Temporal patterns of nasal symptoms in patients with mild severity SARS-CoV-2 infection

Abstract

Background No study to date has analyzed the progression of sinonasal symptoms over time in COVID-19 patients. The purpose of this study is to analyze the progression of sinonasal symptoms and risk factors for olfactory dysfunction in the mild severity COVID-19 patient. Methods An internet survey was used to assess sinonasal symptoms in patients with COVID-19. Changes in rhinologic domain and symptom-specific Sinonasal Outcome Test (SNOT-22) scores were compared at five time points: two weeks before diagnosis, at diagnosis, two weeks after diagnosis, four weeks after diagnosis, and six months after diagnosis. Results 521 responses were collected. Rhinologic domain SNOT-22 scores increased significantly ( p < 0.001) to 8.94 at the time of diagnosis, remained elevated two weeks post-diagnosis (5.14, p = 0.004), and decreased significantly four weeks post-diagnosis (3.14, p = 0.004). Smell-specific SNOT-22 scores peaked at the time of diagnosis (2.05, p < 0.001), remained elevated two weeks after diagnosis (1.19, p < 0.001), and returned to baseline four weeks post-diagnosis (0.64, p > 0.999). Taste-specific SNOT-22 scores also peaked at diagnosis (2.06, p < 0.001), remained elevated two weeks after diagnosis (1.19, p < 0.001), and returned to baseline four weeks after diagnosis (0.71, p > 0.999). There were no significant differences in sense of smell or taste between 1-month and 6-month timepoints. Conclusion Sinonasal symptoms, particularly loss of smell and taste, may be important presenting symptoms in the mild severity COVID-19 patient. Our findings support incorporating these symptoms into screening protocols. Level of evidence: 4

Olfactory recovery following infection with COVID-19: A systematic review

“…COVID-19 was confirmed by RT-PCR test in all but six studies that either used RT-PCR or serology as a diagnostic tool of COVID-19 [ 25 , 48 , 51 , 54 , 58 , 60 ]. Although most of the patients recruited within studies were not hospitalized due to COVID-19 infection [ 17 , 21 – 26 , 28 , 30 – 32 , 35 , 36 , 41 – 43 , 45 , 47 – 49 , 51 , 54 , 56 , 60 ], some did include patients hospitalized either for monitoring purposes or quarantine [ 18 , 19 , 33 , 52 , 55 , 57 – 59 ]. Twelve studies included a mixture of hospitalized and non hospitalized patients [ 15 , 19 , 20 , 27 , 29 , 34 , 38 – 40 , 46 , 50 , 53 ].…”

“…10 studies were conducted in Asia: Turkey (n = 5) [ 18 , 27 , 38 , 41 , 50 ], Iran (n = 2) [ 22 , 55 ], India (n = 2) [ 33 , 52 ], Israel (n = 1) [ 32 ]. Four studies were conducted in North America: United States (n = 4), [ 21 , 42 , 48 , 51 ]. Two studies were conducted in Africa: Egypt (n = 2) [ 34 , 49 ], and two in South America: Brazil (n = 1) [ 53 ], Chile (n = 1) [ 15 , 53 ].…”

“…Two studies were conducted in Africa: Egypt (n = 2) [ 34 , 49 ], and two in South America: Brazil (n = 1) [ 53 ], Chile (n = 1) [ 15 , 53 ]. Of the 44 studies, twenty-five (56.8%) reported no funding requirements for the project [ 16 , 18 , 19 , 22 , 27 – 30 , 32 , 33 , 39 , 40 , 42 – 47 , 49 – 51 , 53 , 58 ]; six (13.6%) studies reported funding for the project (sources included academic institutions, government and not-for-profit organizations) [ 15 , 24 , 25 , 31 , 48 , 57 ], and thirteen (29.5%) did not report whether funding was provided [ 17 , 21 , 23 , 26 , 37 , 38 , 52 , 54 – 56 , 58 , 59 ].…”

“…In studies that prospectively evaluated olfactory dysfunction, the timing of such evaluations varied greatly. The initial evaluations of olfaction were measured from the onset of either olfactory or general symptoms [ 15 , 20 , 25 , 26 , 28 , 31 , 43 – 45 , 53 , 60 ], from the time of positive COVID-19 test [ 16 , 21 , 23 , 33 , 34 , 38 , 45 , 46 , 57 , 59 ], from time of infection [ 24 , 51 ], during active phases of symptomatology [ 47 ], from the time of the swab [ 35 , 36 ], at initial home/clinic visit [ 27 , 30 ], at the time of admission to hospital [ 29 , 52 ], during the recovery period [ 17 , 22 ], after recovery/discharge [ 49 ], or at other specified times [ 41 , 54 , 55 ]. The timing and number of follow-up evaluations also varied amongst studies.…”

“…The timing and number of follow-up evaluations also varied amongst studies. The majority of studies performed one follow-up olfactory re-test following their first initial testing, and thirteen studies performed more than one follow-up evaluation [ 20 , 23 , 24 , 26 , 28 , 34 – 36 , 43 , 51 , 52 , 57 , 60 ].…”