[Skip to Content]
[Skip to Content Landing]

Prevalence of Taste and Smell Dysfunction in Coronavirus Disease 2019

Educational Objective
To understand the prevalence of taste and smell dysfunction in patients with COVID-19
1 Credit CME
Key Points

Question  Are there relevant sinonasal manifestations associated with the onset of coronavirus disease 2019?

Findings  This survey study of 204 patients with coronavirus disease 2019 found that taste reduction was present in 55.4% of patients, whereas smell reduction was present in 41.7% of patients. Severe nasal obstruction was uncommon at the onset of the disease (7.8%).

Meaning  The findings suggest that coronavirus disease 2019 should be suspected when severe reduction of taste and smell are present in the absence of nasal obstruction.


Importance  Early diagnosis of coronavirus disease 2019 (COVID-19) may help control the diffusion of the disease into the population.

Objective  To investigate the presence of sinonasal manifestations at the onset of COVID-19 to achieve an earlier diagnosis.

Design, Setting, and Participants  This retrospective telephone survey study investigated patients diagnosed with COVID-19 from March 5 to March 23, 2020, who were hospitalized or discharged from a single referral center. Patients who were unable to answer (intubated, receiving noninvasive ventilation, or deceased) or unreachable by telephone were excluded. Of 359 consecutive patients, 204 fulfilled the inclusion criteria; 76 were unable to answer, 76 were unreachable by telephone, and 3 refused.

Exposures  Sinonasal manifestations reported before COVID-19 diagnosis were studied with a validated questionnaire: Italian Sino-Nasal Outcome Test 22 (I-SNOT-22). If reduction of taste and/or smell was documented by item 5 of the I-SNOT-22, further inquiries were made to score them separately on a scale from 0 to 5, with 0 indicating no problem and 5 indicating problem as bad as it can be.

Main Outcomes and Measures  The prevalence of sinonasal manifestations preceding COVID-19 diagnosis.

Results  Among the 204 patients enrolled (110 [53.9%] male; mean [SD] age, 52.6 [14.4] years), the median I-SNOT-22 total score was 21 (range, 0-73). I-SNOT-22 identified 116 patients (56.9%) with reduction of taste and/or smell, 113 (55.4%) with taste reduction (median score, 5; range, 2-5), and 85 (41.7%) with smell reduction (median score, 5; range, 1-5). Eighty-two patients (40.2%) reported both. Severe reduction of taste was present in 81 patients (39.7%), and severe reduction of smell was present in 72 patients (35.3%). Only 12 patients (14.8%) with severe taste reduction and 12 patients (16.7%) with severe smell reduction reported severe nasal obstruction. Severe reduction of taste and smell was more prevalent in female vs male patients (odds ratios, 3.16 [95% CI, 1.76-5.67] vs 2.58 [95% CI, 1.43-4.65]) and middle-aged vs younger patients (effect sizes, 0.50 [95% CI, 0.21-0.78] vs 0.85 [95% CI, 0.55-1.15]). No significant association was observed between smoking habits and severe reduction of taste (odds ratio, 0.95; 95% CI, 0.53-1.71) and/or smell (odds ratio, 0.65; 95% CI, 0.35-1.21).

Conclusions and Relevance  The findings of this telephone survey study suggest that reduction of taste and/or smell may be a frequent and early symptom of COVID-19. Nasal obstruction was not commonly present at the onset of the disease in this study. The general practitioner may play a pivotal role in identifying potential COVID-19 in patients at an early stage if taste and/or smell alterations manifest and in suggesting quarantine before confirmation or exclusion of the diagnosis.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: April 17, 2020.

Corresponding Author: Fabio Ferreli, MD, Otorhinolaryngology Unit, Humanitas Clinical and Research Center, IRCCS, Via Alessandro Manzoni 56, Rozzano, 20089 Milan, Italy (fabio_ferreli@yahoo.it).

Published Online: June 18, 2020. doi:10.1001/jamaoto.2020.1155

Author Contributions: Drs Gaino and Di Bari had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Mercante, Ferreli, De Virgilio, Gaino, Di Bari, Morenghi, Azzolini, Spriano.

Acquisition, analysis, or interpretation of data: Mercante, Ferreli, Gaino, Di Bari, Colombo, Russo, Costantino, Pirola, Cugini, Malvezzi, Morenghi, Lagioia.

Drafting of the manuscript: Mercante, Ferreli, De Virgilio, Gaino, Di Bari, Russo, Morenghi.

Critical revision of the manuscript for important intellectual content: Mercante, Ferreli, Gaino, Di Bari, Colombo, Costantino, Pirola, Cugini, Malvezzi, Azzolini, Lagioia, Spriano.

