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Taste and Smell Impairment in COVID-19: an AAO-HNS Anosmia Reporting Tool

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Complete Manuscript Click here to access/download;Complete Manuscript;Manuscript-Revised.doc This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. 1 Taste and smell impairment in COVID-19: An AAO-HNS anosmia reporting tool- 2 based comparative study 3 4 İbrahim Sayin1 MD, Kadriye Kart Yaşar2 MD, Zahide Mine Yazici1 MD. 5 1: Department of Otolaryngology Head and Neck Surgery, Bakırköy Dr.Sadi Konuk 6 Teaching and Research Hospital, Istanbul, Turkey. 7 2: Department of Infectious Diseases, Bakırköy Dr.Sadi Konuk Teaching and 8 Research Hospital, Istanbul, Turkey. 9 10 Corresponding author: Ibrahim Sayin, MD 11 Department of Otolaryngology Head and Neck Surgery Bakırköy Dr. Sadi Konuk 12 Teaching and Research Hospital, Tevfik sağlam Caddesi, No:11. 34147, 13 Bakırköy/İstanbul 14 Telephone/Telefax: +90 414 7253/+90 212 542 44 91 15 E-mail: [email protected] 16 Funding: None Conflicts of interest: None 17 Ibrahim Sayin: conception and design of the work, collecting data, analysis, writing 18 manuscript, final approval of manuscript 19 Kadriye Kart Yaşar: conception of the work, data collection, drafting work, final 20 approval of manuscript 21 Zahide Mine Yazıcı: design of the work, collecting data, analysis, drafting the work, 22 final approval of manuscript 1 This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. 23 Abstract 24 Objective: To identify the taste and smell impairment in COVID-19 positive subjects 25 and compare the findings with COVID-19 negative subjects using the American 26 Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) Anosmia Reporting 27 Tool. 28 Setting: Tertiary referral center/COVID-19 pandemic hospital 29 Study design: Comparative study 30 Subjects and Methods: After power analysis 128 subjects were divided into two 31 groups according to Real-time Polymerase Chain Reaction (RT-PCR) COVID-19 32 testing results. Subjects were called via telephone and the AAO-HNS Anosmia 33 Reporting Tool was used to collect responses. 34 Results: The mean age of the study group was 38.63 ± 10.08 years old. At the time 35 of sampling rhinorrhea were significantly high in the COVID-19 negative group, 36 whereas those complaints described as ‘’other’’ were significantly high in the COVID- 37 19 positive group. There was a significant difference in the smell/taste impairment 38 rates of the groups (n = 46-71.9% for the COVID-19 positive group vs n = 17-26.6% 39 for the COVID-19 negative group, p = 0.001). For subjects with a smell impairment, 40 anosmia rates did not differ between the groups. The rates of hyposmia and 41 parosmia were significantly high in the COVID-19 positive group. For the subjects 42 with taste impairment, ageusia rates did not differ between groups. The rate of 43 hypogeusia and dysgeusia was significantly high in the COVID-19 positive group. 44 Logistic regression analysis indicates that smell/taste impairment in COVID-19 45 positive subjects increases the ODDS ratio by 6.956 (95% CI: 3.16-15.29) times. 2 This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. 46 Conclusion: COVID-19 positive subjects are strongly associated with smell/taste 47 impairment. 48 Keywords: COVID-19, coronavirus, chemosensory, anosmia, dysgeusia 49 50 51 52 53 54 55 56 57 58 59 60 61 62 63 64 65 3 This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. 66 Introduction 67 The world was faced with a novel form of coronavirus, named COronaVIrus Disease 68 2019 (COVID-19) by the World Health Organization (WHO) in December 2019. 69 According to the Coronavirus Study Group (CSG) of the International Committee the 70 virus became known as SARS-CoV-2 .1 71 Since there is no specific treatment or effective vaccine, the outbreak can only be 72 controlled by strict isolation and hygiene rules. COVID-19 is a form of Upper 73 Respiratory Tract Infection (URTI) and the clinical course of every URTI is different, 74 so presenting and alarm symptoms are needed to restrict transmission.2 75 In the early phases of the outbreak, fever, dyspnea, coughing, and travel to endemic 76 counties were used as the main screening parameters. However, during the course 77 of the outbreak, different symptomatology including headache, sore throat, nasal 78 congestion, rhinorrhea, fatigue, tonsil swelling, and conjunctivitis began to be 79 published.3 Among these, frequent chemosensory involvement, as evaluated by 80 smell and taste dysfunctions, were reported.4,5,6 81 During the outbreak many authors reported an increase in the presence of anosmia 82 in COVID-19 subjects. After initial reports, a few studies indicated that anosmia 83 presenting in COVID-19 subjects is more frequent than expected for a routine upper 84 respiratory tract infection. Although most of these reports were not comparative, 85 these findings are also in the Centers for Disease Control and Prevention (CDC) list 86 of symptoms and, according to the CDC, “new loss of taste or smell” can occur within 87 2-14 days of exposure.7 Chemosensory involvement can also occur as a first sign of 88 the disease. This is important because, given that there is no specific treatment or 89 effective vaccine, the outbreak can only be controlled by strict isolation and hygiene 4 This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. 