Ethyl alcohol threshold test: a fast, reliable and affordable olfactory Assessment tool for COVID-19 patients

Eur Arch Otorhinolaryngol. 2020 Oct;277(10):2783-2792. doi: 10.1007/s00405-020-06131-3. Epub 2020 Jun 24.


Objective: COVID-19 patients may present mild symptoms. The identification of paucisymptomatic patients is paramount in order to interrupt the transmission chain of the virus. Olfactory loss could be one of those early symptoms which might help in the diagnosis of COVID-19 patients. In this study, we aim to develop and validate a fast, inexpensive, reliable and easy-to-perform olfactory test for the screening of suspected COVID-19 patients.

Study design: Phase I was a case-control study and Phase II a transversal descriptive study.

Subjects and methods: Olfaction was assessed with the ethyl alcohol threshold test and symptoms with visual analogue scales. The study was designed in two phases: In Phase I, we compared confirmed COVID-19 patients and healthy controls. In Phase II, patients with suspected COVID-19 infection referred for testing were studied.

Results: 275 participants were included in Phase I, 135 in Phase II. The ROC curve showed an AUC of 0.749 in Phase I, 0.737 in Phase II. The cutoff value which offered the highest amount of correctly classified patients was ≥ 2 (10% alcohol) for all age intervals. The odds ratio was 8.19 in Phase I, 6.56 in Phase II with a 75% sensitivity. When cases report normal sense of smell (VAS < 4), it misdiagnoses 57.89% of patients detected by the alcohol threshold test.

Conclusion: The olfactory loss assessed with the alcohol threshold test has shown high sensitivity and odds ratio in both patients with confirmed COVID-19 illness and participants with suspected SARS-CoV-2 infection.

Keywords: COVID-19; Olfaction; Olfactory impairment; SARS-CoV-2; Sniff test.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Betacoronavirus*
  • COVID-19
  • Case-Control Studies
  • Coronavirus Infections / complications*
  • Costs and Cost Analysis
  • Ethanol / pharmacology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Olfaction Disorders / diagnosis*
  • Olfaction Disorders / etiology
  • Olfaction Disorders / physiopathology
  • Pandemics
  • Pneumonia, Viral / complications*
  • SARS-CoV-2
  • Smell
  • Young Adult


  • Ethanol