Statistical analysis: Ferreli, De Virgilio, Morenghi.

Administrative, technical, or material support: Costantino, Pirola, Cugini, Malvezzi, Lagioia.

Supervision: Mercante, Ferreli, De Virgilio, Di Bari, Colombo, Azzolini, Spriano.

Conflict of Interest Disclosures: None reported.

Additional Contributions: Arkadia Translations and Dana Alon, MD, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy, helped with the English language revision of the manuscript. Dr Alon was not compensated for her work. We are grateful to all patients and families for their collaboration and willingness to share their stories in such a difficult situation.

Lu  H , Stratton  CW , Tang  YW .  Outbreak of pneumonia of unknown etiology in Wuhan, China: the mystery and the miracle.   J Med Virol. 2020;92(4):401-402. doi:10.1002/jmv.25678 PubMedGoogle Scholar
Zhu  N , Zhang  D , Wang  W ,  et al; China Novel Coronavirus Investigating and Research Team.  A novel coronavirus from patients with pneumonia in China.   N Engl J Med. 2020;382(8):727-733. doi:10.1056/NEJMoa2001017 PubMedGoogle Scholar
World Health Organization website. WHO characterizes COVID-19 as a pandemic. Accessed March 15, 2020. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/events-as-they-happen
Worldometers website. COVID-19 coronavirus outbreak. Accessed April 4, 2020. https://www.worldometers.info/coronavirus/
Remuzzi  A , Remuzzi  G .  COVID-19 and Italy: what next?   Lancet. 2020;395(10231):1225-1228. doi:10.1016/S0140-6736(20)30627-9 PubMedGoogle Scholar
Grasselli  G , Pesenti  A , Cecconi  M .  Critical care utilization for the COVID-19 outbreak in Lombardy, Italy: early experience and forecast during an emergency response.   JAMA. 2020;323(16):1545-1546. doi:10.1001/jama.2020.4031 PubMedGoogle Scholar
He  F , Deng  Y , Li  W. Coronavirus disease 2019 (COVID-19): what we know? J Med Vir. Published online March 14, 2020. doi:10.1002/jmv.25766
Guan  WJ , Ni  ZY , Hu  Y ,  et al; China Medical Treatment Expert Group for Covid-19.  Clinical characteristics of coronavirus disease 2019 in China.   N Engl J Med. 2020;382(18):1708-1720. doi:10.1056/NEJMoa2002032 PubMedGoogle Scholar
Yang  W , Cao  Q , Qin  L ,  et al.  Clinical characteristics and imaging manifestations of the 2019 novel coronavirus disease (COVID-19):a multi-center study in Wenzhou city, Zhejiang, China.   J Infect. 2020;80(4):388-393. doi:10.1016/j.jinf.2020.02.016 PubMedGoogle Scholar
Jiang  F , Deng  L , Zhang  L , Cai  Y , Cheung  CW , Xia  Z .  Review of the clinical characteristics of coronavirus disease 2019 (COVID-19).   J Gen Intern Med. 2020. Published online March 4, 2020. doi:10.1007/s11606-020-05762-w PubMedGoogle Scholar
Bordi  L , Nicastri  E , Scorzolini  L ,  et al; on Behalf of Inmi Covid-Study Group and Collaborating Centers.  Differential diagnosis of illness in patients under investigation for the novel coronavirus (SARS-CoV-2), Italy, February 2020.   Euro Surveill. 2020;25(8):2000170. doi:10.2807/1560-7917.ES.2020.25.8.2000170 PubMedGoogle Scholar
Giacomelli  A , Pezzati  L , Conti  F ,  et al.  Self-reported olfactory and taste disorders in SARS-CoV-2 patients: a cross-sectional study.   Clin Infect Dis. 2020;ciaa330. doi:10.1093/cid/ciaa330 PubMedGoogle Scholar
Qing  H , Li  Z , Yang  Z ,  et al.  The possibility of COVID-19 transmission from eye to nose.   Acta Ophthalmol. 2020;98(3):e388. doi:10.1111/aos.14412 PubMedGoogle Scholar
Seah  I , Agrawal  R .  Can the coronavirus disease 2019 (COVID-19) affect the eyes? a review of coronaviruses and ocular implications in humans and animals.   Ocul Immunol Inflamm. 2020;28(3):391-395. doi:10.1080/09273948.2020.1738501PubMedGoogle Scholar
Cascella  M , Rajnik  M , Cuomo  A , Dulebohn  SC , Di Napoli  R . Features, Evaluation and Treatment Coronavirus (COVID-19). StatPearls Publishing; 2020. https://www.ncbi.nlm.nih.gov/books/NBK554776/
