Objective screening for olfactory and gustatory dysfunction during the COVID-19 pandemic: a prospective study in healthcare workers using self-administered testing

Austin C Cao; Zachary M Nimmo; Natasha Mirza; Noam A Cohen; Robert M Brody; Richard L Doty

doi:10.1016/j.wjorl.2021.02.001

Objective screening for olfactory and gustatory dysfunction during the COVID-19 pandemic: a prospective study in healthcare workers using self-administered testing

World J Otorhinolaryngol Head Neck Surg. 2021 Feb 12;8(3):249-256. doi: 10.1016/j.wjorl.2021.02.001. Online ahead of print.

Authors

Austin C Cao¹, Zachary M Nimmo¹, Natasha Mirza², Noam A Cohen^{2

3

4}, Robert M Brody², Richard L Doty²

Affiliations

¹ Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
² Department of Otorhinolaryngology-Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA, USA.
³ Corporal Michael J. Crescenz Veterans Administration Medical Center, Philadelphia, PA, USA.
⁴ Monell Chemical Senses Center, Philadelphia, PA, USA.

Abstract

Background: Smell and taste loss are highly prevalent symptoms in coronavirus disease 2019 (COVID-19), although few studies have employed objective measures to quantify these symptoms, especially dysgeusia. Reports of unrecognized anosmia in COVID-19 patients suggests that self-reported measures are insufficient for capturing patients with chemosensory dysfunction.

Objectives: The purpose of this study was to quantify the impact of recent COVID-19 infection on chemosensory function and demonstrate the use of at-home objective smell and taste testing in an at-risk population of healthcare workers.

Methods: Two hundred and fifty healthcare workers were screened for possible loss of smell and taste using online surveys. Self-administered smell and taste tests were mailed to respondents meeting criteria for elevated risk of infection, and one-month follow-up surveys were completed.

Results: Among subjects with prior SARS-CoV-2 infection, 73% reported symptoms of olfactory and/or gustatory dysfunction. Self-reported smell and taste loss were both strong predictors of COVID-19 positivity. Subjects with evidence of recent SARS-CoV-2 infection (<45 days) had significantly lower olfactory scores but equivalent gustatory scores compared to other subjects. There was a time-dependent increase in smell scores but not in taste scores among subjects with prior infection and chemosensory symptoms. The overall infection rate was 4.4%, with 2.5% reported by PCR swab.

Conclusion: Healthcare workers with recent SARS-CoV-2 infection had reduced olfaction and normal gustation on self-administered objective testing compared to those without infection. Rates of infection and chemosensory symptoms in our cohort of healthcare workers reflect those of the general public.

Keywords: Anosmia; Brief Smell Identification Test; COVID-19; Chemosensory dysfunction; Dysgeusia; Gustation; Healthcare workers; Objective testing; Olfaction; Screening; University of Pennsylvania Smell Identification Test.