COVID-19-associated anosmia: Difference between revisions

Jump to navigation Jump to search
VisualWikitext
No edit summary
No edit summary
Line 12: Line 12:


The extent of potential [[olfactory]] [[dysfunction]] due to [[COVID-19]] is still unclear.<ref name="pmid32563019" />
The extent of potential [[olfactory]] [[dysfunction]] due to [[COVID-19]] is still unclear.<ref name="pmid32563019" />
[[Female]] [[Gender-based medicine|gender]] and [[Old age|advanced age]] are [[Risk factor|risk factors]] for developing [[anosmia]] related to [[COVID-19|COVID-19.]]<ref name="pmid31693018" /><ref name="pmid31152646" /><ref name="pmid32466862" />
[[Anosmia]] related to [[COVID-19]], typically has a duration of 8.96 days.<ref name="pmid32563019" /><ref name="pmid323055632" />


To view the complete page of COVID-19, [[COVID-19|click here]].
To view the complete page of COVID-19, [[COVID-19|click here]].
Line 47: Line 51:
*<nowiki/><nowiki/><nowiki/><nowiki/><nowiki/>Several theories have been given to explain the variation of [[Incidence|in]]<nowiki/>[[Incidence|cidence]] of [[Olfaction|olfactory]] [[dysfunction]] among different countries, among these reasons are the [[pathogenicity]] and [[mutation]] capability of [[COVID-19]].<ref name="YaoLu2020">{{cite journal|last1=Yao|first1=Hangping|last2=Lu|first2=Xiangyun|last3=Chen|first3=Qiong|last4=Xu|first4=Kaijin|last5=Chen|first5=Yu|last6=Cheng|first6=Linfang|last7=Liu|first7=Fumin|last8=Wu|first8=Zhigang|last9=Wu|first9=Haibo|last10=Jin|first10=Changzhong|last11=Zheng|first11=Min|last12=Wu|first12=Nanping|last13=Jiang|first13=Chao|last14=Li|first14=Lanjuan|year=2020|doi=10.1101/2020.04.14.20060160}}</ref><ref name="pmid32563019" /><ref name="urlwww.thelancet.com">{{cite web |url=https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30079-5/Abstract |title=www.thelancet.com |format= |work= |accessdate=}}</ref>
*<nowiki/><nowiki/><nowiki/><nowiki/><nowiki/>Several theories have been given to explain the variation of [[Incidence|in]]<nowiki/>[[Incidence|cidence]] of [[Olfaction|olfactory]] [[dysfunction]] among different countries, among these reasons are the [[pathogenicity]] and [[mutation]] capability of [[COVID-19]].<ref name="YaoLu2020">{{cite journal|last1=Yao|first1=Hangping|last2=Lu|first2=Xiangyun|last3=Chen|first3=Qiong|last4=Xu|first4=Kaijin|last5=Chen|first5=Yu|last6=Cheng|first6=Linfang|last7=Liu|first7=Fumin|last8=Wu|first8=Zhigang|last9=Wu|first9=Haibo|last10=Jin|first10=Changzhong|last11=Zheng|first11=Min|last12=Wu|first12=Nanping|last13=Jiang|first13=Chao|last14=Li|first14=Lanjuan|year=2020|doi=10.1101/2020.04.14.20060160}}</ref><ref name="pmid32563019" /><ref name="urlwww.thelancet.com">{{cite web |url=https://www.thelancet.com/journals/lanres/article/PIIS2213-2600(20)30079-5/Abstract |title=www.thelancet.com |format= |work= |accessdate=}}</ref>
*<nowiki/><nowiki/><nowiki/><nowiki/><nowiki/>It is thought that the [[Genotype|genotypes]] of A and C [[Strain (biology)|strains]] of [[COVID-19|SARS-Cov]]<nowiki/>[[COVID-19|-2]] have a greater [[pathogenicity]] for the nasal cavity in humans, this explains the higher [[incidence]] of [[anosmia]] in European countries, where these [[Strain (biology)|strains]] prevail.<ref name="pmid32563019" /><ref name="ForsterForster2020">{{cite journal|last1=Forster|first1=Peter|last2=Forster|first2=Lucy|last3=Renfrew|first3=Colin|last4=Forster|first4=Michael|title=Phylogenetic network analysis of SARS-CoV-2 genomes|journal=Proceedings of the National Academy of Sciences|volume=117|issue=17|year=2020|pages=9241–9243|issn=0027-8424|doi=10.1073/pnas.2004999117}}</ref>
*<nowiki/><nowiki/><nowiki/><nowiki/><nowiki/>It is thought that the [[Genotype|genotypes]] of A and C [[Strain (biology)|strains]] of [[COVID-19|SARS-Cov]]<nowiki/>[[COVID-19|-2]] have a greater [[pathogenicity]] for the nasal cavity in humans, this explains the higher [[incidence]] of [[anosmia]] in European countries, where these [[Strain (biology)|strains]] prevail.<ref name="pmid32563019" /><ref name="ForsterForster2020">{{cite journal|last1=Forster|first1=Peter|last2=Forster|first2=Lucy|last3=Renfrew|first3=Colin|last4=Forster|first4=Michael|title=Phylogenetic network analysis of SARS-CoV-2 genomes|journal=Proceedings of the National Academy of Sciences|volume=117|issue=17|year=2020|pages=9241–9243|issn=0027-8424|doi=10.1073/pnas.2004999117}}</ref>
*<nowiki/><nowiki/><nowiki/><nowiki/><nowiki/>To view the pathophysiology of COVID-19, click here.
*<nowiki/><nowiki/><nowiki/><nowiki/><nowiki/>To view the pathophysiology of COVID-19, [[COVID-19 pathophysiology|click here]].


==Causes==
==Causes==
Line 55: Line 59:


* Now in day, more than 200 types of [[viruses]] are identified to cause [[anosmia]]; [[coronavirus]] [[Strain (biology)|strains]] (7 of them) are responsable of 10-15% of the cases.<ref name="pmid32277751" /><ref name="pmid16253889">{{cite journal |vauthors=Eccles R |title=Understanding the symptoms of the common cold and influenza |journal=Lancet Infect Dis |volume=5 |issue=11 |pages=718–25 |date=November 2005 |pmid=16253889 |pmc=7185637 |doi=10.1016/S1473-3099(05)70270-X |url=}}</ref><ref name="pmid32563019" />
* Now in day, more than 200 types of [[viruses]] are identified to cause [[anosmia]]; [[coronavirus]] [[Strain (biology)|strains]] (7 of them) are responsable of 10-15% of the cases.<ref name="pmid32277751" /><ref name="pmid16253889">{{cite journal |vauthors=Eccles R |title=Understanding the symptoms of the common cold and influenza |journal=Lancet Infect Dis |volume=5 |issue=11 |pages=718–25 |date=November 2005 |pmid=16253889 |pmc=7185637 |doi=10.1016/S1473-3099(05)70270-X |url=}}</ref><ref name="pmid32563019" />
*To view causes of COVID-19, click here.
*To view causes of COVID-19, [[COVID-19 causes|click here]].