90 measures.1,2 In addition, these subjects are potential ENT clinic patients in the future 91 for sustained taste and smell loss. The clinical course, along with other symptoms 92 and their timing, requires specialist monitoring to identify its properties. Clarifying the 93 chemosensory involvement not only provides valuable data for clinical evaluation but 94 also gives important clinical information of the virus characteristics, which may be 95 used by researchers from different disciplines. 96 The American Academy of Otolaryngology Head and Neck Surgery (AAO-HNS) are 97 continuously screening the outbreak and providing Otolaryngology Head and Neck 98 Surgery specialists with information about various aspects of the outbreak. As a 99 result of cumulative anecdotal evidence of anosmia/dysgeusia around the world 100 during the outbreak, the COVID-19 Anosmia Reporting Tool was developed in March 101 2020 by the AAO-HNS.8 This tool was developed by two committees of the AAO- 102 HNS; the Infectious Disease, and Patient Safety Quality Improvement committees. 103 The tool is completed online either by the medical provider or the patient, and 104 consists of 17 questions relating to demographic factors, COVID status, risk factors, 105 symptoms, and onset of anosmia/dysgeusia etc., and may be found at 106 https://www.entnet.org/content/reporting-tool-patients-anosmia-related-covid-19. This 107 anosmia reporting tool collects data to establish the importance of smell and taste 108 impairment in the clinical course of COVID-19. For this purpose we used the tool and 109 conducted a comparative study with COVID-19 negative subjects. 110 111 112 113 5 This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. 114 Methods 115 This study was conducted at Bakırköy Dr.Sadi Konuk Teaching and Research 116 Hospital, with ethical approval obtained from Bakırköy Dr.Sadi Konuk Teaching and 117 Research Hospital local ethics committee. Subjects with upper respiratory tract 118 infection symptoms who had been assessed as COVID-19 positive were enrolled. All 119 subjects underwent Real-time Polymerase Chain Reaction (RT-PCR) testing. 120 The exclusion criteria included subjects under the age of 18 and those without upper 121 respiratory tract infection symptoms. These subjects had undergone routine COVID- 122 19 testing as relatives of COVID-19 subjects and healthcare workers etc. In addition, 123 the exclusion criteria included subjects with pending results, those who had tested 124 negative for COVID-19 but were regarded as COVID-19 positive based on their 125 clinical presentations (presumed positive), and subjects required to remain in an 126 intensive care unit. 127 Subjects were divided into two groups; COVID-19 Positive (Group A) and COVID-19 128 Negative (Group B) according to RT-PCR results. Two questionnaires were 129 prepared, based on the AAO-HNS Anosmia Reporting Tool, for groups A and B 130 respectively. 131 According to power analysis, 64 subjects were required for each group. All 132 questionnaires were uploaded to Google Forms, and subjects admitted to clinics and 133 hospital began screening. All subjects were contacted by telephone and asked to 134 confirm they fulfill the inclusion criteria. Where the subject fulfilled the inclusion 135 criteria and informed consent was then obtained, the questionnaire was completed 136 with the assistance of physicians(1, 2, 3) and recorded to Google Forms. 137 6 This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. This manuscript has been accepted for publication in Otolaryngology-Head and Neck Surgery. 138 Questionnaires 139 Questionnaire of COVID-19 positive subjects ( Supplemental questionnaire 1) 140 The AAO-HNS Anosmia Reporting Tool was used to evaluate subjects.8 The 141 questionnaire included 17 questions, with one question asking about both anosmia 142 and dysgeusia. To obtain more detailed data, we expanded this question and 143 separated anosmia and dysgeusia questions from each other. Subjects were asked 144 to identify the type of smell and taste impairments separately, with a smell 145 impairment sub-grouped as anosmia, hyposmia and parosmia, and a taste 146 impairment sub-grouped as ageusia, hypogeusia and dysgeusia.
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