COVID-19-associated anosmia

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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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