==Differentiating COVID-19-associated anosmia from other Diseases==
==Differentiating COVID-19-associated anosmia from other Diseases==


* When differentiating [[anosmia]] due to [[COVID-19]] [[infection]] from other causes, it is important to pay attention into the presentation:
* When differentiating [[anosmia]] due to [[COVID-19]] [[infection]] from other causes, it is important to pay attention into the presentation:
**Acute smell loss (other [[Upper respiratory infections|upper respiratory viral infections]], head injuries).<ref name="urlAnosmia - StatPearls - NCBI Bookshelf" />
**Acute [[smell]] loss (other [[Upper respiratory infections|upper respiratory viral infections]], head injuries).<ref name="urlAnosmia - StatPearls - NCBI Bookshelf" />
**Chronic smell loss (normal aging, rhinitis, nasal polyps, neoplasms, neurodegenerative disorders).<ref name="urlAnosmia - StatPearls - NCBI Bookshelf" />
**Chronic [[smell]] loss (normal aging, [[rhinitis]], [[Nasal polyp|nasal polyps]], [[neoplasms]], [[Neurodegenerative disease|neurodegenerative disorders]]).<ref name="urlAnosmia - StatPearls - NCBI Bookshelf" />
**Intermittent smell loss (allergic rhinitis, use of topical drugs).<ref name="urlAnosmia - StatPearls - NCBI Bookshelf" />
**Intermittent [[Smell Loss|smell loss]] ([[allergic rhinitis]], use of [[Topical application|topical]] drugs).<ref name="urlAnosmia - StatPearls - NCBI Bookshelf" />
**Congenital smell loss (Kallmann syndrome).<ref name="urlAnosmia - StatPearls - NCBI Bookshelf" />
**Congenital [[smell]] loss ([[Kallmann syndrome]]).<ref name="urlAnosmia - StatPearls - NCBI Bookshelf" />
*To view the differential diagnosis of COVID-19, click here.<br />
*To view the differential diagnosis of COVID-19, [[COVID-19 differential diagnosis|click here]].<br />


==Epidemiology and Demographics==
==Epidemiology and Demographics==


* Postviral [[anosmia]] constitutes 40% of all [[anosmia]] causes in adults.<ref name="pmid32277751">{{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>{{Cite journal|last=Zhu N, Zhang D, Wang W et al. A Novel Welge -Lussen A, Wolfensberger M.|first=|date=2006|title=Olfactory disorders following upper respiratory tract infections|url=|journal=Adv Otorhinolaryngol|volume=|pages=|via=}}</ref>
* Postviral [[anosmia]] constitutes 40% of all [[anosmia]] causes in adults.<ref name="pmid32277751">{{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>{{Cite journal|last=Zhu N, Zhang D, Wang W et al. A Novel Welge -Lussen A, Wolfensberger M.|first=|date=2006|title=Olfactory disorders following upper respiratory tract infections|url=|journal=Adv Otorhinolaryngol|volume=|pages=|via=}}</ref>
* Severe [[Olfaction|olfactory]] loss (complete [[anosmia]]) is estimated to have an estimated [[prevalence]] of around 5% in general population studies (independently of infection).<ref name="pmid32277751" /><ref name="pmid15064632">{{cite journal |vauthors=Brämerson A, Johansson L, Ek L, Nordin S, Bende M |title=Prevalence of olfactory dysfunction: the skövde population-based study |journal=Laryngoscope |volume=114 |issue=4 |pages=733–7 |date=April 2004 |pmid=15064632 |doi=10.1097/00005537-200404000-00026 |url=}}</ref>
* Severe [[Olfaction|olfactory]] loss (complete [[anosmia]]) is estimated to have an estimated [[prevalence]] of around 5% in general population studies (independently of [[infection]]).<ref name="pmid32277751" /><ref name="pmid15064632">{{cite journal |vauthors=Brämerson A, Johansson L, Ek L, Nordin S, Bende M |title=Prevalence of olfactory dysfunction: the skövde population-based study |journal=Laryngoscope |volume=114 |issue=4 |pages=733–7 |date=April 2004 |pmid=15064632 |doi=10.1097/00005537-200404000-00026 |url=}}</ref>
*Further studies are requiered to establish the incidence of [[anosmia]] in [[COVID-19]]+ patients.<ref name="pmid32277751" />
*Further studies are requiered to establish the [[incidence]] of [[anosmia]] in [[COVID-19]]+ patients.<ref name="pmid32277751" />
*The [[prevalence]] of [[anosmia]] related to [[COVID-19]] vary widely from one study to the other among several countries:<ref name="MenniValdes2020">{{cite journal|last1=Menni|first1=Cristina|last2=Valdes|first2=Ana|last3=Freydin|first3=Maxim B|last4=Ganesh|first4=Sajaysurya|last5=El-Sayed Moustafa|first5=Julia|last6=Visconti|first6=Alessia|last7=Hysi|first7=Pirro|last8=Bowyer|first8=Ruth C E|last9=Mangino|first9=Massimo|last10=Falchi|first10=Mario|last11=Wolf|first11=Jonathan|last12=Steves|first12=Claire|last13=Spector|first13=Tim|year=2020|doi=10.1101/2020.04.05.20048421}}</ref>
*The [[prevalence]] of [[anosmia]] related to [[COVID-19]] vary widely from one study to the other among several countries:<ref name="MenniValdes2020">{{cite journal|last1=Menni|first1=Cristina|last2=Valdes|first2=Ana|last3=Freydin|first3=Maxim B|last4=Ganesh|first4=Sajaysurya|last5=El-Sayed Moustafa|first5=Julia|last6=Visconti|first6=Alessia|last7=Hysi|first7=Pirro|last8=Bowyer|first8=Ruth C E|last9=Mangino|first9=Massimo|last10=Falchi|first10=Mario|last11=Wolf|first11=Jonathan|last12=Steves|first12=Claire|last13=Spector|first13=Tim|year=2020|doi=10.1101/2020.04.05.20048421}}</ref>


Line 166: Line 170:
|}
|}


* To view screening for COVID-19, click here.<br />
* To view screening for COVID-19, [[COVID-19 epidemiology and demographics|click here]].<br />


==Risk Factors==
==Risk Factors==
Line 174: Line 178:
**[[Male|Female]] gender<ref name="pmid31152646" /><ref name="pmid32466862" />
**[[Male|Female]] gender<ref name="pmid31152646" /><ref name="pmid32466862" />
**Genetic susceptibility
**Genetic susceptibility
*Susceptibility to [[COVID-19]] [[infection]] is influenced to some degree by the 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, click here.
*To view the epidemiology and demographics of COVID-19, [[COVID-19 risk factors|click here]].


