Olfactory and Gustatory Dysfunction as an Early Identifier of COVID-19 in Adults and Children: An International Multicenter Study

Chenghao Qiu; Chong Cui; Charlotte Hautefort; Antje Haehner; Jun Zhao; Qi Yao; Hui Zeng; Eric J Nisenbaum; Li Liu; Yu Zhao; Di Zhang; Corinna G Levine; Ivette Cejas; Qi Dai; Mei Zeng; Philippe Herman; Clement Jourdaine; Katja de With; Julia Draf; Bing Chen; Dushyantha T Jayaweera; James C Denneny 3rd; Roy Casiano; Hongmeng Yu; Adrien A Eshraghi; Thomas Hummel; Xuezhong Liu; Yilai Shu; Hongzhou Lu

doi:10.1177/0194599820934376

Olfactory and Gustatory Dysfunction as an Early Identifier of COVID-19 in Adults and Children: An International Multicenter Study

Otolaryngol Head Neck Surg. 2020 Oct;163(4):714-721. doi: 10.1177/0194599820934376. Epub 2020 Jun 16.

Authors

Chenghao Qiu¹, Chong Cui^{2

3}, Charlotte Hautefort⁴, Antje Haehner⁵, Jun Zhao⁶, Qi Yao⁷, Hui Zeng⁸, Eric J Nisenbaum⁹, Li Liu¹⁰, Yu Zhao^{2

3}, Di Zhang¹¹, Corinna G Levine⁹, Ivette Cejas⁹, Qi Dai^{2

3}, Mei Zeng¹², Philippe Herman⁴, Clement Jourdaine⁴, Katja de With¹³, Julia Draf⁵, Bing Chen^{2

3}, Dushyantha T Jayaweera¹⁴, James C Denneny 3rd¹⁵, Roy Casiano⁹, Hongmeng Yu^{2

3}, Adrien A Eshraghi⁹, Thomas Hummel⁵, Xuezhong Liu⁹, Yilai Shu^{2

3}, Hongzhou Lu¹⁰

Affiliations

¹ Center of Stomatology, Shanghai Public Health Clinical Center, Shanghai, China.
² ENT Institute and Otorhinolaryngology Department of the Affiliated Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology, Institutes of Biomedical Sciences, Fudan University, Shanghai, China.
³ NHC Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China.
⁴ Department of Head and Neck Surgery, Hopital Lariboisiere, University of Paris, Paris, France.
⁵ Smell and Taste Clinic, Department of Otorhinolaryngology, TU Dresden, Dresden, Germany.
⁶ Center of Pediatrics, Shanghai Public Health Clinical Center, Shanghai, China.
⁷ Department of Otorhinolaryngology, Chinese and Western Medicine Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁸ Department of Cardiovascularology, The Third People's Hospital of Shenzhen, Shenzhen, China.
⁹ Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹⁰ Department of Infectious Diseases, Shanghai Public Health Clinical Center, Shanghai, China.
¹¹ Department of Otolaryngology, The Third People's Hospital of Shenzhen, Shenzhen, China.
¹² Department of Infectious Diseases, Children's Hospital of Fudan University, Shanghai, China.
¹³ Division of Infectious Diseases, University Hospital Carl Gustav Carus at the TU Dresden, Dresden, Germany.
¹⁴ Department of Medicine, Division of Infectious Diseases, University of Miami Miller School of Medicine, Miami, Florida, USA.
¹⁵ American Academy of Otolaryngology-Head and Neck Surgery, Alexandria, Virginia, USA.

Abstract

Objective: To evaluate the prevalence and characteristics of olfactory or gustatory dysfunction in coronavirus disease 2019 (COVID-19) patients.

Study design: Multicenter case series.

Setting: Five tertiary care hospitals (3 in China, 1 in France, 1 in Germany).

Subjects and methods: In total, 394 polymerase chain reaction (PCR)-confirmed COVID-19-positive patients were screened, and those with olfactory or gustatory dysfunction were included. Data including demographics, COVID-19 severity, patient outcome, and the incidence and degree of olfactory and/or gustatory dysfunction were collected and analyzed. The Questionnaire of Olfactory Disorders (QOD) and visual analog scale (VAS) were used to quantify olfactory and gustatory dysfunction, respectively. All subjects at 1 hospital (Shanghai) without subjective olfactory complaints underwent objective testing.

Results: Of 394 screened subjects, 161 (41%) reported olfactory and/or gustatory dysfunction and were included. Incidence of olfactory and/or gustatory disorders in Chinese (n = 239), German (n = 39), and French (n = 116) cohorts was 32%, 69%, and 49%, respectively. The median age of included subjects was 39 years, 92 of 161 (57%) were male, and 10 of 161 (6%) were children. Of included subjects, 10% had only olfactory or gustatory symptoms, and 19% had olfactory and/or gustatory complaints prior to any other COVID-19 symptom. Of subjects with objective olfactory testing, 10 of 90 demonstrated abnormal chemosensory function despite reporting normal subjective olfaction. Forty-three percent (44/102) of subjects with follow-up showed symptomatic improvement in olfaction or gustation.

Conclusions: Olfactory and/or gustatory disorders may represent early or isolated symptoms of severe acute respiratory syndrome coronavirus 2 infection. They may serve as a useful additional screening criterion, particularly for the identification of patients in the early stages of infection.

Keywords: COVID-19; COVID-19 screening; SARS-CoV-2; anosmia; dysgeusia; gustatory dysfunction; olfactory dysfunction.

Publication types

Multicenter Study
Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Betacoronavirus*
COVID-19
Child
China / epidemiology
Coronavirus Infections / complications*
Coronavirus Infections / diagnosis
Coronavirus Infections / epidemiology
Early Diagnosis*
Female
France / epidemiology
Germany / epidemiology
Humans
Male
Olfaction Disorders / epidemiology
Olfaction Disorders / etiology*
Pandemics
Pneumonia, Viral / complications*
Pneumonia, Viral / diagnosis
Pneumonia, Viral / epidemiology
Prevalence
Retrospective Studies
SARS-CoV-2
Smell / physiology*
Taste Disorders / epidemiology
Taste Disorders / etiology*
Young Adult

Grants and funding

KL2 TR002737/TR/NCATS NIH HHS/United States