Anosmia as a Prominent Symptom of COVID-19 Infection

Karimi, Ebrahim; Firouzifar, Mohammadreza; Khamushian, Parnian; Ansari, Reza; Ardehali, Mojtaba Mohammadi; Heidari, Farrokh

doi:10.4193/rhin20.140

Cited by 124 publications

(119 citation statements)

References 5 publications

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“…15 Although multiple COVID-19 studies report acute smell or taste disorders as a distinguishing symptom, no other studies report diagnostic accuracy or sufficient details to compute likelihood ratios for hyposmia or hypogeusia. [16][17][18][19][20][21] Loss of smell is not necessarily associated with nasal obstruction or rhinorrhea. 22 In one case-control study, new-onset smell and taste disorders are more common with COVID-19 than with influenza (39% vs. 13%).…”

Section: Clinical Examinationmentioning

confidence: 99%

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Diagnosing COVID‐19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases

Carpenter

Mudd

West

et al. 2020

Academic Emergency Medicine

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Objective Severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) emerged as a global pandemic in early 2020 with rapidly evolving approaches to diagnosing the clinical illness called coronavirus disease (COVID‐19). The primary objective of this scoping review is to synthesize current research of the diagnostic accuracy of history, physical examination, routine laboratory tests, real‐time reverse transcription–polymerase chain reaction (rRT‐PCR), immunology tests, and computed tomography (CT) for the emergency department (ED) diagnosis of COVID‐19. Secondary objectives included a synopsis of diagnostic biases likely with current COVID‐19 research as well as corresponding implications of false‐negative and false‐positive results for clinicians and investigators. Methods A Preferred Reporting Items for Systematic Reviews and Meta‐Analyses–Scoping Review (PRISMA‐ScR)–adherent synthesis of COVID‐19 diagnostic accuracy through May 5, 2020, was conducted. The search strategy was designed by a medical librarian and included studies indexed by PubMed and Embase since January 2020. Results A total of 1,907 citations were screened for relevance. Patients without COVID‐19 are rarely reported, so specificity and likelihood ratios were generally unavailable. Fever is the most common finding, while hyposmia and hypogeusia appear useful to rule in COVID‐19. Cough is not consistently present. Lymphopenia is the mostly commonly reported laboratory abnormality and occurs in over 50% of COVID‐19 patients. rRT‐PCR is currently considered the COVID‐19 criterion standard for most diagnostic studies, but a single test sensitivity ranges from 60% to 78%. Multiple reasons for false‐negatives rRT‐PCR exist, including sample site tested and disease stage during which sample was obtained. CT may increase COVID‐19 sensitivity in conjunction with rRT‐PCR, but guidelines for imaging patients most likely to benefit are emerging. IgM and IgG serology levels are undetectable in the first week of COVID‐19, but sensitivity (range = 82% to 100%) and specificity (range = 87% to 100%) are promising. Whether detectable COVID‐19 antibodies correspond to immunity remains unanswered. Current studies do not adhere to accepted diagnostic accuracy reporting standards and likely report significantly biased results if the same tests were to be applied to general ED populations with suspected COVID‐19. Conclusions With the exception of fever and disorders of smell/taste, history and physical examination findings are unhelpful to distinguish COVID‐19 from other infectious conditions that mimic SARS‐CoV‐2 like influenza. Routine laboratory tests are also nondiagnostic, although lymphopenia is a common finding and other abnormalities may predict severe disease. Although rRT‐PCR is the current criterion standard, more inclusive consensus‐based criteria will likely emerge because of the high false‐negative rate of PCR tests. The role of serology and CT in ED assessments remains undefined.