==Screening==
==Screening==


*A screening strategy, duly validated for 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 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:
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 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, click here.<br />
*To view screening for COVID-19, [[COVID-19 screening|click here]].<br />


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
Line 190: Line 194:
* [[Anosmia]] related to [[COVID-19]], typically has a duration of 8.96 days.<ref name="pmid32563019" /><ref name="pmid323055632" />
* [[Anosmia]] related to [[COVID-19]], typically has a duration of 8.96 days.<ref name="pmid32563019" /><ref name="pmid323055632" />
* 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 olfactory disfunction associated to COVID-19, is highly variable depending on the capacity and rate of regeneration of the neuroeptielium.<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" />
*To view natural history, complications, and prognosis of COVID-19, click here.
*To view natural history, complications, and prognosis of COVID-19, [[COVID-19 natural history, complications and prognosis|click here]].


==Diagnosis==
==Diagnosis==
Line 198: Line 202:
* [[Olfaction|Olfactory]] [[Function (biology)|function]] [[test]] (OFT) has been the study of choice for diagnosis of [[anosmia]] and [[olfactory]] [[dysfunction]].<ref name="OttavianoCarecchio2020">{{cite journal|last1=Ottaviano|first1=G.|last2=Carecchio|first2=M.|last3=Scarpa|first3=B.|last4=Marchese-Ragona|first4=R.|title=Olfactory and rhinological evaluations in SARS-CoV-2 patients complaining of olfactory loss|journal=Rhinology journal|volume=0|issue=0|year=2020|pages=0–0|issn=03000729|doi=10.4193/Rhin20.136}}</ref><ref name="pmid32563019" /><ref name="MoeinHashemian20202" /><ref name="VairaSalzano20202">{{cite journal|last1=Vaira|first1=Luigi Angelo|last2=Salzano|first2=Giovanni|last3=Petrocelli|first3=Marzia|last4=Deiana|first4=Giovanna|last5=Salzano|first5=Francesco Antonio|last6=De Riu|first6=Giacomo|title=Validation of a self-administered olfactory and gustatory test for the remotely evaluation of COVID-19 patients in home quarantine|journal=Head & Neck|year=2020|issn=10433074|doi=10.1002/hed.26228}}</ref>
* [[Olfaction|Olfactory]] [[Function (biology)|function]] [[test]] (OFT) has been the study of choice for diagnosis of [[anosmia]] and [[olfactory]] [[dysfunction]].<ref name="OttavianoCarecchio2020">{{cite journal|last1=Ottaviano|first1=G.|last2=Carecchio|first2=M.|last3=Scarpa|first3=B.|last4=Marchese-Ragona|first4=R.|title=Olfactory and rhinological evaluations in SARS-CoV-2 patients complaining of olfactory loss|journal=Rhinology journal|volume=0|issue=0|year=2020|pages=0–0|issn=03000729|doi=10.4193/Rhin20.136}}</ref><ref name="pmid32563019" /><ref name="MoeinHashemian20202" /><ref name="VairaSalzano20202">{{cite journal|last1=Vaira|first1=Luigi Angelo|last2=Salzano|first2=Giovanni|last3=Petrocelli|first3=Marzia|last4=Deiana|first4=Giovanna|last5=Salzano|first5=Francesco Antonio|last6=De Riu|first6=Giacomo|title=Validation of a self-administered olfactory and gustatory test for the remotely evaluation of COVID-19 patients in home quarantine|journal=Head & Neck|year=2020|issn=10433074|doi=10.1002/hed.26228}}</ref>
* In many studies, full [[Olfaction|olfactory]] [[Function (biology)|function]] tests have been disregarded.<ref name="pmid32563019" />
* In many studies, full [[Olfaction|olfactory]] [[Function (biology)|function]] tests have been disregarded.<ref name="pmid32563019" />
*[[Olfaction|Olfactory]] [[Function (biology)|function]] [[test|tests]] is mainly carried out semi-quantitatively using olfactory bars or bottles kits, which are presented to the patient in order to determine the olfaction thresholds.<ref name="pmid32466862">{{cite journal |vauthors=Lop Gros J, Iglesias Coma M, González Farré M, Serra Pujadas C |title=Olfactory dysfunction in COVID-19, a review of the evidence and implications for pandemic management |journal=Acta Otorrinolaringol Esp |volume= |issue= |pages= |date=May 2020 |pmid=32466862 |doi=10.1016/j.otorri.2020.04.003 |url=}}</ref>
*[[Olfaction|Olfactory]] [[Function (biology)|function]] [[test|tests]] is mainly carried out semi-quantitatively using olfactory bars or bottles kits, which are presented to the patient in order to determine the [[olfaction]] thresholds.<ref name="pmid32466862">{{cite journal |vauthors=Lop Gros J, Iglesias Coma M, González Farré M, Serra Pujadas C |title=Olfactory dysfunction in COVID-19, a review of the evidence and implications for pandemic management |journal=Acta Otorrinolaringol Esp |volume= |issue= |pages= |date=May 2020 |pmid=32466862 |doi=10.1016/j.otorri.2020.04.003 |url=}}</ref>
*Some of the most used [[Olfaction|olfactory]] [[Function (biology)|function]] [[test|tests]] are the University of Pennsylvania Smell Identification Test-40 and the Barcelona Smell Test-24, which respectively have 40 and 24 different olfactory stimuli, and are therefore laborious and slow to administer.<ref name="pmid32466862" /><ref name="pmid17882917">{{cite journal |vauthors=Doty RL |title=Office procedures for quantitative assessment of olfactory function |journal=Am J Rhinol |volume=21 |issue=4 |pages=460–73 |date=2007 |pmid=17882917 |doi=10.2500/ajr.2007.21.3043 |url=}}</ref> For large series of patients evaluations the ''4-item Pocket Smell Test'' and the 12-item ''Brief Smell Identification Test'' are prefered.<ref name="pmid32466862" /><ref name="pmid31053960">{{cite journal |vauthors=Joseph T, Auger SD, Peress L, Rack D, Cuzick J, Giovannoni G, Lees A, Schrag AE, Noyce AJ |title=Screening performance of abbreviated versions of the UPSIT smell test |journal=J. Neurol. |volume=266 |issue=8 |pages=1897–1906 |date=August 2019 |pmid=31053960 |pmc=6647236 |doi=10.1007/s00415-019-09340-x |url=}}</ref>
*Some of the most used [[Olfaction|olfactory]] [[Function (biology)|function]] [[test|tests]] are the University of Pennsylvania Smell Identification Test-40 and the Barcelona Smell Test-24, which respectively have 40 and 24 different [[Olfaction|olfactory]] [[stimuli]], and are therefore laborious and slow to administer.<ref name="pmid32466862" /><ref name="pmid17882917">{{cite journal |vauthors=Doty RL |title=Office procedures for quantitative assessment of olfactory function |journal=Am J Rhinol |volume=21 |issue=4 |pages=460–73 |date=2007 |pmid=17882917 |doi=10.2500/ajr.2007.21.3043 |url=}}</ref> For large series of patients evaluations the ''4-item Pocket Smell Test'' and the 12-item ''Brief Smell Identification Test'' are prefered.<ref name="pmid32466862" /><ref name="pmid31053960">{{cite journal |vauthors=Joseph T, Auger SD, Peress L, Rack D, Cuzick J, Giovannoni G, Lees A, Schrag AE, Noyce AJ |title=Screening performance of abbreviated versions of the UPSIT smell test |journal=J. Neurol. |volume=266 |issue=8 |pages=1897–1906 |date=August 2019 |pmid=31053960 |pmc=6647236 |doi=10.1007/s00415-019-09340-x |url=}}</ref>
*To view the study of choice for diagnosis of COVID-19, click here.<br />
*To view the study of choice for diagnosis of COVID-19, [[COVID-19 diagnostic study of choice|click here]].<br />


