https://orcid.org/0000-0001-9112-3986, Mehmet DÜZLÜ, Alper CEYLAN, Hakan TUTAR, Süleyman CEBECİ, Muammer Melih ŞAHİN, Murat DİZBAY, Eray UZUNOĞLU, Mücahit YALÇIN, Gökçen CESUR, Mehmet YILDIZ, Hasan Selçuk ÖZGER, Pınar AYSERT YILDIZ

Assessment of olfactory and gustatory functions in COVID-19 patients

Background/aim: This study aims to evaluate of olfactory and gustatory functions of COVID-19 patients and possible risk factors for olfactory and gustatory dysfunctions. Materials and methods: The cross-sectional study included adult patients who were diagnosed with COVID-19 in Gazi University Hospital between April 2020 and June 2020. Volunteered patients participated in a survey in which olfactory and gustatory functions and various clinical information were questioned. Sinonasal Outcome Test-22 was also administrated to all patients. Results: A hundred and seventy-one patients participated in this study. Olfactory and gustatory dysfunctions rates were 10.5% (n: 18) and 10.5% (n: 18), respectively. Patients without any symptom other than smell and taste dysfunctions were clustered as group 1 and patients who are clinically symptomatic were clustered as group 2. Olfactory dysfunction occurred in 8% of group 1 and 17.4% of group 2 (p = 0.072). Gustatory dysfunction rate of smokers was 19.7% and significantly higher than gustatory dysfunction rate of nonsmokers (5.5%) (p = 0.007). Twenty-seven-point-eight percent of the patients with olfactory dysfunction (n = 5) were male and 72.2% (n: 13) were female. Sex did not show significant effect on rate of olfactory dysfunction. Twenty-five patients participated in psychophysical olfactory function test. No participant reported olfactory dysfunction at the time of test. Of the participants, 64% (n: 16) were normosmic and 36% (n: 9) were hyposmic according to Sniffin’ Stick test. Conclusion: Olfactory and gustatory dysfunctions are more common in patients who are clinically symptomatic than those diagnosed during contact tracing. Objective tests may show that frequency of olfactory dysfunction is greater than frequency of self-reported olfactory dysfunction.Key words: COVID-19, anosmia, ageusia, sniffin sticks

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1. Guan W, Ni Z, Hu Y, Liang W, Ou C et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine 2020; 382 (18): 1708-1720. doi: 10.1056/NEJMoa2002032
2. Wang D, Hu B, Hu C, Zhu F, Liu X et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus– Infected Pneumonia in Wuhan, China. JAMA 2020; 323 (11): 1061-1069. doi: 10.1001/jama.2020.1585
3. Mao L, Jin H, Wang M, Hu Y, Chen S et al. Neurologic Manifestations of Hospitalized Patients With Coronavirus Disease 2019 in Wuhan, China. JAMA Neurology 2020; 77 (6):683-690. doi: 10.1001/jamaneurol.2020.1127
4. Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD 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. European Archives of Otorhinolaryngology 2020; 277 (8):2251-2261. doi: 10.1007/s00405-020-05965-1
5. Vaira LA, Salzano G, Deiana G, De Riu G. Anosmia and Ageusia: Common Findings in COVID-19 Patients. Laryngoscope 2020; 130 (7):1787. doi: 10.1002/lary.28692
6. Gane SB, Kelly C, Hopkins C. Isolated sudden onset anosmia in COVID-19 infection. A novel syndrome? Rhinology 2020; 58 (3): 299-301. doi:10.4193/Rhin20.114
