www.who.int/emergencies/diseases/novel-coronavirus-2019 |title=Coronavirus disease (COVID-19) |format= |work= |accessdate=}}</ref><ref name="pmid322777512">{{cite journal |vauthors=Hopkins C, Surda P, Kumar N |title=Presentation of new onset anosmia during the COVID-19 pandemic |journal=Rhinology |volume=58 |issue=3 |pages=295–298 |date=June 2020 |pmid=32277751 |doi=10.4193/Rhin20.116 |url=}}</ref> <ref name="pmid8560170">{{cite journal |vauthors=Ikeda K, Sakurada T, Suzaki Y, Takasaka T |title=Efficacy of systemic corticosteroid treatment for anosmia with nasal and paranasal sinus disease |journal=Rhinology |volume=33 |issue=3 |pages=162–5 |date=September 1995 |pmid=8560170 |doi= |url=}}</ref><ref name="pmid8560170" /><ref name="pmid319501562">{{cite journal |vauthors=Yan CH, Rathor A, Krook K, Ma Y, Rotella MR, Dodd RL, Hwang PH, Nayak JV, Oyesiku NM, DelGaudio JM, Levy JM, Wise J, Wise SK, Patel ZM |title=Effect of Omega-3 Supplementation in Patients With Smell Dysfunction Following Endoscopic Sellar and Parasellar Tumor Resection: A Multicenter Prospective Randomized Controlled Trial |journal=Neurosurgery |volume= |issue= |pages= |date=January 2020 |pmid=31950156 |doi=10.1093/neuros/nyz559 |url=}}</ref><ref name="pmid31950156">{{cite journal |vauthors=Yan CH, Rathor A, Krook K, Ma Y, Rotella MR, Dodd RL, Hwang PH, Nayak JV, Oyesiku NM, DelGaudio JM, Levy JM, Wise J, Wise SK, Patel ZM |title=Effect of Omega-3 Supplementation in Patients With Smell Dysfunction Following Endoscopic Sellar and Parasellar Tumor Resection: A Multicenter Prospective Randomized Controlled Trial |journal=Neurosurgery |volume= |issue= |pages= |date=January 2020 |pmid=31950156 |doi=10.1093/neuros/nyz559 |url=}}</ref><ref name="RedenLill2012">{{cite journal|last1=Reden|first1=Jens|last2=Lill|first2=Katja|last3=Zahnert|first3=Thomas|last4=Haehner|first4=Antje|last5=Hummel|first5=Thomas|title=Olfactory function in patients with postinfectious and posttraumatic smell disorders before and after treatment with vitamin A: A double-blind, placebo-controlled, randomized clinical trial|journal=The Laryngoscope|volume=122|issue=9|year=2012|pages=1906–1909|issn=0023852X|doi=10.1002/lary.23405}}</ref><ref name="pmid12439184">{{cite journal |vauthors=Hummel T, Heilmann S, Hüttenbriuk KB |title=Lipoic acid in the treatment of smell dysfunction following viral infection of the upper respiratory tract |journal=Laryngoscope |volume=112 |issue=11 |pages=2076–80 |date=November 2002 |pmid=12439184 |doi=10.1097/00005537-200211000-00031 |url=}}</ref><ref name="pmid124391842">{{cite journal |vauthors=Hummel T, Heilmann S, Hüttenbriuk KB |title=Lipoic acid in the treatment of smell dysfunction following viral infection of the upper respiratory tract |journal=Laryngoscope |volume=112 |issue=11 |pages=2076–80 |date=November 2002 |pmid=12439184 |doi=10.1097/00005537-200211000-00031 |url=}}</ref><ref name="pmid28040824">{{cite journal |vauthors=Sorokowska A, Drechsler E, Karwowski M, Hummel T |title=Effects of olfactory training: a meta-analysis |journal=Rhinology |volume=55 |issue=1 |pages=17–26 |date=March 2017 |pmid=28040824 |doi=10.4193/Rhin16.195 |url=}}</ref><ref name="pmid32466862" /><ref name="pmid15563908">{{cite journal |vauthors=Seiden AM |title=Postviral olfactory loss |journal=Otolaryngol. Clin. North Am. |volume=37 |issue=6 |pages=1159–66 |date=December 2004 |pmid=15563908 |doi=10.1016/j.otc.2004.06.007 |url=}}</ref>
* Olfactory training suggest small to moderate benefit for patients with post-viral [[Olfaction|olfactory]] [[dysfunction]].<ref name="pmid322777512">{{cite journal |vauthors=Hopkins C, Surda P, Kumar N |title=Presentation of new onset anosmia during the COVID-19 pandemic |journal=Rhinology |volume=58 |issue=3 |pages=295–298 |date=June 2020 |pmid=32277751 |doi=10.4193/Rhin20.116 |url=}}</ref>
*[[Dosage]] has not been clarified by the source, but [[doses]] of 40–60 mg/day for 10–14 days of oral [[prednisolone]] have been shown to improve the mean [[Olfaction|olfactory]] recognition threshold in other causes of [[viral]] [[anosmia]].