===History and Symptoms===
===History and Symptoms===
Line 210: Line 214:
*[[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" />
*To view the history and symptoms of COVID-19, click here.
*To view the history and symptoms of COVID-19, [[COVID-19 history and symptoms|click here]].


===Physical Examination===
===Physical Examination===


* Physical examination using kits of different olfactory stimuli may disclose conductive, sensorineural, or mixed 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" />
* There is no typical physical finding for anosmia related to COVID-19.
* There is no typical physical finding for [[anosmia]] related to [[COVID-19]].
* To rule out other conditions physicians may:
* To rule out other conditions physicians may:


Line 222: Line 226:
** Do a fundoscopy for evidence of raised intracranial pressure due to head trauma.<ref name="urlAnosmia - StatPearls - NCBI Bookshelf" />
** Do a fundoscopy for evidence of raised intracranial pressure due to head trauma.<ref name="urlAnosmia - StatPearls - NCBI Bookshelf" />
** Do skin prick testing for allergic rhinitis.<ref name="urlAnosmia - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK482152/ |title=Anosmia - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
** Do skin prick testing for allergic rhinitis.<ref name="urlAnosmia - StatPearls - NCBI Bookshelf">{{cite web |url=https://www.ncbi.nlm.nih.gov/books/NBK482152/ |title=Anosmia - StatPearls - NCBI Bookshelf |format= |work= |accessdate=}}</ref>
* To view the complete physical examination in COVID-19, click here.
* To view the complete physical examination in COVID-19, [[COVID-19 physical examination|click here]].


===Laboratory Findings===
===Laboratory Findings===


* [[Laboratory diagnosis of virus|Laboratory testing]] and self-isolation should be made in patients who present with [[anosmia]], even if this is found as an isolated [[symptom]].<ref name="pmid32563019" />
* [[Laboratory diagnosis of virus|Laboratory testing]] and self-isolation should be made in patients who present with [[anosmia]], even if this is found as an isolated [[symptom]].<ref name="pmid32563019" />
* To view the laboratory findings on COVID-19, click here.
* To view the laboratory findings on COVID-19, [[COVID-19 laboratory findings|click here]].


===Electrocardiogram===
===Electrocardiogram===


* There are no typical electrocardiographic findings for anosmia related to COVID-19.
* There are no typical [[electrocardiographic]] findings for [[anosmia]] related to [[COVID-19]].
* To view the electrocardiogram findings on COVID-19, click here.<br />
* To view the electrocardiogram findings on COVID-19, [[COVID-19 electrocardiogram|click here]].<br />


===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 finidings 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.<br />
* To view the x-ray finidings on COVID-19, [[COVID-19 x ray|click here]].<br />


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===


* There are no typical echocardiographic findings for anosmia related to COVID-19.
* There are no typical [[Echocardiography|echocardiographic]] findings for [[anosmia]] related to [[COVID-19]].
* To view the echocardiographic findings on COVID-19, click here.<br />
* To view the echocardiographic findings on COVID-19, [[COVID-19 echocardiography and ultrasound|click here]].<br />


===CT scan===
===CT scan===


* [[Computed tomography|CT scan]] imaging to the [[nasal cavity]] and [[sinus]] may be used to exclude other causes, for example, a case report that revealed [[Inflammation|inflammatory]] blockage of the olfactory cleft in one patient.<ref name="pmid32563019" />
* [[Computed tomography|CT scan]] imaging to the [[nasal cavity]] and [[sinus]] may be used to exclude other causes, for example, a case report that revealed [[Inflammation|inflammatory]] blockage of the olfactory cleft in one patient.<ref name="pmid32563019" />
*To view the CT scan findings on COVID-19, click here.
*To view the CT scan findings on COVID-19, [[COVID-19 CT scan|click here]].


===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 finidings 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.<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 finidings 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.<br />
* To view other imaging findings on COVID-19, [[COVID-19 other imaging findings|click here]].<br />


===Other Diagnostic Studies===
===Other Diagnostic Studies===


* To view other diagnostic studies for COVID-19, click here.<br />
* To view other diagnostic studies for COVID-19, [[COVID-19 other diagnostic studies|click here]].<br />


==Treatment==
==Treatment==
Line 269: Line 273:
* 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>
* 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>
* [[Alpha lipoic acid]],<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> [[omega-3]] supplementation,<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> and intranasal [[Vitamin A derivatives|vitamin A]]<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" />
* [[Alpha lipoic acid]],<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> [[omega-3]] supplementation,<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> and intranasal [[Vitamin A derivatives|vitamin A]]<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" />
*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>
*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>
*To view medical treatment for COVID-19, click here.
*To view medical treatment for COVID-19, click here.


===Surgery===
===Surgery===


* There are no surgical procedures for [[anosmia]] related to [[COVID-19]].<br />
* There are no [[surgical procedures]] for [[anosmia]] related to [[COVID-19]].<br />


===Primary Prevention===
===Primary Prevention===


* Telemedicine in [[otorhinolaryngology]] may be a good strategy for reducing [[cross-infection]] [[COVID-19]] in physicians.<ref name="pmid32563019" /><ref name="MengDai2020">{{cite journal|last1=Meng|first1=Xiangming|last2=Dai|first2=Zhiyong|last3=Hang|first3=Chao|last4=Wang|first4=Yangyang|title=Smartphone-enabled wireless otoscope-assisted online telemedicine during the COVID-19 outbreak|journal=American Journal of Otolaryngology|volume=41|issue=3|year=2020|pages=102476|issn=01960709|doi=10.1016/j.amjoto.2020.102476}}</ref> <br />
*[[Telemedicine]] in [[otorhinolaryngology]] may be a good strategy for reducing [[cross-infection]] [[COVID-19]] in [[physicians]].<ref name="pmid32563019" /><ref name="MengDai2020">{{cite journal|last1=Meng|first1=Xiangming|last2=Dai|first2=Zhiyong|last3=Hang|first3=Chao|last4=Wang|first4=Yangyang|title=Smartphone-enabled wireless otoscope-assisted online telemedicine during the COVID-19 outbreak|journal=American Journal of Otolaryngology|volume=41|issue=3|year=2020|pages=102476|issn=01960709|doi=10.1016/j.amjoto.2020.102476}}</ref> <br />


