Paranasal sinuses computed tomography findings in anosmia of COVID-19

ObjectiveOlfactory dysfunction in coronavirus disease-2019 (COVID-19) is poorly understood. Thus, mechanistic data are needed to elucidate the pathophysiological drivers of anosmia of COVID-19.MethodsWe performed the current study in patients who presented with anosmia and COVID-19 as documented by the polymerase chain reaction (PCR) assay between April 1st and May 15st, 2020. We assessed for the conductive causes of anosmia with computed tomography (CT) of paranasal sinuses.Results49 patients who presented with anosmia and positive PCR assay for COVID-19 were included. The average age was 45 ± 12.2 years. Complete anosmia was present in 85.7% of patients and 91.8% of patients reported sudden onset of olfactory dysfunction. Taste disturbance was common (75.5%). There were no significant pathological changes in the paranasal sinuses on CT scans. Olfactory cleft and ethmoid sinuses appeared normal while in other sinuses, partial opacification was detected only in some cases.ConclusionWe did not find significant mucosal changes or olfactory cleft abnormality on CT imaging in patients with anosmia of COVID-19. Conductive causes of anosmia (i.e., mucosal disease) do not seem play a significant role in anosmia of COVID-19.     

Olfactory and taste disorders in COVID-19: a systematic review

IntroductionThe SARS-CoV-2 virus causes COVID-19, and it is responsible for the largest pandemic since the 1918 H1N1 influenza outbreak. The classic symptoms of the disease have been well defined by the World Health Organization; however, olfactory/gustatory disorders have been reported in some studies, but there are still several missing points in the understanding and in the consensus about the clinical management of these cases.ObjectiveTo identify evidence in the scientific literature about olfactory/gustatory disorders, their clinical presentation, prevalence and possible specific treatments associated with COVID-19.MethodsA systematic review of articles published up to April 25, 2020 was performed in Medline, Cochrane Clinical Trials, ScienceDirect, Lilacs, Scopus and Google Schoolar, OpenGrey.eu, DissOnline, The New York Academy of Medicine and Reasearch Gate. Inclusion criteria: (1) Studies on patients with COVID-19; (2) Records of COVID-19 signs/symptoms, and olfactory/gustatory functions. Exclusion criteria: (1) Studies on non-human coronavirus; (2) Review articles; (3) Experimental studies (in animals or in vitro); (4) Olfactory/gustatory disorders initiated prior to SARS-CoV-2 infection. The risk assessment of bias of the selected studies was performed using the Newcastle-Ottawa scale.ResultsSix articles from the 1788 records met the inclusion criteria and were analyzed. A total of 1457 patients of different ethnicities were assessed; of them, 885 (60.7%) and 822 (56.4%) had smell and taste disorders, respectively, with women being most often affected. There were olfactory/gustatory disorders even without nasal obstruction/rhinorrhea and beginning even before the signs/symptoms of COVID-19; the recovery of smell/taste, when it occurs, usually happened in the first two weeks after COVID-19 resolution. There is evidence that olfactory/gustatory disorders are strong predictors of infection by SARS-CoV-2, and it is possible to recommend patient isolation, as early as of the medical consultation, preventing the spread of the virus. No scientific evidence has been identified for effective treatments for any of the disorders.ConclusionOlfactory/gustatory disorders may occur at varying intensities and prior to the general symptoms of COVID-19 and should be considered as part of the clinical features of COVID-19, even in mild cases. There is still no scientific evidence of specific treatments for such disorders in COVID-19 disease.     

Biopsy of the olfactory epithelium from the superior nasal septum: is it possible to obtain neurons without damaging olfaction?