Fang  Y , Zhang  H , Xie  J ,  et al.  Sensitivity of chest CT for COVID-19: comparison to RT-PCR.   Radiology. 2020;200432. doi:10.1148/radiol.2020200432 PubMedGoogle Scholar
Yang  W , Yan  F .  Patients with RT-PCR-confirmed COVID-19 and normal chest CT.   Radiology. 2020;295(2):E3. doi:10.1148/radiol.2020200702PubMedGoogle Scholar
Mozzanica  F , Preti  A , Gera  R ,  et al.  Cross-cultural adaptation and validation of the SNOT-22 into Italian.   Eur Arch Otorhinolaryngol. 2017;274(2):887-895. doi:10.1007/s00405-016-4313-x PubMedGoogle Scholar
Chan  JF , Yuan  S , Kok  KH ,  et al.  A familial cluster of pneumonia associated with the 2019 novel coronavirus indicating person-to-person transmission: a study of a family cluster.   Lancet. 2020;395(10223):514-523. doi:10.1016/S0140-6736(20)30154-9 PubMedGoogle Scholar
Zhou  P , Yang  XL , Wang  XG ,  et al.  A pneumonia outbreak associated with a new coronavirus of probable bat origin.   Nature. 2020;579(7798):270-273. doi:10.1038/s41586-020-2012-7 PubMedGoogle Scholar
Choudhary  R , Kapoor  MS , Singh  A , Bodakhe  SH .  Therapeutic targets of renin-angiotensin system in ocular disorders.   J Curr Ophthalmol. 2016;29(1):7-16. doi:10.1016/j.joco.2016.09.009 PubMedGoogle Scholar
Liang  L , Wu  P .  There may be virus in conjunctival secretion of patients with COVID-19.   Acta Ophthalmol. 2020;98(3):223. doi:10.1111/aos.14413 PubMedGoogle Scholar
Lovato  A , de Filippis  C .  Clinical presentation of COVID-19: a systematic review focusing on upper airway symptoms.   Ear Nose Throat J. 2020;145561320920762. Published online April 13, 2020. PubMedGoogle Scholar
Hopkins  C , Surda  P , Kumar  N .  Presentation of new onset anosmia during the COVID-19 pandemic.   Rhinology. Published online April 11, 2020. PubMedGoogle Scholar
Lechien  JR , Chiesa-Estomba  CM , De Siati  DR ,  et al.  Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study.   Eur Arch Otorhinolaryngol. Published online April 6, 2020. doi:10.1007/s00405-020-05965-1 PubMedGoogle Scholar
Seiden  AM .  Postviral olfactory loss.   Otolaryngol Clin North Am. 2004;37(6):1159-1166. doi:10.1016/j.otc.2004.06.007 PubMedGoogle Scholar
Suzuki  M , Saito  K , Min  WP ,  et al.  Identification of viruses in patients with postviral olfactory dysfunction.   Laryngoscope. 2007;117(2):272-277. doi:10.1097/01.mlg.0000249922.37381.1e PubMedGoogle Scholar
Netland  J , Meyerholz  DK , Moore  S , Cassell  M , Perlman  S .  Severe acute respiratory syndrome coronavirus infection causes neuronal death in the absence of encephalitis in mice transgenic for human ACE2.   J Virol. 2008;82(15):7264-7275. doi:10.1128/JVI.00737-08 PubMedGoogle Scholar
van Riel  D , Verdijk  R , Kuiken  T .  The olfactory nerve: a shortcut for influenza and other viral diseases into the central nervous system.   J Pathol. 2015;235(2):277-287. doi:10.1002/path.4461 PubMedGoogle Scholar
Gorbalenya  A , Baker  S , Baric  R ,  et al; Coronaviridae Study Group of the International Committee on Taxonomy of Viruses.  The species severe acute respiratory syndrome-related coronavirus: classifying 2019-nCoV and naming it SARS-CoV-2.   Nat Microbiol. 2020;5(4):536-544. doi:10.1038/s41564-020-0695-z PubMedGoogle Scholar
Pellegrino  R , Walliczek-Dworschak  U , Winter  G , Hull  D , Hummel  T .  Investigation of chemosensitivity during and after an acute cold.   Int Forum Allergy Rhinol. 2017;7(2):185-191. doi:10.1002/alr.21869 PubMedGoogle Scholar
Doty  RL , Shaman  P , Dann  M .  Development of the University of Pennsylvania Smell Identification Test: a standardized microencapsulated test of olfactory function.   Physiol Behav. 1984;32(3):489-502. doi:10.1016/0031-9384(84)90269-5 PubMedGoogle Scholar
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity


My Saved Searches

You currently have no searches saved.


My Saved Courses

You currently have no courses saved.