7. Giacomelli A, Pezzati L, Conti F, Bernacchia D, Siano M et al. Self-reported Olfactory and Taste Disorders in Patients With Severe Acute Respiratory Coronavirus 2 Infection: A Crosssectional Study. Clinical Infectious Diseases 2020; 71 (15): 889- 890. doi: 10.1093/cid/ciaa330
8. Vaira LA, Deiana G, Fois AG, Pirina P, Madeddu G et al. Objective evaluation of anosmia and ageusia in COVID-19 patients: Single-center experience on 72 cases. Head and Neck 2020; 42 (6): 1252-1258. doi: 10.1002/hed.26204
9. Welge-Lüssen A, Wolfensberger M. Olfactory disorders following upper respiratory tract infections. Advances in OtoRhino-Laryngology 2006; 63:125-132. doi: 10.1159/000093758
10. Suzuki M, Saito K, Min WP, Vladau C, Toida K 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
11. van Riel D, Verdijk R, Kuiken T. The olfactory nerve: a shortcut for influenza and other viral diseases into the central nervous system. The Journal of Pathology 2015; 235 (2): 277-287. doi: 10.1002/path.4461
12. Xu H, Zhong L, Deng J, Peng J, Dan H et al. High expression of ACE2 receptor of 2019-nCoV on the epithelial cells of oral mucosa. International Journal of Oral Science 2020; 12 (1):8. doi: 10.1038/s41368-020-0074-x
13. Chen M, Shen W, Rowan NR, Kulaga H, Hillel A et al. Elevated ACE2 expression in the olfactory neuroepithelium: implications for anosmia and upper respiratory SARS-CoV-2 entry and replication. bioRxiv 2020. doi: 10.1101/2020.05.08.084996
14. Miners S, Kehoe PG, Love S. Cognitive impact of COVID-19: looking beyond the short term. Alzheimer’s Research and Therapy 2020; 12 (1): 170. doi: 10.1186/s13195-020-00744-w
15. Brann DH, Tsukahara T, Weinreb C, Lipovsek M, Van den Berge K et al. Non-neuronal expression of SARS-CoV-2 entry genes in the olfactory system suggests mechanisms underlying COVID19-associated anosmia. bioRxiv 2020:2020.2003.2025.009084. doi: 10.1101/2020.03.25.009084
16. Finsterer J, Stollberger C. Causes of hypogeusia/hyposmia in SARS-CoV2 infected patients. Journal of Medical Virology 2020; 92 (10):1793-1794. doi: 10.1002/jmv.25903
17. Baig AM, Sanders EC. Potential neuroinvasive pathways of SARS-CoV-2: Deciphering the spectrum of neurological deficit seen in coronavirus disease-2019 (COVID-19). Journal of Medical Virology 2020; 92 (10): 1845-1857. doi: 10.1002/ jmv.26105
18. Rumeau C, Nguyen DT, Jankowski R. How to assess olfactory performance with the Sniffin’ Sticks test(®). European Annals of Otorhinolaryngology, Head and Neck Diseases 2016; 133 (3): 203-206. doi: 10.1016/j.anorl.2015.08.004
19. Tomlins J, Hamilton F, Gunning S, Sheehy C, Moran E et al. Clinical features of 95 sequential hospitalised patients with novel coronavirus 2019 disease (COVID-19), the firstUK cohort. Journal of Infection 2020; 81 (2): e59-e61. doi: 10.1016/j.jinf.2020.04.020
20. Moein ST, Hashemian SM, Mansourafshar B, KhorramTousi A, Tabarsi P et al. Smell dysfunction: a biomarker for COVID-19. International Forum of Allergy and Rhinology 2020; 10 (8): 944-950. doi: 10.1002/alr.22587
21. Agyeman AA, Chin KL, Landersdorfer CB, Liew D, OforiAsenso R. Smell and Taste Dysfunction in Patients With COVID-19: A Systematic Review and Meta-analysis. Mayo Clinic proceedings 2020; 95 (8): 1621-1631. doi: 10.1016/j. mayocp.2020.05.030
22. Dong X, Cao Y, Lu X, Zhang J, Du H et al. Eleven faces of coronavirus disease 2019. Allergy 2020; 75 (7): 1699-1709. doi: 10.1111/all.14289
23. Lechien JR, Ducarme M, Place S, Chiesa-Estomba CM, Khalife M et al. Objective Olfactory Findings in Hospitalized Severe COVID-19 Patients. Pathogens 2020; 9 (8): 627.