IntroductionOlfactory epithelium biopsy has been useful for studying diverse otorhinolaryngological and neurological diseases, including the potential to better understand the pathophysiology behind COVID-19 olfactory manifestations. However, the safety and efficacy of the technique for obtaining human olfactory epithelium are still not fully established.ObjectiveThis study aimed to determine the safety and efficacy of harvesting olfactory epithelium cells, nerve bundles, and olfactory epithelium proper for morphological analysis from the superior nasal septum.MethodsDuring nasal surgery, 22 individuals without olfactory complaints underwent olfactory epithelium biopsies from the superior nasal septum. The efficacy of obtaining olfactory epithelium, verification of intact olfactory epithelium and the presence of nerve bundles in biopsies were assessed using immunofluorescence. Safety for the olfactory function was tested psychophysically using both unilateral and bilateral tests before and 1 month after the operative procedure.ResultsOlfactory epithelium was found in 59.1% of the subjects. Of the samples, 50% were of the quality necessary for morphological characterization and 90.9% had nerve bundles. There was no difference in the psychophysical scores obtained in the bilateral olfactory test (University of Pennsylvania Smell Identification Test [UPSIT®]) between means before biopsy: 32.3 vs. postoperative: 32.5, p = 0.81. Also, no significant decrease occurred in unilateral testing (mean unilateral test scores 6 vs. 6.2, p = 0.46). None out of the 56 different odorant identification significantly diminished (p > 0.05).ConclusionThe technique depicted for olfactory epithelium biopsy is highly effective in obtaining neuronal olfactory tissue, but it has moderate efficacy in achieving samples useful for morphological analysis. Olfactory sensitivity remained intact.     

Olfactory dysfunction in COVID-19: a marker of good prognosis?

IntroductionIn May 2020, the World Health Organization recognized olfactory dysfunction as a COVID-19 symptom. The presence of hyposmia/anosmia may be a marker of good prognosis in COVID-19.ObjectiveTo associate the presence of olfaction disorder to the clinical condition severity in patients with COVID-19.MethodsIndividuals with the flu syndrome caused by SARS-CoV-2, diagnosed from March to June 2020, were recruited. They were divided into three groups: mild flu syndrome, severe flu syndrome (admitted to hospital wards) and critical illness (admitted to the ICU). Inpatients were interviewed by telephone contact after hospital discharge and their medical records were also evaluated regarding complementary test results. Outpatients answered an electronic questionnaire containing only clinical information.ResultsA total of 261 patients participated in the study: 23.75% with mild flu syndrome, 57.85% with severe flu syndrome and 18.40% with critical illness. A total of 66.28% patients with COVID-19 had olfaction disorders. In approximately 56.58% of the individuals the smell alterations lasted between 9 days and 2 months. There was a significantly higher proportion of individuals with olfactory dysfunction in the group with mild flu syndrome than in the severe flu syndrome group (mild × severe – p < 0.001; Odds Ratio = 4.63; 95% CI [1.87–10.86]). This relationship was also maintained between patients with mild flu syndrome and critically-ill patients (mild × critical – p < 0.001; Odds Ratio = 9.28; 95% CI [3.52–25.53]).ConclusionOlfaction dysfunction was significantly more prevalent in patients with mild flu syndrome in COVID-19. It may be a predictor of a good prognosis for this infection. New population-based studies must be carried out to corroborate these findings.     

The diagnostic value of detecting sudden smell loss among asymptomatic COVID-19 patients in early stage: The possible early sign of COVID-19

ImportanceThe newly emerged coronavirus disease 19 (COVID-19), is threatening the world. Olfactory or gustatory dysfunction is reported as one of the symptoms worldwide. As reported so far, different clinical features have been reported according to outbreak sites and gender; most of the patients, who complained of anosmia or hyposmia, were Europeans. We had a fast review for novel articles about COVID-19 infection and olfactory function.ObservationsRapid reviews for COVID-19 or other viral infection and olfactory and/or gustatory dysfunctions were done in this review. Up to date, a lot of reports have shown that olfactory dysfunction is related to viral infections but no exact mechanism, clinical course, and definite treatment have been discovered, which is also same in COVID-19. In general, intranasal steroid (INS) and oral steroid for short time help improve the recovery of the olfactory function in case of olfactory dysfunction after virus infection. Considering severe respiratory complications and immunocompromised state of COVID-19, the use of steroid should be limited and cautious because we do not have enough data to support the usage of steroid to treat olfactory dysfunction in the clinical course of COVID-19.Conclusions and relevanceIn the days of pandemic COVID-19, we should keep in mind that olfactory dysfunctions, even without other upper respiratory infection or otolaryngologic symptoms, might be the early signs of COVID-19.     