* [[Alpha lipoic acid]] (600 mg/day),<ref name="pmid8560170" /><ref name="pmid12439184">{{cite journal |vauthors=Hummel T, Heilmann S, Hüttenbriuk KB |title=Lipoic acid in the treatment of smell dysfunction following viral infection of the upper respiratory tract |journal=Laryngoscope |volume=112 |issue=11 |pages=2076–80 |date=November 2002 |pmid=12439184 |doi=10.1097/00005537-200211000-00031 |url=}}</ref><ref name="pmid124391842">{{cite journal |vauthors=Hummel T, Heilmann S, Hüttenbriuk KB |title=Lipoic acid in the treatment of smell dysfunction following viral infection of the upper respiratory tract |journal=Laryngoscope |volume=112 |issue=11 |pages=2076–80 |date=November 2002 |pmid=12439184 |doi=10.1097/00005537-200211000-00031 |url=}}</ref> [[omega-3]] supplementation (2000mg/day),<ref name="pmid8560170" /><ref name="pmid319501562">{{cite journal |vauthors=Yan CH, Rathor A, Krook K, Ma Y, Rotella MR, Dodd RL, Hwang PH, Nayak JV, Oyesiku NM, DelGaudio JM, Levy JM, Wise J, Wise SK, Patel ZM |title=Effect of Omega-3 Supplementation in Patients With Smell Dysfunction Following Endoscopic Sellar and Parasellar Tumor Resection: A Multicenter Prospective Randomized Controlled Trial |journal=Neurosurgery |volume= |issue= |pages= |date=January 2020 |pmid=31950156 |doi=10.1093/neuros/nyz559 |url=}}</ref><ref name="pmid31950156">{{cite journal |vauthors=Yan CH, Rathor A, Krook K, Ma Y, Rotella MR, Dodd RL, Hwang PH, Nayak JV, Oyesiku NM, DelGaudio JM, Levy JM, Wise J, Wise SK, Patel ZM |title=Effect of Omega-3 Supplementation in Patients With Smell Dysfunction Following Endoscopic Sellar and Parasellar Tumor Resection: A Multicenter Prospective Randomized Controlled Trial |journal=Neurosurgery |volume= |issue= |pages= |date=January 2020 |pmid=31950156 |doi=10.1093/neuros/nyz559 |url=}}</ref> and intranasal [[Vitamin A derivatives|vitamin A]] (10,000 U/day)<ref name="pmid8560170" /><ref name="RedenLill2012">{{cite journal|last1=Reden|first1=Jens|last2=Lill|first2=Katja|last3=Zahnert|first3=Thomas|last4=Haehner|first4=Antje|last5=Hummel|first5=Thomas|title=Olfactory function in patients with postinfectious and posttraumatic smell disorders before and after treatment with vitamin A: A double-blind, placebo-controlled, randomized clinical trial|journal=The Laryngoscope|volume=122|issue=9|year=2012|pages=1906–1909|issn=0023852X|doi=10.1002/lary.23405}}</ref><ref name="pmid28040824">{{cite journal |vauthors=Sorokowska A, Drechsler E, Karwowski M, Hummel T |title=Effects of olfactory training: a meta-analysis |journal=Rhinology |volume=55 |issue=1 |pages=17–26 |date=March 2017 |pmid=28040824 |doi=10.4193/Rhin16.195 |url=}}</ref> have been shown to improve objective tests of [[Olfaction|olfactory]] recovery in a small uncontrolled studies of patients with [[COVID-19]] related [[anosmia]], although, further investigation is needed before these therapies can be widely recomended.<ref name="pmid322777512" />
* Olfactory training suggest small to moderate benefit for patients with post-viral [[Olfaction|olfactory]] [[dysfunction]].
*The main problem for the study of [[anosmia]] related to [[COVID-19]] treatment is that the majority of patients do not give importance to this [[symptom]] and recover [[spontaneously]], without [[medical attention]], so little evidence to support [[pharmacotherapy]] exists.<ref name="pmid32466862" /><ref name="pmid15563908">{{cite journal |vauthors=Seiden AM |title=Postviral olfactory loss |journal=Otolaryngol. Clin. North Am. |volume=37 |issue=6 |pages=1159–66 |date=December 2004 |pmid=15563908 |doi=10.1016/j.otc.2004.06.007 |url=}}</ref>
*[[Alpha lipoic acid]] (600 mg/day), [[omega-3]] supplementation (2000mg/day),and intranasal [[Vitamin A derivatives|vitamin A]] (10,000 U/day)have been shown to improve objective tests of [[Olfaction|olfactory]] recovery in a small uncontrolled studies of patients with [[COVID-19]] related [[anosmia]], although, further investigation is needed before these therapies can be widely recomended.
*The main problem for the study of [[anosmia]] related to [[COVID-19]] treatment is that the majority of patients do not give importance to this [[symptom]] and recover [[spontaneously]], without [[medical attention]], so little evidence to support [[pharmacotherapy]] exists.
*To view medical treatment for COVID-19, click here.
*To view medical treatment for COVID-19, click here.


