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Olfaction and Taste

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

JAMA Otolaryngology–Head & Neck Surgery

Published Online: June 18, 2020

Original Investigation

Article Information and Disclosures

Giuseppe Mercante, MD^1,2;

Fabio Ferreli, MD^1,2;

Armando De Virgilio, MD, PhD^1,2;

Francesca Gaino, MD²;

Matteo Di Bari, MD^1,2;

Giovanni Colombo, MD^1,2;

Elena Russo, MD^1,2;

Andrea Costantino, MD^1,2;

Francesca Pirola, MD^1,2;

Giovanni Cugini, MD²;

Luca Malvezzi, MD²;

Emanuela Morenghi, MS, PhD³;

Elena Azzolini, MD^1,4;

Michele Lagioia, MD⁴;

Giuseppe Spriano, MD^1,2

Author Affiliations

¹Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
²Otorhinolaryngology Unit, Humanitas Clinical and Research Center, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), Rozzano, Milan, Italy
³Biostatistics Unit, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy
⁴Clinical Quality Department, Humanitas Clinical and Research Center, IRCCS, Rozzano, Milan, Italy

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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.

Abstract

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.

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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.

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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

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