2019冠状病毒疾病相关嗅觉障碍

2019冠状病毒疾病(COVID-19)的致病病毒为新型冠状病毒SARS-CoV-2,其主要临床表现为发热、干咳、乏力等上呼吸道感染症状,严重者可快速进展为急性呼吸窘迫综合征、脓毒症休克、难以纠正代谢性酸中毒和出凝血功能障碍及多器官功能衰竭等.多国流行病学研究调查表明嗅觉障碍是COVID-19的临床症状之一,甚至是部分...     

Alteraciones del olfato en la COVID-19, revisión de la evidencia e implicaciones en el manejo de la pandemia

There is debate as to whether olfactory dysfunction should be considered a symptom of COVID-19 infection. We undertook a systematic literature review of the articles indexed in PubMed on olfactory disorders in viral respiratory tract conditions, with special emphasis on COVID-19. The main objective was to find evidence of clinical interest to support the relationship between anosmia and COVID-19. Olfactory disorders in upper respiratory tract infections are frequent, most caused by obstruction due to oedema of the nasal mucosa. Occasionally, post-viral sensorineural olfactory dysfunction occurs, with a variable prognosis. The evidence on anosmia in COVID-19 patients is extremely limited, corresponding to a level 5 or D of the Centre for Evidence-Based Medicine. According to the available evidence, it seems reasonable to apply isolation, hygiene and social distancing measures in patients with recent olfactory disorders as the only symptom, although the usefulness of diagnostic tests for this type of patient should be studied.     

Patterns and clinical outcomes of olfactory and gustatory disorders in six months: Prospective study of 1031 COVID-19 patients

ObjectiveThis study aims to comprehensively evaluate olfactory and gustatory dysfunctions during the COVID-19 pandemic regarding onset, course, associated symptoms, prognosis and relation to patients' demographics, treatment received and other symptoms.Patients& methodsThis is a prospective study conducted on patients proven to be infected with COVID-19 and with olfactory/gustatory dysfunction symptoms. Detailed history was taken from each patient about the onset of this dysfunction, associated symptoms. Then follow-up survey was done after 6 months to evaluate the prognosis.Results1031 patients were included in the study, aged 18 to 69 years old, with 31.8% were male. Olfactory/gustatory dysfunctions occurred after other COVID-19 symptoms in 43.5% of cases, occurred suddenly in 80.4% and gradually in 19.6%. These dysfunctions were anosmia & ageusia in 50.2%, hyposmia & hypogeusia in 23.3%, anosmia alone in 17.7%, phantosmia in 18%, Parosmia in 28.4%. In terms of recovery 6-month follow up, 680 patients (66%) recovered completely, 22.1% recovered partially while 11.9% did not recover. Most improvement occurred in the first two weeks. Headache, malaise, nasal obstruction and rhinorrhea were the commonest COVID-19 symptoms associated.ConclusionMost recovery of olfactory/gustatory dysfunction in COVID-19 infection occurs at the first two weeks and is unrelated to patient demographics, treatment or olfactory training. Parosmia is an independent predictor for complete recovery, while phantosmia is significantly associated with lower probability of complete recovery.     

