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      Prevalence of Olfactory Dysfunction in Coronavirus Disease 2019 (COVID‐19): A Meta‐analysis of 27,492 Patients

      research-article
      Author(s): , MD, MMed (ORL‐HNS) 1 , , , PhD 2 , , MBBS, MMed (ORL‐HNS) 3
      Publication date (Electronic):
      Journal: The Laryngoscope
      Publisher: John Wiley & Sons, Inc.
      Keywords: Coronavirus, COVID‐19, olfactory, smell, meta‐analysis

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          Abstract

          Objectives/Hypothesis

          Olfactory dysfunction has been observed as one of the clinical manifestations in COVID‐19 patients. We aimed to conduct a systematic review and meta‐analysis to estimate the overall pooled prevalence of olfactory dysfunction in COVID‐19 patients.

          Study Design

          Systematic review and meta‐analyses.

          Methods

          PubMed, Scopus, Web of Science, Embase, and Google Scholar databases were searched to identify studies published between 1 December 2019 and 23 July 2020. We used random‐effects model to estimate the pooled prevalence with 95% confidence intervals (CIs). Heterogeneity was assessed using the I 2 statistic and Cochran's Q test. Robustness of the pooled estimates was checked by different subgroup and sensitivity analyses This study is registered with PROSPERO (CRD42020183768).

          Results

          We identified 1162 studies, of which 83 studies (n = 27492, 61.4% female) were included in the meta‐analysis. Overall, the pooled prevalence of olfactory dysfunction in COVID‐19 patients was 47.85% [95% CI: 41.20–54.50]. We observed olfactory dysfunction in 54.40% European, 51.11% North American, 31.39% Asian, and 10.71% Australian COVID‐19 patients. Anosmia, hyposmia, and dysosmia were observed in 35.39%, 36.15%, and 2.53% of the patients, respectively. There were discrepancies in the results of studies with objective (higher prevalence) versus subjective (lower prevalence) evaluations. The discrepancy might be due to false‐negative reporting observed in self‐reported health measures.

          Conclusions

          The prevalence of olfactory dysfunction in COVID‐19 patients was found to be 47.85% based on high‐quality evidence. Due to the subjective measures of most studies pooled in the analysis, further studies with objective measures are advocated to confirm the finding.

          Level of Evidence

          2 Laryngoscope, 2020

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          Most cited references132

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          Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China

          Chaolin Huang, Yeming Wang, Xingwang Li … (2020)
          Summary Background A recent cluster of pneumonia cases in Wuhan, China, was caused by a novel betacoronavirus, the 2019 novel coronavirus (2019-nCoV). We report the epidemiological, clinical, laboratory, and radiological characteristics and treatment and clinical outcomes of these patients. Methods All patients with suspected 2019-nCoV were admitted to a designated hospital in Wuhan. We prospectively collected and analysed data on patients with laboratory-confirmed 2019-nCoV infection by real-time RT-PCR and next-generation sequencing. Data were obtained with standardised data collection forms shared by WHO and the International Severe Acute Respiratory and Emerging Infection Consortium from electronic medical records. Researchers also directly communicated with patients or their families to ascertain epidemiological and symptom data. Outcomes were also compared between patients who had been admitted to the intensive care unit (ICU) and those who had not. Findings By Jan 2, 2020, 41 admitted hospital patients had been identified as having laboratory-confirmed 2019-nCoV infection. Most of the infected patients were men (30 [73%] of 41); less than half had underlying diseases (13 [32%]), including diabetes (eight [20%]), hypertension (six [15%]), and cardiovascular disease (six [15%]). Median age was 49·0 years (IQR 41·0–58·0). 27 (66%) of 41 patients had been exposed to Huanan seafood market. One family cluster was found. Common symptoms at onset of illness were fever (40 [98%] of 41 patients), cough (31 [76%]), and myalgia or fatigue (18 [44%]); less common symptoms were sputum production (11 [28%] of 39), headache (three [8%] of 38), haemoptysis (two [5%] of 39), and diarrhoea (one [3%] of 38). Dyspnoea developed in 22 (55%) of 40 patients (median time from illness onset to dyspnoea 8·0 days [IQR 5·0–13·0]). 26 (63%) of 41 patients had lymphopenia. All 41 patients had pneumonia with abnormal findings on chest CT. Complications included acute respiratory distress syndrome (12 [29%]), RNAaemia (six [15%]), acute cardiac injury (five [12%]) and secondary infection (four [10%]). 13 (32%) patients were admitted to an ICU and six (15%) died. Compared with non-ICU patients, ICU patients had higher plasma levels of IL2, IL7, IL10, GSCF, IP10, MCP1, MIP1A, and TNFα. Interpretation The 2019-nCoV infection caused clusters of severe respiratory illness similar to severe acute respiratory syndrome coronavirus and was associated with ICU admission and high mortality. Major gaps in our knowledge of the origin, epidemiology, duration of human transmission, and clinical spectrum of disease need fulfilment by future studies. Funding Ministry of Science and Technology, Chinese Academy of Medical Sciences, National Natural Science Foundation of China, and Beijing Municipal Science and Technology Commission.
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            Clinical Characteristics of Coronavirus Disease 2019 in China