===Secondary Prevention===
===Secondary Prevention===

Revision as of 04:23, 6 July 2020

WikiDoc Resources for COVID-19-associated anosmia

Articles

Most recent articles on COVID-19-associated anosmia

Most cited articles on COVID-19-associated anosmia

Review articles on COVID-19-associated anosmia

Articles on COVID-19-associated anosmia in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on COVID-19-associated anosmia

Images of COVID-19-associated anosmia

Photos of COVID-19-associated anosmia

Podcasts & MP3s on COVID-19-associated anosmia

Videos on COVID-19-associated anosmia

Evidence Based Medicine

Cochrane Collaboration on COVID-19-associated anosmia

Bandolier on COVID-19-associated anosmia

TRIP on COVID-19-associated anosmia

Clinical Trials

Ongoing Trials on COVID-19-associated anosmia at Clinical Trials.gov

Trial results on COVID-19-associated anosmia

Clinical Trials on COVID-19-associated anosmia at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on COVID-19-associated anosmia

NICE Guidance on COVID-19-associated anosmia

NHS PRODIGY Guidance

FDA on COVID-19-associated anosmia

CDC on COVID-19-associated anosmia

Books

Books on COVID-19-associated anosmia

News

COVID-19-associated anosmia in the news

Be alerted to news on COVID-19-associated anosmia

News trends on COVID-19-associated anosmia

Commentary

Blogs on COVID-19-associated anosmia

Definitions

Definitions of COVID-19-associated anosmia

Patient Resources / Community

Patient resources on COVID-19-associated anosmia

Discussion groups on COVID-19-associated anosmia

Patient Handouts on COVID-19-associated anosmia

Directions to Hospitals Treating COVID-19-associated anosmia

Risk calculators and risk factors for COVID-19-associated anosmia

Healthcare Provider Resources

Symptoms of COVID-19-associated anosmia

Causes & Risk Factors for COVID-19-associated anosmia

Diagnostic studies for COVID-19-associated anosmia

Treatment of COVID-19-associated anosmia

Continuing Medical Education (CME)

CME Programs on COVID-19-associated anosmia

International

COVID-19-associated anosmia en Espanol

COVID-19-associated anosmia en Francais

Business

COVID-19-associated anosmia in the Marketplace

Patents on COVID-19-associated anosmia

Experimental / Informatics

List of terms related to COVID-19-associated anosmia

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Moises Romo 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.[1]

Anosmia may appear without any other symptoms or signs in patients with COVID-19 infection.[2]

The extent of potential olfactory dysfunction due to COVID-19 is still unclear.[3]

Female gender and advanced age are risk factors for developing anosmia related to COVID-19.[4][5][6]

Anosmia related to COVID-19, typically has a duration of 8.96 days.[3][7]

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[3]
Date of publication Country Author Number of patients Prevalence
March 26, 2020 Italy Giacomelli et al.[28] 59 33.9%
March 27, 2020 Iran Bagheri et al.[29] 10,069 48.23%
April 1, 2020 Italy Vaira et al.[30] 320 19.4%
April 6, 2020 European countries Lechien et al.[31] 417 85.6%
April 7, 2020 United Kingdom Menni et al.[32] 579 59.41%
April 12, 2020 United States Yan et al.[33] 59 68%
April 16, 2020 France Klopfenstein et al.[34] 47 47%
April 17, 2020 Iran Moein et al.[8] 60 98.33%
April 22, 2020 United Kingdom Spinato et al.[35] 202 64.4%
April 22, 2020 Iran Heidari et al.[36] 23 69.57%
April 22, 2020 Spain Beltran-Corbellini et al.[37] 79 31.65%
April 24, 2020 United States Yan et al.[38] 169 75.7%
May 1, 2020 Germany Luers et al.[39] 72 74%
May 1, 2020 Italy Vaira et al.[40] 33 75.8%

Risk Factors

Screening

Natural History, Complications, and Prognosis

  • Anosmia related to COVID-19, typically has a duration of 8.96 days.[3][7]
  • Approximately 82% of patients with anosmia related to COVID-19 recover within 2 weeks and 98% of them within 28 days.[3][7][47]
  • 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.[6]
  • To view natural history, complications, and prognosis of COVID-19, click here.

Diagnosis

Diagnostic Study of Choice

History and Symptoms

Physical Examination

    • Closely inspect the nasal cavity and paranasal sinuses to look for polyps or neoplasms.[24]
    • Complete a neurological examination for neurodegenerative disorders.[24]
    • Do a fundoscopy for evidence of raised intracranial pressure due to head trauma.[24]
    • Do skin prick testing for allergic rhinitis.[24]
  • 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 finidings 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 finidings 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 finidings 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

