Frequency and Clinical Utility of Olfactory Dysfunction in COVID-19: a Systematic Review and Meta-analysis

Curr Allergy Asthma Rep. 2020 Oct 13;20(12):76. doi: 10.1007/s11882-020-00972-y.


Background: Olfactory dysfunction (OD) has been gaining recognition as a symptom of COVID-19, but its clinical utility has not been well defined.

Objectives: To quantify the clinical utility of identifying OD in the diagnosis of COVID-19 and determine an estimate of the frequency of OD amongst these patients.

Methods: PubMed was searched up to 1 August 2020. Meta-analysis A included studies if they compared the frequency of OD in COVID-19 positive patients (proven by reverse transcription polymerase chain reaction) to COVID-19 negative controls. Meta-analysis B included studies if they described the frequency of OD in COVID-19 positive patients and if OD symptoms were explicitly asked in questionnaires or interviews or if smell tests were performed.

Results: The pooled frequency of OD in COVID-19 positive patients (17,401 patients, 60 studies) was 0.56 (0.47-0.64) but differs between detection via smell testing (0.76 [0.51-0.91]) and survey/questionnaire report (0.53 [0.45-0.62]), although not reaching statistical significance (p = 0.089). Patients with reported OD were more likely to test positive for COVID-19 (diagnostic odds ratio 11.5 [8.01-16.5], sensitivity 0.48 (0.40 to 0.56), specificity 0.93 (0.90 to 0.96), positive likelihood ratio 6.10 (4.47-8.32) and negative likelihood ratio 0.58 (0.52-0.64)). There was significant heterogeneity amongst studies with possible publication bias.

Conclusion: Frequency of OD in COVID-19 differs greatly across studies. Nevertheless, patients with reported OD were significantly more likely to test positive for COVID-19. Patient-reported OD is a highly specific symptom of COVID-19 which should be included as part of the pre-test screening of suspect patients.

Keywords: COVID-19; Coronavirus 2; Meta-analysis; Olfaction disorders; Severe acute respiratory syndrome.

Publication types

  • Meta-Analysis
  • Systematic Review

MeSH terms

  • Betacoronavirus
  • COVID-19
  • Coronavirus Infections / physiopathology*
  • Humans
  • Olfaction Disorders / complications*
  • Olfaction Disorders / physiopathology*
  • Pandemics
  • Pneumonia, Viral / physiopathology*
  • SARS-CoV-2
  • Self Report
  • Smell*
  • Surveys and Questionnaires
  • Symptom Assessment