Natural trajectory of recovery of COVID-19 associated olfactory loss

ImportancePrevalence of post-viral olfactory loss has increased dramatically due to the frequency and severity of olfactory dysfunction associated with infection by the SARS-CoV-2 virus.ObjectiveTo determine the trajectory of COVID-19 olfactory loss over a six-month period. A key secondary objective is to assess predictive factors associated with the recovery of olfaction.DesignLongitudinal repeated-measures study that enrolled from May 5, 2020 to February 2, 2021, with the last date of data collection on June 15, 2021.SettingBarnes-Jewish HealthCare/Washington University School of Medicine facilities (Saint Louis, Missouri, USA).ParticipantsIndividuals who tested positive for SARS-CoV-2 by real-time polymerase chain reaction on nasopharyngeal swab and indicated olfactory loss on COVID-19 screening questionnaire. Individuals were excluded if they had previously diagnosed history of olfactory loss, neurodegenerative disorders, <18 years of age, admitted to hospital service, unable to read, write, and understand English, or lacked computer or internet access.Interventions/exposuresWatch and wait for spontaneous recovery.Main outcome(s) and measure(s)Participants completed olfactory assessments every 30 days for six months. Each assessment consisted of the University of Pennsylvania Smell Identification Test (UPSIT), an objective “scratch-and-sniff” test, and Clinical Global Impressions (CGI), a subjective Likert rating scale.ResultsThe mean age was 41 years old (SD = 16). 39 (80 %) were female and 42 (86 %) white. At baseline assessment of objective olfaction, 18 (36 %) participants had anosmia or severe hyposmia. Subjective, complete recovery at six months was 81 % (95 % CI 74 % to 88 %). Likelihood of recovery was associated with age <50 years (aHR = 8.1 (95 % CI 1.1 to 64.1)) and mild olfactory loss at baseline (UPSIT = 30–33 for males and 31–34 for females) (aHR 6.2 (95 % CI 1.2 to 33.0)).Conclusions and relevanceThe trajectory of olfactory recovery among adults with COVID-19 olfactory loss illustrated rapid recovery within 2–3 weeks of infection, and by six months 81 % had recovered based on self-report. Age <50 years old and mild severity of olfactory loss at baseline were associated with increased likelihood of recovery of olfaction. These findings can be used to inform shared decision-making with patients.     

Objective evaluation and predictive value of olfactory dysfunction among patients hospitalized with COVID-19

ObjectivesOlfactory dysfunction is a frequent feature of COVID-19. Despite the growing evidence, current knowledge on the subject remains insufficient, so that data obtained with different tools, from multiple centers and in distinct scenarios are welcome. Yet, the predictive value of olfactory dysfunction in terms of the overall prognosis of COVID-19 is unknown. This study aims to evaluate the olfactory function of hospitalized patients with COVID-19 and the impact of the results on their clinical outcomes.MethodsPatients with severe acute respiratory distress syndrome (ARDS) admitted to a university tertiary hospital were recruited and divided into those with ARDS due to COVID-19, and those with ARDS of any other cause. Sociodemographic and clinical data were collected at baseline and the patients had their objective olfactory function evaluated by the Alcohol Sniff Test on admission and during hospital stay. The participants were then followed up until reaching an endpoint: hospital discharge, endotracheal intubation, transfer to the intensive care unit, or death. Patients with COVID-19 were also subgrouped and compared according to their olfactory thresholds and to their overall clinical outcomes. The obtained data was analyzed using R software. Level of significance was set at 0.05.ResultsEighty-two patients were included (of which 58 had COVID-19). 87.93% of the patients with COVID-19 had diminished olfactory dysfunction on admission. The mean length of hospital stay among patients with olfactory dysfunction was greater (7.84 vs 6.14 days) and nine individuals in this subgroup had poor overall outcomes. None of those with normal olfactory function developed critical COVID-19. The mean olfactory function was significantly worse among patients with COVID-19 and poor outcomes (3.97 vs 7.90 cm, P = .023).ConclusionObjective olfactory dysfunction is frequent in ARDS caused by SARS-CoV-2 infection. Patients with longitudinal poorer outcomes present worse olfactory thresholds on admission.     