  1. ↑ 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 1.9 Hopkins C, Surda P, Kumar N (June 2020). "Presentation of new onset anosmia during the COVID-19 pandemic". Rhinology. 58 (3): 295–298. doi:10.4193/Rhin20.116. PMID 32277751 Check |pmid= value (help).
  2. ↑ 2.0 2.1 2.2 2.3 Hopkins C, Surda P, Kumar N (June 2020). "Presentation of new onset anosmia during the COVID-19 pandemic". Rhinology. 58 (3): 295–298. doi:10.4193/Rhin20.116. PMID 32277751 Check |pmid= value (help).
  3. ↑ 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 3.12 3.13 3.14 3.15 3.16 3.17 3.18 3.19 3.20 3.21 3.22 3.23 Meng X, Deng Y, Dai Z, Meng Z (June 2020). "COVID-19 and anosmia: A review based on up-to-date knowledge". Am J Otolaryngol. 41 (5): 102581. doi:10.1016/j.amjoto.2020.102581. PMC 7265845 Check |pmc= value (help). PMID 32563019 Check |pmid= value (help).
  4. ↑ 4.0 4.1 4.2 Stogbauer J, Wirkner K, Engel C, Moebus S, Pundt N, Teismann H, Loffler M, Hummel T, Beule AG, Berger K (April 2020). "Prevalence and risk factors of smell dysfunction - a comparison between five German population-based studies". Rhinology. 58 (2): 184–191. doi:10.4193/Rhin19.181. PMID 31693018.
  5. ↑ 5.0 5.1 5.2 Wang X, Zhang C, Xia X, Yang Y, Zhou C (October 2019). "Effect of gender on odor identification at different life stages: a meta-analysis". Rhinology. 57 (5): 322–330. doi:10.4193/Rhin19.005. PMID 31152646.
  6. ↑ 6.00 6.01 6.02 6.03 6.04 6.05 6.06 6.07 6.08 6.09 6.10 6.11 6.12 6.13 Lop Gros J, Iglesias Coma M, González Farré M, Serra Pujadas C (May 2020). "Olfactory dysfunction in COVID-19, a review of the evidence and implications for pandemic management". Acta Otorrinolaringol Esp. doi:10.1016/j.otorri.2020.04.003. PMID 32466862 Check |pmid= value (help).
  7. ↑ 7.0 7.1 7.2 7.3 Klopfenstein T, Kadiane-Oussou NJ, Toko L, Royer PY, Lepiller Q, Gendrin V, Zayet S (April 2020). "Features of anosmia in COVID-19". Med Mal Infect. doi:10.1016/j.medmal.2020.04.006. PMC 7162775 Check |pmc= value (help). PMID 32305563 Check |pmid= value (help).
  8. ↑ 8.0 8.1 8.2 Moein, Shima T.; Hashemian, Seyed MohammadReza; Mansourafshar, Babak; Khorram‐Tousi, Ali; Tabarsi, Payam; Doty, Richard L. (2020). "Smell dysfunction: a biomarker for COVID‐19". International Forum of Allergy & Rhinology. doi:10.1002/alr.22587. ISSN 2042-6976.
  9. ↑ "[2004.09338] Augmented Curation of Unstructured Clinical Notes from a Massive EHR System Reveals Specific Phenotypic Signature of Impending COVID-19 Diagnosis".
  10. ↑ Beltrán‐Corbellini, Á.; Chico‐García, J. L.; Martínez‐Poles, J.; Rodríguez‐Jorge, F.; Natera‐Villalba, E.; Gómez‐Corral, J.; Gómez‐López, A.; Monreal, E.; Parra‐Díaz, P.; Cortés‐Cuevas, J. L.; Galán, J. C.; Fragola‐Arnau, C.; Porta‐Etessam, J.; Masjuan, J.; Alonso‐Cánovas, A. (2020). "Acute‐onset smell and taste disorders in the context of COVID‐19: a pilot multicentre polymerase chain reaction based case–control study". European Journal of Neurology. doi:10.1111/ene.14273. ISSN 1351-5101.
  11. ↑ Hummel T, Whitcroft KL, Andrews P, Altundag A, Cinghi C, Costanzo RM, Damm M, Frasnelli J, Gudziol H, Gupta N, Haehne A, Holbrook E, Hong SC, Hornung D, Hüttenbrink KB, Kamel R, Kobayashi M, Konstantinidis I, Landis BN, Leopold DA, Macchi A, Miwa T, Moesges R, Mullol J, Mueller CA, Ottaviano G, Passali GC, Philpott C, Pinto JM, Ramakrishnan VJ, Rombaux P, Roth Y, Schlosser RA, Shu B, Soler G, Stjärne P, Stuck BA, Vodicka J, Welge-Luessen A (March 2017). "Position paper on olfactory dysfunction". Rhinol. Suppl. 54 (26): 1–30. doi:10.4193/Rhino16.248. PMID 29528615.
  12. ↑ Baig AM, Khaleeq A, Ali U, Syeda H (April 2020). "Evidence of the COVID-19 Virus Targeting the CNS: Tissue Distribution, Host-Virus Interaction, and Proposed Neurotropic Mechanisms". ACS Chem Neurosci. 11 (7): 995–998. doi:10.1021/acschemneuro.0c00122. PMC 7094171 Check |pmc= value (help). PMID 32167747 Check |pmid= value (help).
  13. ↑ Rockx B, Kuiken T, Herfst S, Bestebroer T, Lamers MM, Oude Munnink BB, de Meulder D, van Amerongen G, van den Brand J, Okba N, Schipper D, van Run P, Leijten L, Sikkema R, Verschoor E, Verstrepen B, Bogers W, Langermans J, Drosten C, Fentener van Vlissingen M, Fouchier R, de Swart R, Koopmans M, Haagmans BL (May 2020). "Comparative pathogenesis of COVID-19, MERS, and SARS in a nonhuman primate model". Science. 368 (6494): 1012–1015. doi:10.1126/science.abb7314. PMC 7164679 Check |pmc= value (help). PMID 32303590 Check |pmid= value (help). Vancouver style error: initials (help)
  14. ↑ Zou L, Ruan F, Huang M, Liang L, Huang H, Hong Z, Yu J, Kang M, Song Y, Xia J, Guo Q, Song T, He J, Yen HL, Peiris M, Wu J (March 2020). "SARS-CoV-2 Viral Load in Upper Respiratory Specimens of Infected Patients". N. Engl. J. Med. 382 (12): 1177–1179. doi:10.1056/NEJMc2001737. PMC 7121626 Check |pmc= value (help). PMID 32074444 Check |pmid= value (help).
  15. ↑ 15.0 15.1 15.2 Dubé M, Le Coupanec A, Wong A, Rini JM, Desforges M, Talbot PJ (September 2018). "Axonal Transport Enables Neuron-to-Neuron Propagation of Human Coronavirus OC43". J. Virol. 92 (17). doi:10.1128/JVI.00404-18. PMC 6096804. PMID 29925652. Vancouver style error: initials (help)
  16. ↑ Koyuncu OO, Hogue IB, Enquist LW (April 2013). "Virus infections in the nervous system". Cell Host Microbe. 13 (4): 379–93. doi:10.1016/j.chom.2013.03.010. PMC 3647473. PMID 23601101.
  17. ↑ Sungnak W, Huang N, Bécavin C, Berg M, Queen R, Litvinukova M, Talavera-López C, Maatz H, Reichart D, Sampaziotis F, Worlock KB, Yoshida M, Barnes JL (May 2020). "SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes". Nat. Med. 26 (5): 681–687. doi:10.1038/s41591-020-0868-6. PMID 32327758 Check |pmid= value (help).