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Section: Clinical Examinationmentioning

confidence: 99%

“…16 Anosmia is more common in women and may persist for 2 weeks. 17 Predictive models incorporating a change in taste or smell to distinguish COVID-19 from viral mimics appear most sensitive. 26 Cough is only present in 58% patients.…”

Section: Clinical Examinationmentioning

confidence: 99%

Diagnosing COVID‐19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases

Carpenter

Mudd

West

et al. 2020

Academic Emergency Medicine

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“…Among these, only olfactory loss was reported by 27.7% of patients, ageusia by 20.3% and both by 52%. Similarly, Heidari et al, Clemency et al and Gudbjartsson et al evaluated their COVID-19 patients who complained of olfactory dysfunction through a telephone interview/verbal questionnaire 8-10 . A multicentre questionnaire study 11 , based on 417 mild-moderate COVID-19 patients, reported olfactory dysfunction in 85.6% of cases (n = 357).…”

Section: Sense Of Smell Evaluation In Confirmed Covid-19 Patients By mentioning

confidence: 99%

Loss of smell in COVID-19 patients: a critical review with emphasis on the use of olfactory tests

Marchese‐Ragona

Restivo

Corso

et al. 2020

Acta Otorhinolaryngol Ital

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SUMMARY Since December 2019, an outbreak of a newly isolated coronavirus (SARS-CoV-2) appeared in Wuhan, China, and then spread worldwide. Recently, it has emerged that a number of patients may present with sudden hyposmia, sometimes without other symptoms of the disease. We performed a critical review on the methods used to date to investigate the olfactory function in COVID-19 patients in order to establish which should be considered the most appropriate to use during this pandemic. Literature analysis showed that the diagnosis of hyposmia in COVID-19 patients was mainly made through subjective symptomatology collected by questionnaires and/or interview. Psychophysical tests were carried out in a few studies showing significant discrepancies between the self-reported sense of smell and test results. To date the methods used by authors to investigate smell impairment in COVID-19 patients have been very heterogeneous and predominantly based on self-reported questionnaires leading to confusing and inconclusive results. We suggest that simple validated self-administered psychophysical olfactory tests could be a valuable instrument to investigate isolated/quarantined or hospitalised COVID-19 patients referring smell impairment in order to confirm olfactory dysfunction.

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“…[9,10]. Newer initial presenting symptoms of COVID include anosmia (absent ), hyposmia(reduced sense of smell) [11] and dysgeusia (altered taste).…”

Section: Introductionmentioning

confidence: 99%

The New Normal of ENT OPD - Adapting Safe Practices.

Yeolekar

Bhalerao²,

Bhalerao³

2020

Preprint

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The COVID-19 epidemic originating in China has spread rapidly worldwide and converted to pandemic proportions in March 2020. In India and densely populated countries like Brazil and USA the numbers are still rising. Clinicians all over the world are trying to contain it by minimizing the cross-transmission of disease among hospital staff members. In the field of Otorhinolaryngology (ENT) the doctors are exposed to high viral load while examining the patients. Therefore contingency plans are required for dealing with patients in outpatient clinics, and while performing diagnostic endoscopies, minor procedures in OPD and surgeries in operating rooms. Infected patients may shed severe acute respiratory syndrome coronavirus-2 (SARS-CoV- 2) particles into their environment via body secretions. Therefore, Otolaryngologists should be vigilant. In this submission, we share our experience of an innovative practice plan in redesigning the ENT OPD setup, endoscopy set up and OT so as to reduce the risk of transmission of virus not only to doctors but other healthcare workers. We hope that our modifications will serve as a guide for every Otolaryngologist throughout India towards performing their clinical duties confidently without any apprehension and ensuring adequate safety during this testing times in their small set-up/ clinical establishments.

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Anosmia as a Prominent Symptom of COVID-19 Infection

Cited by 124 publications

References 5 publications

Diagnosing COVID‐19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases

Diagnosing COVID‐19 in the Emergency Department: A Scoping Review of Clinical Examinations, Laboratory Tests, Imaging Accuracy, and Biases

Loss of smell in COVID-19 patients: a critical review with emphasis on the use of olfactory tests

The New Normal of ENT OPD - Adapting Safe Practices.

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