Incomplete and late recovery of sudden olfactory dysfunction in COVID-19

IntroductionSudden olfactory dysfunction is a new symptom related to COVID-19, with little data on its duration or recovery rate.ObjectiveTo characterize patients with sudden olfactory dysfunction during the COVID-19 pandemic, especially their recovery data.MethodsAn online survey was conducted by the Brazilian Society of Otorhinolaryngology and Cervico-Facial Surgery, and Brazilian Academy of Rhinology, including doctors who assessed sudden olfactory dysfunction patients starting after February 1st, 2020. Participants were posteriorly asked by e-mail to verify data on the recovery of sudden olfactory loss and test for COVID-19 at the end of the data collection period.Results253 sudden olfactory dysfunction patients were included, of which 59.1% were females with median age of 36 years, with a median follow-up period of 31 days. 183 patients (72.3%) had been tested for COVID-19, and of those 145 (79.2%) tested positive. Patients that tested positive for COVID-19 more frequently showed non-specific inflammatory symptoms (89.7% vs. 73.7%; p = 0.02), a lower rate of total recovery of sudden olfactory dysfunction (52.6% vs. 70.3%; p = 0.05) and a longer duration to achieve total recovery (15 days vs. 10 days; p = 0.0006) than the ones who tested negative for COVID-19. Considering only positive-COVID-19 patients, individuals with sudden hyposmia completely recovered more often than the ones with sudden anosmia (68.4% vs. 50.0%; p = 0.04).ConclusionPositive-COVID-19 patients with sudden olfactory dysfunction showed lower total recovery rate and longer duration than negative-COVID-19 patients. Additionally, total recovery was seen more frequently in positive-COVID-19 patients with sudden hyposmia than the ones with sudden anosmia.     

Anosmia caused by inhaled hazardous substances. Significance for expert assessment general practice

BACKGROUND: Both environmental and occupational pollutants can affect the functional integrity of the olfactory epithelium or even destroy olfactory tissue. However, occupational hyposmia and anosmia have not been included into the list of occupational diseases. Therefore, compensation of occupationally induced smell disorders is difficult. OBJECTIVE: To evaluate patients with toxic hyposmia for the pollutants involved and to discuss consequences for occupational and environmental medicine. METHODS: A total of 19 patients were evaluated in our departments between 1993 and 1997 for olfactory disorders related to environmental or occupational pollutants. The charts of these patients were retrospectically analyzed and the causative pollutants compared with the literature. RESULTS: A chronical exposure to mixtures of metal dusts and steam, volatile organic substances, and anorganic gases were the most common pollutants involved in occupational dysosmia. Only one case of acute development of an anosmia due to exposure to CO and combustion gases was documented. CONCLUSIONS: Olfactory disorders are underestimated in occupational and environmental medicine. Relevance of olfactotoxic substances for occupational medicine can be postulated in metal and chemical workers, in welding and disinfection. The list of occupational diseases should be completed by olfactory hyposmia and anosmia.     

上呼吸道感染后嗅觉障碍患者嗅上皮超微结构观察

目的通过对上呼吸道感染后嗅觉障碍的患者鼻腔大体及嗅上皮超微结构的研究，从形态学上观察嗅觉减退或丧失的超微结构改变。方法选择上呼吸道感染后嗅觉减退或丧失患者10例，用T＆T嗅觉测试法测试患者的嗅觉功能。常规前鼻镜、鼻内镜下对鼻腔大体结构进行观察，鼻内镜下钳取嗅区黏膜行透射电镜超微结构观察。结果上呼吸道感染后嗅觉障碍患者嗅黏膜超微结构有以下变化：①嗅上皮结构层次仍能保持，但细胞间隙增宽；②上皮表面嗅泡明显减少，即使嗅泡存在，其末端的纤毛也明显减少，部分嗅泡呈空泡状改变；③微绒毛细胞和支持细胞表面的微绒毛减少或缺失；④支持细胞的细胞核变形或固缩，嗅细胞的树突水肿变形，细胞器减少。结论上呼吸道感染后嗅觉功能障碍与嗅黏膜上皮超微结构的改变密切相关。患者嗅泡及嗅泡内纤毛缺失，微绒毛细胞及支持细胞的微绒毛减少是引起嗅觉减退的主要原因，支持细胞胞核的变形及嗅细胞树突的形态学改变与嗅觉改变相关。     