  18. ↑ Capelli, Marco; Gatti, Patrizia (2020). "Anosmia and COVID-19 in south Lombardy: description of the first cases series in Europe". B-ENT. 16 (1): 86–90. doi:10.5152/B-ENT.2020.20129. ISSN 2684-4907.
  19. ↑ Yao, Hangping; Lu, Xiangyun; Chen, Qiong; Xu, Kaijin; Chen, Yu; Cheng, Linfang; Liu, Fumin; Wu, Zhigang; Wu, Haibo; Jin, Changzhong; Zheng, Min; Wu, Nanping; Jiang, Chao; Li, Lanjuan (2020). doi:10.1101/2020.04.14.20060160. Missing or empty |title= (help)
  20. ↑ "www.thelancet.com".
  21. ↑ Forster, Peter; Forster, Lucy; Renfrew, Colin; Forster, Michael (2020). "Phylogenetic network analysis of SARS-CoV-2 genomes". Proceedings of the National Academy of Sciences. 117 (17): 9241–9243. doi:10.1073/pnas.2004999117. ISSN 0027-8424.
  22. ↑ Suzuki M, Saito K, Min WP, Vladau C, Toida K, Itoh H, Murakami S (February 2007). "Identification of viruses in patients with postviral olfactory dysfunction". Laryngoscope. 117 (2): 272–7. doi:10.1097/01.mlg.0000249922.37381.1e. PMC 7165544 Check |pmc= value (help). PMID 17277621.
  23. ↑ Eccles R (November 2005). "Understanding the symptoms of the common cold and influenza". Lancet Infect Dis. 5 (11): 718–25. doi:10.1016/S1473-3099(05)70270-X. PMC 7185637 Check |pmc= value (help). PMID 16253889.
  24. ↑ 24.0 24.1 24.2 24.3 24.4 24.5 24.6 24.7 "Anosmia - StatPearls - NCBI Bookshelf".
  25. ↑ Zhu N, Zhang D, Wang W et al. A Novel Welge -Lussen A, Wolfensberger M. (2006). "Olfactory disorders following upper respiratory tract infections". Adv Otorhinolaryngol.
  26. ↑ Brämerson A, Johansson L, Ek L, Nordin S, Bende M (April 2004). "Prevalence of olfactory dysfunction: the skövde population-based study". Laryngoscope. 114 (4): 733–7. doi:10.1097/00005537-200404000-00026. PMID 15064632.
  27. ↑ Menni, Cristina; Valdes, Ana; Freydin, Maxim B; Ganesh, Sajaysurya; El-Sayed Moustafa, Julia; Visconti, Alessia; Hysi, Pirro; Bowyer, Ruth C E; Mangino, Massimo; Falchi, Mario; Wolf, Jonathan; Steves, Claire; Spector, Tim (2020). doi:10.1101/2020.04.05.20048421. Missing or empty |title= (help)
  28. ↑ Giacomelli A, Pezzati L, Conti F, Bernacchia D, Siano M, Oreni L, Rusconi S, Gervasoni C, Ridolfo AL, Rizzardini G, Antinori S, Galli M (March 2020). "Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study". Clin. Infect. Dis. doi:10.1093/cid/ciaa330. PMC 7184514 Check |pmc= value (help). PMID 32215618 Check |pmid= value (help).
  29. ↑ Bagheri, Seyed Hamid Reza; Asghari, Ali Mohammad; Farhadi, Mohammad; Shamshiri, Ahmad Reza; Kabir, Ali; Kamrava, Seyed Kamran; Jalessi, Maryam; Mohebbi, Alireza; Alizadeh, Rafieh; Honarmand, Ali Asghar; Ghalehbaghi, Babak; Salimi, Alireza (2020). doi:10.1101/2020.03.23.20041889. Missing or empty |title= (help)
  30. ↑ Vaira LA, Salzano G, Deiana G, De Riu G (July 2020). "Anosmia and Ageusia: Common Findings in COVID-19 Patients". Laryngoscope. 130 (7): 1787. doi:10.1002/lary.28692. PMC 7228304 Check |pmc= value (help). PMID 32237238 Check |pmid= value (help).
  31. ↑ Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, Dequanter D, Blecic S, El Afia F, Distinguin L, Chekkoury-Idrissi Y, Hans S, Delgado IL, Calvo-Henriquez C, Lavigne P, Falanga C, Barillari MR, Cammaroto G, Khalife M, Leich P, Souchay C, Rossi C, Journe F, Hsieh J, Edjlali M, Carlier R, Ris L, Lovato A, De Filippis C, Coppee F, Fakhry N, Ayad T, Saussez S (April 2020). "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. doi:10.1007/s00405-020-05965-1. PMC 7134551 Check |pmc= value (help). PMID 32253535 Check |pmid= value (help).
  32. ↑ Menni, Cristina; Valdes, Ana; Freydin, Maxim B; Ganesh, Sajaysurya; El-Sayed Moustafa, Julia; Visconti, Alessia; Hysi, Pirro; Bowyer, Ruth C E; Mangino, Massimo; Falchi, Mario; Wolf, Jonathan; Steves, Claire; Spector, Tim (2020). doi:10.1101/2020.04.05.20048421. Missing or empty |title= (help)
  33. ↑ Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS (April 2020). "Association of chemosensory dysfunction and COVID-19 in patients presenting with influenza-like symptoms". Int Forum Allergy Rhinol. doi:10.1002/alr.22579. PMC 7262089 Check |pmc= value (help). PMID 32279441 Check |pmid= value (help).
  34. ↑ Klopfenstein, T.; Kadiane-Oussou, N.J.; Toko, L.; Royer, P.-Y.; Lepiller, Q.; Gendrin, V.; Zayet, S. (2020). "Features of anosmia in COVID-19". Médecine et Maladies Infectieuses. doi:10.1016/j.medmal.2020.04.006. ISSN 0399-077X.
  35. ↑ Spinato, Giacomo; Fabbris, Cristoforo; Polesel, Jerry; Cazzador, Diego; Borsetto, Daniele; Hopkins, Claire; Boscolo-Rizzo, Paolo (2020). "Alterations in Smell or Taste in Mildly Symptomatic Outpatients With SARS-CoV-2 Infection". JAMA. 323 (20): 2089. doi:10.1001/jama.2020.6771. ISSN 0098-7484.
  36. ↑ Heidari, F.; Karimi, E.; Firouzifar, M.; Khamushian, P.; Ansari, R.; Mohammadi Ardehali, M.; Heidari, F. (2020). "Anosmia as a Prominent Symptom of COVID-19 Infection". Rhinology journal. 58 (3): 302–303. doi:10.4193/Rhin20.140. ISSN 0300-0729.
  37. ↑ Beltrán‐Corbellini, Á.; Chico‐García, J. L.; Martínez‐Poles, J.; Rodríguez‐Jorge, F.; Natera‐Villalba, E.; Gómez‐Corral, J.; Gómez‐López, A.; Monreal, E.; Parra‐Díaz, P.; Cortés‐Cuevas, J. L.; Galán, J. C.; Fragola‐Arnau, C.; Porta‐Etessam, J.; Masjuan, J.; Alonso‐Cánovas, A. (2020). "Acute‐onset smell and taste disorders in the context of COVID‐19: a pilot multicentre polymerase chain reaction based case–control study". European Journal of Neurology. doi:10.1111/ene.14273. ISSN 1351-5101.
