COVID-19 and olfactory dysfunction - an ENT perspective to the current COVID-19 pandemic

Abstract

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Otolaryngology in the COVID-19 pandemic era: the impact on our clinical practice

“…In April 2020, WHO added loss of smell and taste to the official lists of COVID-19 symptoms [11]. In particular, anosmia rates in SARS-COV-2 positive patients vary significantly among studies and are in the order of 30-70%, while in some of the patients anosmia may be the only present symptom [12][13][14][15][16]. For example, new data arrive from a recently conducted European multicenter study in which patients with laboratoryconfirmed COVID-19 infection completed olfactory and gustatory questionnaires.…”

“…There is a very high heteterogeneity among studies, with proportions ranging from 5 to 98% [16]. Differences in clinical work-up, specific regional patient characteristics or viral strains might be possible explanations for these rate variations [15]. The COVID-19-related anosmia is reported to be different from the well-known post-viral loss of smell, which follows rhinitis or other upper respiratory tract infections.…”

“…Ceasing intranasal steroids could lead to more sneezing and thus easier transmission of the virus. Systemic steroids in patients with AR or CRS should be administered with caution and only in the absence or failure of other alternative therapies (eg., patients with CRS in whom surgical therapy is not possible due to the pandemic, or patients with CRS with polyps in whom biological therapy with Dupilumab was not effective) [15,47,48].…”

“…During the pandemic oral corticosteroids should be avoided in new cases of anosmia in the absence of an obvious cause (e.g., head trauma, nasal polyps), since recovery can occur in the first weeks after onset [14,15,20,49]. Topical nasal corticosteroid application is controversial.…”

“…Despite existing recommendations against their use in patients with olfactory and gustatory dysfunction without nasal obstruction [20], the use of intranasal corticosteroids can be considered, in the form of spray formulation with a long applicator so the olfactory cleft can be reached to minimize potential viral spill. The controversy about corticosteroids brings attention to other treatment options for smell disorders, such as olfactory training, omega 3 supplements, topical vitamin A, and zinc [15,50].…”