Clinical, Prognostic, and Predictive Value of Olfactory Dysfunction for COVID-19: A Prospective Controlled Study

Otolaryngol Head Neck Surg. 2022 Jul;167(1):187-196. doi: 10.1177/01945998211057024. Epub 2021 Nov 2.


Objective: To evaluate the effect of olfactory dysfunction on the course and severity of COVID-19 and its prognostic and predictive significance for COVID-19.

Study design: Prospective case-control study.

Setting: Ondokuz Mayıs University School of Medicine.

Methods: Reverse transcription polymerase chain reaction (PCR)-positive patients, patients with COVID-19-related symptoms who had a negative PCR result, and healthy controls were included in the study. Clinicodemographic characteristics, inflammatory markers, and computed tomography stages were recorded. Disease progression and intensive care unit admission were registered. The visual analog scale (0, worst; 10, best) was used to evaluate subjective olfactory, taste, and nasal breathing ability, and the Sniffin' Sticks identification (SS-ID) test was used for psychophysical olfactory assessment.

Results: Mean SS-ID scores were significantly lower in the positive group (8.77) than in the negative (10.43) and healthy control (12.17) groups. VAS-smell scores were significantly lower and anosmia was more prevalent in PCR-positive patients (P < .01). SS-ID and VAS-smell scores were significantly correlated (r = 0.681, P < .001). The inflammatory parameters, pulmonary infiltration stage, disease progression, and ICU admission were not associated with SS-ID scores. A cutoff SS-ID score <9 resulted in 55.56% sensitivity in predicting COVID-19 positivity, and a cutoff VAS-smell score <8 yielded 72.22% sensitivity.

Conclusion: Olfactory dysfunction was detected objectively and subjectively in the PCR-positive group, and no difference was found in terms of taste function and nasal breathing. The severity and prognosis of COVID-19 are not exclusively dependent on olfactory dysfunction. The degree of olfactory dysfunction can be useful in predicting PCR positivity.

Keywords: COVID-19; OD; Sniffin’ Sticks test; anosmia; smell loss.

MeSH terms

  • COVID-19* / complications
  • Case-Control Studies
  • Disease Progression
  • Humans
  • Olfaction Disorders* / diagnosis
  • Olfaction Disorders* / etiology
  • Prognosis
  • Smell