  38. ↑ Yan, Carol H.; Faraji, Farhoud; Prajapati, Divya P.; Ostrander, Benjamin T.; DeConde, Adam S. (2020). "Self‐reported olfactory loss associates with outpatient clinical course in COVID‐19". International Forum of Allergy & Rhinology. doi:10.1002/alr.22592. ISSN 2042-6976.
  39. ↑ Heindl, Ludwig M; Lehmann, Clara; Klein, Florian; Dewald, Felix; Augustin, Max; Wawer Matos, Philomena A; Loreck, Niklas; Rokohl, Alexander C; Luers, Jan C (2020). "Olfactory and Gustatory Dysfunction in Coronavirus Disease 19 (COVID-19)". Clinical Infectious Diseases. doi:10.1093/cid/ciaa525. ISSN 1058-4838.
  40. ↑ Vaira, Luigi Angelo; Salzano, Giovanni; Petrocelli, Marzia; Deiana, Giovanna; Salzano, Francesco Antonio; De Riu, Giacomo (2020). "Validation of a self-administered olfactory and gustatory test for the remotely evaluation of COVID-19 patients in home quarantine". Head & Neck. doi:10.1002/hed.26228. ISSN 1043-3074.
  41. ↑ Williams, Frances MK; Freydin, Maxim; Mangino, Massimo; Couvreur, Simon; Visconti, Alessia; Bowyer, Ruth CE; Le Roy, Caroline I; Falchi, Mario; Sudre, Carole; Davies, Richard; Hammond, Christopher; Menni, Cristina; Steves, Claire; Spector, Tim (2020). doi:10.1101/2020.04.22.20072124. Missing or empty |title= (help)
  42. ↑ Nguyen DT, Rumeau C, Gallet P, Jankowski R (April 2016). "Olfactory exploration: State of the art". Eur Ann Otorhinolaryngol Head Neck Dis. 133 (2): 113–8. doi:10.1016/j.anorl.2015.08.038. PMID 26384780.
  43. ↑ Simopoulos E, Katotomichelakis M, Gouveris H, Tripsianis G, Livaditis M, Danielides V (July 2012). "Olfaction-associated quality of life in chronic rhinosinusitis: adaptation and validation of an olfaction-specific questionnaire". Laryngoscope. 122 (7): 1450–4. doi:10.1002/lary.23349. PMID 22566102.
  44. ↑ 44.0 44.1 Robert Pellegrin, Keiland W. Cooper, Antonella Di Pizio, Paule V. Joseph, Surabhi Bhutani, Valentina Parma (2020). "Corona Viruses and the Chemical Senses: Past, Present, and Future". Oxford University. line feed character in |title= at position 40 (help)
  45. ↑ "www.entuk.org" (PDF).
  46. ↑ 46.0 46.1 "AAO-HNSF 2020 Annual Meeting & OTO Experience | American Academy of Otolaryngology-Head and Neck Surgery".
  47. ↑ Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS (April 2020). "Association of chemosensory dysfunction and COVID-19 in patients presenting with influenza-like symptoms". Int Forum Allergy Rhinol. doi:10.1002/alr.22579. PMC 7262089 Check |pmc= value (help). PMID 32279441 Check |pmid= value (help).
  48. ↑ Ottaviano, G.; Carecchio, M.; Scarpa, B.; Marchese-Ragona, R. (2020). "Olfactory and rhinological evaluations in SARS-CoV-2 patients complaining of olfactory loss". Rhinology journal. 0 (0): 0–0. doi:10.4193/Rhin20.136. ISSN 0300-0729.
  49. ↑ Vaira, Luigi Angelo; Salzano, Giovanni; Petrocelli, Marzia; Deiana, Giovanna; Salzano, Francesco Antonio; De Riu, Giacomo (2020). "Validation of a self-administered olfactory and gustatory test for the remotely evaluation of COVID-19 patients in home quarantine". Head & Neck. doi:10.1002/hed.26228. ISSN 1043-3074.
  50. ↑ Doty RL (2007). "Office procedures for quantitative assessment of olfactory function". Am J Rhinol. 21 (4): 460–73. doi:10.2500/ajr.2007.21.3043. PMID 17882917.
  51. ↑ Joseph T, Auger SD, Peress L, Rack D, Cuzick J, Giovannoni G, Lees A, Schrag AE, Noyce AJ (August 2019). "Screening performance of abbreviated versions of the UPSIT smell test". J. Neurol. 266 (8): 1897–1906. doi:10.1007/s00415-019-09340-x. PMC 6647236 Check |pmc= value (help). PMID 31053960.
  52. ↑ "Neue Corona-Symptome entdeckt: Virologe Hendrik Streeck zum Virus".
  53. ↑ Heidari F, Karimi E, Firouzifar M, Khamushian P, Ansari R, Mohammadi Ardehali M, Heidari F (June 2020). "Anosmia as a prominent symptom of COVID-19 infection". Rhinology. 58 (3): 302–303. doi:10.4193/Rhin20.140. PMID 32319971 Check |pmid= value (help).
  54. ↑ Hummel T, Heilmann S, Hüttenbriuk KB (November 2002). "Lipoic acid in the treatment of smell dysfunction following viral infection of the upper respiratory tract". Laryngoscope. 112 (11): 2076–80. doi:10.1097/00005537-200211000-00031. PMID 12439184.
  55. ↑ 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 (January 2020). "Effect of Omega-3 Supplementation in Patients With Smell Dysfunction Following Endoscopic Sellar and Parasellar Tumor Resection: A Multicenter Prospective Randomized Controlled Trial". Neurosurgery. doi:10.1093/neuros/nyz559. PMID 31950156.
  56. ↑ Sorokowska A, Drechsler E, Karwowski M, Hummel T (March 2017). "Effects of olfactory training: a meta-analysis". Rhinology. 55 (1): 17–26. doi:10.4193/Rhin16.195. PMID 28040824.
  57. ↑ Seiden AM (December 2004). "Postviral olfactory loss". Otolaryngol. Clin. North Am. 37 (6): 1159–66. doi:10.1016/j.otc.2004.06.007. PMID 15563908.
  58. ↑ Meng, Xiangming; Dai, Zhiyong; Hang, Chao; Wang, Yangyang (2020). "Smartphone-enabled wireless otoscope-assisted online telemedicine during the COVID-19 outbreak". American Journal of Otolaryngology. 41 (3): 102476. doi:10.1016/j.amjoto.2020.102476. ISSN 0196-0709.
  59. ↑ Vaira, Luigi Angelo; Salzano, Giovanni; Petrocelli, Marzia; Deiana, Giovanna; Salzano, Francesco Antonio; De Riu, Giacomo (2020). "Validation of a self-administered olfactory and gustatory test for the remotely evaluation of COVID-19 patients in home quarantine". Head & Neck. doi:10.1002/hed.26228. ISSN 1043-3074.


Template:WikiDoc Sources

Retrieved from "https://www.wikidoc.org/index.php?title=COVID-19-associated_anosmia&oldid=1621641"