A multicenter study to investigate the positive rate of SARS-CoV-2 in middle ear and mastoid specimens from otologic surgery patients

ObjectiveSevere acute respiratory syndrome coronavirus-2 (SARS-CoV-2), a novel coronavirus, causes coronavirus disease 2019 (COVID-19). Otologic surgeries with drilling by powered instruments induce significant aerosols, which may induce SARS-CoV-2 transmission to medical staff if SARS-CoV-2 exists in the middle ear and mastoid cavity. During a COVID-19 pandemic, therefore, confirming a negative COVID-19 test prior to otologic surgery is recommended. However, previous coronavirus studies demonstrated that coronavirus was detected in the middle ear in some patients even though the polymerase chain reaction (PCR) test using their nasopharyngeal swab was negative. This study aimed to elucidate the probability of a positive SARS-CoV-2 PCR test in the middle ear or mastoid specimens from otologic surgery patients in whom SARS-CoV-2 was not detected by preoperative PCR test using a nasopharyngeal swab.MethodsWe conducted a prospective, multicenter clinical study. Between April 2020 and December 2021, during the COVID-19 pandemic, 251 ears of the 228 participants who underwent otologic surgery were included in this study. All participants had no symptoms suggesting COVID-19 or close contact with a confirmed COVID-19 patient two weeks prior to the surgery. They were also negative in the SARS-CoV-2 PCR tests using a nasopharyngeal swab before surgery. We collected mucosa, granulation, bone dust with mucosa or fluid from the middle ear or mastoid for the SARS-CoV-2 PCR tests during each otologic surgery.ResultsThe median age of the participants at surgery was 31.5 years old. Mastoidectomy using a powered instrument was conducted in 180 of 251 otologic surgeries (71.8%). According to intraoperative findings, active inflammation in the middle ear or mastoid cavities was evident in 20 otologic surgeries (8.0%), while minor inflammation was observed in 77 (30.7%). All SARS-CoV-2 PCR tests of otologic specimens showed a negative result. No patient suffered from COVID-19 within two months after otologic surgery. Furthermore, no hospital-acquired infections associated with otologic surgery occurred in our institutionsConclusionsOur results showed that PCR testing did not detect SARS-CoV-2 in middle ear and mastoid specimens, suggesting that the risk of transmission of SARS-CoV-2 is not high in otologic surgeries even using powered instruments when both clinical and laboratory tests are confirmed to be negative for COVID-19.     

Patients with COVID-19-associated olfactory impairment also show impaired trigeminal function

ObjectiveNext to olfactory function, the nose can also perceive chemestetic sensations mediated by the trigeminal nerve. While olfactory dysfunction as a symptom of COVID-19 is well described, there has been little research on the limitation of other nasal sensory inputs due to SARS-CoV-2 infection. The aim of this study was to determine possible limitations of nasal chemesthesis after COVID-19 infection by a psychophysiological diagnostic tool.MethodsIn 65 patients with a PCR-confirmed, former COVID-19 disease, olfaction was tested by means of a sniffin' sticks test, tasting by taste sprays and chemesthesis with a menthol dilution series. The subjective self-assessment of the patients was recorded via a questionnaire.ResultsWe found a restriction of nasal chemesthesis and the extent correlated with the loss of smell, as well as with the values of the taste score, but not with subjective self-assessment.ConclusionNot only the ability to smell and taste, but also nasal chemesthesis is affected by COVID-19.     