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==References==
==References==
{{reflist|2}}
{{reflist|2}}
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo M.D. Fahimeh Shojaei, M.D.

Synonyms and keywords: anosmia, olfactory dysfunction, SARS-CoV-2, dysgeusia

Overview

Total or parcial loss of olfactory function (anosmia/hyposmia) has been formally recognized as a characteristic symptom of COVID-19 infection, and may be the most common sign of infection due to this virus. Anosmia may appear without any other symptoms or signs in patients with COVID-19 infection. The extent of potential olfactory dysfunction due to COVID-19 is still unclear. Female gender and advanced age are risk factors for developing anosmia related to COVID-19. Anosmia related to COVID-19, typically has a duration of 8.96 days.

To view the complete page of COVID-19, click here.

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating COVID-19-associated anosmia from other Diseases

Epidemiology and Demographics

Prevalence of anosmia in patients with COVID-19[1]
Date of publication Country Author Number of patients Prevalence
March 26, 2020 Italy Giacomelli et al.[22] 59 33.9%
March 27, 2020 Iran Bagheri et al.[23] 10,069 48.23%
April 1, 2020 Italy Vaira et al.[24] 320 19.4%
April 6, 2020 European countries Lechien et al.[25] 417 85.6%
April 7, 2020 United Kingdom Menni et al.[26] 579 59.41%
April 12, 2020 United States Yan et al.[27] 59 68%
April 16, 2020 France Klopfenstein et al.[28] 47 47%
April 17, 2020 Iran Moein et al.[2] 60 98.33%
April 22, 2020 United Kingdom Spinato et al.[29] 202 64.4%
April 22, 2020 Iran Heidari et al.[30] 23 69.57%
April 22, 2020 Spain Beltran-Corbellini et al.[31] 79 31.65%
April 24, 2020 United States Yan et al.[32] 169 75.7%
May 1, 2020 Germany Luers et al.[33] 72 74%
May 1, 2020 Italy Vaira et al.[34] 33 75.8%


Risk Factors

Screening

Natural History, Complications, and Prognosis

  • Early clinical features before developing anosmia related to COVID-19 include cough, fever, and arthralgias.
  • Anosmia related to COVID-19, typically has a duration of 8.96 days.[1][45]
  • Approximately 82% of patients with anosmia related to COVID-19 recover within 2 weeks and 98% of them within 28 days.[1][45][46]
  • The intensity and duration of the olfactory disfunction associated to COVID-19, is highly variable depending on the capacity and rate of regeneration of the neuroepitielium.[5]
  • A recent review by JAMA showed that 96% of the patients recover from anosmia within one year of its onset. At 6 months, 85% of the patients recovered from anosmia. Parosmia was not evaluated, and it can be potentially more debilitating for patients.[47]
  • To view natural history, complications, and prognosis of COVID-19, click here.

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Common Symptoms

Less Common Symptoms

  • To view the history and symptoms of COVID-19, click here.

Physical Examination

HEENT
    • Closely inspect the nasal cavity and paranasal sinuses to look for polyps or neoplasms.[20]
    • Complete a neurological examination for neurodegenerative disorders.[20]
    • Do a fundoscopy for evidence of raised intracranial pressure due to head trauma.[20]
    • Do skin prick testing for allergic rhinitis.[20]
  • To view the complete physical examination in COVID-19, click here.

Laboratory Findings

Electrocardiogram

X-ray

  • X-ray imaging to the nasal cavity and sinus (Cadwell and Waters projections) does not demonstrate any typical findings in patients with anosmia due to COVID-19, but may be used to exclude other causes
  • To view the x-ray finidings on COVID-19, click here.

Echocardiography or Ultrasound

CT scan

MRI

  • MRI imaging to the nasal cavity and sinus does not demonstrate any typical findings in patients with anosmia due to COVID-19 but may be used to exclude other causes.
  • To view the MRI findings on COVID-19, click here.

Other Imaging Findings

  • Ultrasound imaging to the nasal cavity and sinus does not demonstrate any typical findings in patients with anosmia due to COVID-19 but may be used to exclude other causes.
  • To view other imaging findings on COVID-19, click here.

Other Diagnostic Studies

  • To view other diagnostic studies for COVID-19, click here.

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention


References

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