24. Paderno A, Schreiber A, Grammatica A, Raffetti E, Tomasoni M et al. Smell and taste alterations in COVID-19: a crosssectional analysis of different cohorts. International Forum of Allergy Rhinology 2020; 10 (8):955-962. doi: 10.1002/alr.22610
25. Yan CH, Faraji F, Prajapati DP, Ostrander BT, DeConde AS. Self-reported olfactory loss associates with outpatient clinical course in COVID-19. International Forum of Allergy Rhinology 2020; 10 (7):821-831. doi: 10.1002/alr.22592
26. Hopkins C, Vaira LA, De Riu G. Self-reported olfactory loss in COVID-19: is it really a favorable prognostic factor? International Forum of Allergy and Rhinology 2020; 10 (7): 926. doi: 10.1002/alr.22608
27. D’Ascanio L, Pandolfini M, Cingolani C, Latini G, Gradoni P et al. Olfactory Dysfunction in COVID-19 Patients: Prevalence and Prognosis for Recovering Sense of Smell. Otolaryngology, Head and Neck Surgery 2021; 164 (1): 82-86. doi: 10.1177/0194599820943530
28. Hopkins C, Surda P, Vaira LA, Lechien JR, Safarian M et al. Six month follow-up of self-reported loss of smell during the COVID-19 pandemic. Rhinology 2021; 59 (1): 26-31. doi: 10.4193/Rhin20.544
29. Lee Y, Min P, Lee S, Kim SW. Prevalence and Duration of Acute Loss of Smell or Taste in COVID-19 Patients. Journal of Korean Medical Science 2020; 35 (18): e174. 1 doi: 0.3346/ jkms.2020.35.e174
30. Al-Ani RM, Acharya D. Prevalence of Anosmia and Ageusia in Patients with COVID-19 at a Primary Health Center, Doha, Qatar. Indian journal of otolaryngology and head and neck surgery 2020;1-7. doi: 10.1007/s12070-020-02064-9
31. Vaira LA, Lechien JR, Khalife M, Petrocelli M, Hans S et al. Psychophysical Evaluation of the Olfactory Function: European Multicenter Study on 774 COVID-19 Patients. Pathogens 2021;10 (1):62. doi: 10.3390/pathogens10010062
32. Chéruel F, Jarlier M, Sancho-Garnier H. Effect of cigarette smoke on gustatory sensitivity, evaluation of the deficit and of the recovery time-course after smoking cessation. Tobacco Induced Diseases 2017; 15:15. doi: 10.1186/s12971-017-0120-4
33. Klopfenstein T, Kadiane-Oussou NJ, Toko L, Royer PY, Lepiller Q et al. Features of anosmia in COVID-19. Médecine et Maladies Infectieuses 2020; 50 (5): 436-439. doi: 10.1016/j. medmal.2020.04.006
34. Lechien JR, Chiesa-Estomba CM, Vaira LA, De Riu G, Cammaroto G et al. Epidemiological, otolaryngological, olfactory and gustatory outcomes according to the severity of COVID-19: a study of 2579 patients. European Archives of Otorhinolaryngology 2021; 1-9. doi: 10.1007/s00405-020-06548-w
35. Samaranayake LP, Fakhruddin KS, Mohammad OE, Panduwawala C, Bandara N et al. Attributes of dysgeusia and anosmia of coronavirus disease 2019 (COVID-19) in hospitalized patients. Oral Diseases 2020. doi: 10.1111/odi.13713
36. Wehling E, Nordin S, Espeseth T, Reinvang I, Lundervold AJ. Unawareness of olfactory dysfunction and its association with cognitive functioning in middle aged and old adults. Archives of Clinical Neuropsychology 2011; 26 (3): 260-269. doi: 10.1093/arclin/acr019