JAMA- Olfactory Dysfunction in COVID-19 Diagnosis and Management

The inclusion of loss of smell or taste among COVID 19 symptoms follows the emergence of evidence that suggests that COVID-19 frequently impairs the sense of smell. For example, in a study from Iran, 59 of 60 patients hospitalized with COVID-19 were found to have an impaired sense of smell according to psychophysical olfactory testing. Olfactory dysfunction (OD), defined as the reduced or distorted ability to smell during sniffing (orthonasal olfaction) or eating (retronasal olfaction), is often reported in mild or even asymptomatic cases; in a study from Italy, 64% of 202 mildly symptomatic patients reported impaired olfaction. Many patients report impairment of smell and taste interchangeably. Although it is possible that SARS-CoV-2 targets both olfactory and gustatory systems, in most cases of dysfunction not related to COVID-19 in which patients describe altered taste, this symptom can be attributed to impaired retronasal olfaction (flavor) rather than impaired gustation (sweet, salty, sour, bitter). For this reason, it is thought that the chemosensory impairment in COVID-19 is likely olfactory. Clinical Assessment During the current pandemic, patients with recent-onset acute smell and/or taste dysfunction, with or without other symptoms of COVID-19, should undergo a period of self-isolation and, when possible, SARS-CoV-2 testing. In patients with symptoms that require acute hospital admission (eg, respiratory distress), chemosensory assessment of smell and taste should only be considered when the clinical condition allows and appropriate PPE is available Subjective self-assessment of chemosensory function should not be relied on for diagnosis because of limited correlation with more objective measures. Psychophysical assessment involves presentation of odorants/tastants, with test outcome dependent on the patient’s response. Such tests are more reliable than a subjective assessment alone and should be performed in patients with COVID-19 when possible. Olfactory psychophysical assessment tools most commonly test 1 or a combination of odor threshold (minimum strength of an odor that can be perceived), odor discrimination (differentiation between different odors), and odor identification (identification of odors). Ideally, tools targeting odor threshold, discrimination, and identification using a standard multicomponent olfactory testing device should be employed. Treatment Olfactory training involves repeat and deliberate sniffing of a set of odorants (commonly lemon, rose, cloves, and eucalyptus) for 20 seconds each at least twice a day for at least 3 months (or longer if possible). Studies have demonstrated improved olfaction in patients with postinfectious OD after olfactory training. Oral and intranasal corticosteroids have been used to exclude an inflammatory component in patients with postinfectious OD. However, corticosteroids are not currently recommended for individuals with postinfectious OD because evidence of benefit is lacking and there is a potential risk of harm. Other medications that have shown promise in postinfectious OD include intranasal sodium citrate, which is thought to modulate olfactory receptor transduction cascades, intranasal vitamin A, which may act to promote olfactory neurogenesis, and systemic omega-3, which may act through neuroregenerative or anti-inflammatory means. To read more-https://jamanetwork.com/journals/jama/fullarticle/2766523

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Olfactory dysfunction have been reported in cases of COVID-19, such cases require hospital admission. Assessment and treatment of olfactory dysfunctionis described nicely
Few has been described that are suffering from olfactory dysfunction not in all cases of C19. Thanks for discussing olfactory dysfunction in detail and analytical manner.
Thanks Dr Vipin Bihari Jain
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