            Wei-jie Guan, Zheng-yi Ni, Yu Hu … (2020)
            Abstract Background Since December 2019, when coronavirus disease 2019 (Covid-19) emerged in Wuhan city and rapidly spread throughout China, data have been needed on the clinical characteristics of the affected patients. Methods We extracted data regarding 1099 patients with laboratory-confirmed Covid-19 from 552 hospitals in 30 provinces, autonomous regions, and municipalities in mainland China through January 29, 2020. The primary composite end point was admission to an intensive care unit (ICU), the use of mechanical ventilation, or death. Results The median age of the patients was 47 years; 41.9% of the patients were female. The primary composite end point occurred in 67 patients (6.1%), including 5.0% who were admitted to the ICU, 2.3% who underwent invasive mechanical ventilation, and 1.4% who died. Only 1.9% of the patients had a history of direct contact with wildlife. Among nonresidents of Wuhan, 72.3% had contact with residents of Wuhan, including 31.3% who had visited the city. The most common symptoms were fever (43.8% on admission and 88.7% during hospitalization) and cough (67.8%). Diarrhea was uncommon (3.8%). The median incubation period was 4 days (interquartile range, 2 to 7). On admission, ground-glass opacity was the most common radiologic finding on chest computed tomography (CT) (56.4%). No radiographic or CT abnormality was found in 157 of 877 patients (17.9%) with nonsevere disease and in 5 of 173 patients (2.9%) with severe disease. Lymphocytopenia was present in 83.2% of the patients on admission. Conclusions During the first 2 months of the current outbreak, Covid-19 spread rapidly throughout China and caused varying degrees of illness. Patients often presented without fever, and many did not have abnormal radiologic findings. (Funded by the National Health Commission of China and others.)
            Article 0 comments Cited 13817 times – based on 0 reviews     Review now
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              Is Open Access

              A pneumonia outbreak associated with a new coronavirus of probable bat origin

              Peng Zhou, Xing-Lou Yang, Xian-Guang Wang … (2020)
              Since the outbreak of severe acute respiratory syndrome (SARS) 18 years ago, a large number of SARS-related coronaviruses (SARSr-CoVs) have been discovered in their natural reservoir host, bats 1–4 . Previous studies have shown that some bat SARSr-CoVs have the potential to infect humans 5–7 . Here we report the identification and characterization of a new coronavirus (2019-nCoV), which caused an epidemic of acute respiratory syndrome in humans in Wuhan, China. The epidemic, which started on 12 December 2019, had caused 2,794 laboratory-confirmed infections including 80 deaths by 26 January 2020. Full-length genome sequences were obtained from five patients at an early stage of the outbreak. The sequences are almost identical and share 79.6% sequence identity to SARS-CoV. Furthermore, we show that 2019-nCoV is 96% identical at the whole-genome level to a bat coronavirus. Pairwise protein sequence analysis of seven conserved non-structural proteins domains show that this virus belongs to the species of SARSr-CoV. In addition, 2019-nCoV virus isolated from the bronchoalveolar lavage fluid of a critically ill patient could be neutralized by sera from several patients. Notably, we confirmed that 2019-nCoV uses the same cell entry receptor—angiotensin converting enzyme II (ACE2)—as SARS-CoV.
              Article 0 comments Cited 10330 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Jeyasakthy Saniasiaya:
                ORCID: https://orcid.org/0000-0003-1974-4379
                shakthy_18@yahoo.com
                Journal
                Journal ID (nlm-ta): Laryngoscope
                Journal ID (iso-abbrev): Laryngoscope
                Journal ID (doi): 10.1002/(ISSN)1531-4995
                Journal ID (publisher-id): LARY
                Title: The Laryngoscope
                Publisher: John Wiley & Sons, Inc. (Hoboken, USA )
                ISSN (Print): 0023-852X
                ISSN (Electronic): 1531-4995
                Publication date (Electronic): 05 December 2020
                Electronic Location Identifier: 10.1002/lary.29286
                Affiliations
                [ 1 ] Department of Otorhinolaryngology, Faculty of Medicine University of Malaya, Jalan University Kuala Lumpur Malaysia
                [ 2 ] Department of Haematology School of Medical Sciences, Universiti Sains Malaysia Kubang Kerian Malaysia
                [ 3 ] Department of Otorhinolaryngology‐Head and Neck Surgery School of Medical Sciences, Universiti Sains Malaysia Kubang Kerian Malaysia
                Author notes
                [*] [* ] Send correspondence to Jeyasakthy Saniasiaya, Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Jalan Universiti, 50603, Kuala Lumpur, Malaysia. E‐mail: shakthy_18@ 123456yahoo.com

                Author information
                https://orcid.org/0000-0003-1974-4379
                https://orcid.org/0000-0001-5937-6473
                https://orcid.org/0000-0001-9138-9215
                Article
                Publisher ID: LARY29286
                DOI: 10.1002/lary.29286
                PMC ID: 7753439
                PubMed ID: 33219539
                SO-VID: ccb0db84-e53f-427e-9eb7-e53b2eb992fc
                Copyright © © 2020 American Laryngological, Rhinological and Otological Society Inc, "The Triological Society" and American Laryngological Association (ALA)
                License:

                This article is being made freely available through PubMed Central as part of the COVID-19 public health emergency response. It can be used for unrestricted research re-use and analysis in any form or by any means with acknowledgement of the original source, for the duration of the public health emergency.

                History
                Date received : 04 June 2020
                Date revision received : 26 October 2020
                Date accepted : 18 November 2020
                Page count
                Figures: 3, Tables: 3, Pages: 14, Words: 10936
                Categories
                Subject: Olfaction‐Chemosensation
                Subject: Olfaction‐Chemosensation
                Custom metadata
                source-schema-version-number 2.0
                edited-state corrected-proof
                details-of-publishers-convertor Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.6 mode:remove_FC converted:22.12.2020

                ScienceOpen disciplines: Otolaryngology
                Keywords: coronavirus,covid‐19,olfactory,smell,meta‐analysis
                Data availability:
                ScienceOpen disciplines: Otolaryngology
                Keywords: coronavirus, covid‐19, olfactory, smell, meta‐analysis

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