Biomolecular endotype factors involved in COVID-19 airway infectivity: A systematic review

ObjectivesTo review the current knowledge of biomolecular factors surrounding otorhinolaryngeal illnesses and analyze their presence in COVID-19 virulence. Emphasis was placed on cytokines and vitamin D for determining susceptibility of illness.MethodsA primary literature search of PubMed and Google Scholar for articles published between January 1, 2002 to May 31, 2020, was performed without language restrictions from May 8, 2020 to May 31, 2020. A focused second search was conducted from October 31, 2020 to November 2, 2020 for articles published between January 1, 2002 to October 31, 2020. Eligible articles were selected after evaluation of titles, abstracts, and references. A total of 45 were included in this review.ResultsDiffering endotype classification schemes are used to determine cytokines present in chronic rhinosinusitis, asthma, and allergies. While immunologic responses and biomarkers are primary methods of differentiation, recent literature has also implicated geographic distribution of chronic rhinosinusitis patients in accounting for cytokine variations. The cytokines of interest (IL-4, IL-13, and INF-γ) present in the endotypes of these conditions may point towards protective mechanisms against COVID-19 through downregulation of the ACE2 receptor. These cytokines and Vitamin D highlight new areas of study for factors affecting SARS-CoV-2 virulence.ConclusionsFurther research is needed to understand the effects of Vitamin D and the various cytokines prevalent among endotypes of nasal/pharyngeal illnesses on COVID-19 pathogenesis. Findings may point towards epidemiologic trends of SARS-CoV-2 transmission and have future therapeutic indications.     

Congenital anosmia

Seven patients with congenital anosmia underwent detailed chemosensory evaluation, followed by the performance of biopsies of the olfactory region. Olfactory epithelium was not found in any of the biopsy specimens. It appears therefore that patients with congenital anosmia lack any olfactory epithelium. Several possible explanations for this finding are discussed. The most attractive hypothesis is that the olfactory placode forms either normally or abnormally during development but later degenerates and is replaced with respiratory epithelium. Only one patient in our series had congenital anosmia in association with a syndrome (Kallmann's syndrome), indicating that congenital anosmia is found more often as an isolated symptom.     

The effects of SARS-CoV-2 on hearing thresholds in COVID-19 patients with non-hospitalized mild disease

IntroductionCOVID-19 may have many nonspecific symptoms, such as hearing loss, tinnitus and dizziness. This study aims to investigate the effects of SARS-CoV-2 on the hearing thresholds of patients with COVID-19.MethodsA total of 20 patients aged 20–55 years who were diagnosed with COVID-19 were included in this study. The relationship between the pure-tone thresholds of patients before and after COVID-19 was evaluated.ResultsThere was no statistically significant difference between bone conduction pure-tone thresholds in all frequencies before and after COVID-19.ConclusionSARS-CoV-2 has no effects on the hearing thresholds in patients with non-hospitalized mild COVID-19 disease. Further studies are needed to investigate the possible effects of SARS-CoV-2 on the auditory system.     

Clinical,virological and immunological evolution of the olfactory and gustatory dysfunction in COVID-19

PurposeNew-onset olfactory and gustatory dysfunction (OGD) represents a well-acknowledged COVID-19 red flag. Nevertheless, its clinical, virological and serological features are still a matter of debate.Materials and methodsFor this cohort study, 170 consecutive subjects with new-onset OGD were consecutively recruited. Otolaryngological examination, OGD subjective grading, nasopharyngeal swabs (NS) for SARS-CoV-2 RNA detection and serum samples (SS) collection for SARS-CoV-2 IgG quantification were conducted at baseline and after one (T1), two (T2) and four weeks (T3).ResultsSARS-CoV-2 infection was confirmed in 79% of patients. Specifically, 43% of positive patients were detected only by SS analysis. The OGD was the only clinical complaint in 10% of cases. Concurrent sinonasal symptoms were reported by 45% of patients. Subjective improvement at T3 was reported by 97% of patients, with 40% recovering completely. Hormonal disorders and RNA detectability in NS were the only variables associated with OGD severity. Recovery rate was higher in case of seasonal influenza vaccination, lower in patients with systemic involvement and severe OGD. Not RNA levels nor IgG titers were correlated with recovery.ConclusionClinical, virological and serological features of COVID-19 related OGD were monitored longitudinally, offering valuable hints for future research on the relationship between host characteristics and chemosensory dysfunctions.