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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 4  |  Issue : 4  |  Page : 348-351

Smell disturbance among Saudi COVID-19 Patients


1 Department of Otolaryngology, College of Medicine, King Saud University, Riyadh, Saudi Arabia
2 Medical intern, College of Medicine, King Saud University, Riyadh, Saudi Arabia
3 Dental intern, College of Medicine, King Saud University, Riyadh, Saudi Arabia

Date of Submission22-Nov-2020
Date of Acceptance13-Jun-2021
Date of Web Publication06-Oct-2021

Correspondence Address:
Ahmad S Alroqi
Department of Otolaryngology, College of Medicine, King Saud University, Riyadh
Saudi Arabia
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jnsm.jnsm_148_20

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  Abstract 


Objectives: Recently, COVID-19 was declared a pandemic, and since then, many studies have examined its symptomatology. In this study, we aimed to focus on Saudi patients with COVID-19 who also experienced smell dysfunction. We hypothesized that there would be a high percentage of COVID-19 patients with smell dysfunction in the Saudi population. Methodology: A quantitative, observational, cross-sectional study was carried out in Riyadh, Saudi Arabia in August 2020 and was designed to assess anosmia and hyposmia in Saudi patients with a positive COVID-19 test. Only Saudi adults with confirmed COVID-19 were enrolled in the study. We distributed an electronic, self-administered questionnaire through social media platforms, and personal contact to query the patients who had a positive COVID-19 test. Results: The study included 1005 patients, of whom 63.5% were female. More than three quarters (76.7%) were between the ages of 18 and 38 years. Most of them (74.1%) were healthy, while some of them (25%) reported associated comorbidities. Overall, approximately three-quarters (72%) of the participants developed smell dysfunction during the infection period, with (17.3%) experiencing a partial loss of smell (hyposmia), and (54%) experiencing a complete loss of smell (anosmia). Conclusions: Our study revealed that approximately three-quarters (72%) of the participants with COVID-19 developed smell dysfunction during the infection period, which supports our hypothesis.

Keywords: Anosmia, coronavirus, COVID-19, dysosmia, hyposmia, olfaction, Saudi, smell dysfunction


How to cite this article:
Alroqi AS, Alothaim LO, Albugami SJ, Alothaim NO, Alqabbani AA, Alromaih SR, Alharbi SO, Alangari FS, Saja DK, AlMutawa SS. Smell disturbance among Saudi COVID-19 Patients. J Nat Sci Med 2021;4:348-51

How to cite this URL:
Alroqi AS, Alothaim LO, Albugami SJ, Alothaim NO, Alqabbani AA, Alromaih SR, Alharbi SO, Alangari FS, Saja DK, AlMutawa SS. Smell disturbance among Saudi COVID-19 Patients. J Nat Sci Med [serial online] 2021 [cited 2021 Dec 1];4:348-51. Available from: https://www.jnsmonline.org/text.asp?2021/4/4/348/327593




  Introduction Top


The outbreak in Saudi Arabia began with one case of a Saudi national who had recently returned from Iran. The COVID-19 diagnosis was confirmed on March 2, 2020. According to the WHO, the most common symptoms are fever, dry cough, and dyspnea, and the less common symptoms are sore throat, loss of taste or smell, diarrhea, and headache. However, several studies have revealed a significant association between anosmia and COVID-19 in the United States, Europe, South Korea, and Turkey.

One study of 417 patients with laboratory-confirmed COVID-19 across 12 European hospitals found that change in smell was a common clinical finding in patients who were positive for COVID-19.[1] A study from Germany has also reported that anosmia was found in more than two-thirds of patients, while Italian and Swiss doctors have reported similar findings, with many patients displaying ageusia. In addition, data from South Korea suggest that anosmia is present in 30% of patients who are positive for COVID-19.[2]

Another study in Iran found that 98% of patients experienced some smell dysfunction.[3] Furthermore, a study in the USA reported that 68% of the patients who tested positive for COVID-19 experienced a loss of smell compared to 16% who were negative for COVID-19 and concluded that “chemosensory dysfunction was strongly associated with COVID-19 infection and should be considered when screening symptoms.”[4]

In contrast to these countries, China has reported that olfactory dysfunction (OD) is an uncommon symptom. Many other previous studies reported that anosmia manifests in the early stages of the disease or in less severe COVID-19 disease.[5],[6] In a Korean study, the prevalence was significantly more common among females, and younger individuals, although two studies found that OD was not related to sex or age. Another study found that anosmia was more common in COVID-19 disease than in other respiratory infections. Therefore, anosmia can be a good indicator for COVID-19, and smell testing can be used as a screening tool.

In this study, we aim to explore the smell dysfunction in Saudi patients confirmed to have COVID-19.


  Methodology Top


A quantitative, observational, and cross-sectional study was designed to assess anosmia and hyposmia in Saudi patients with confirmed COVID-19 disease. The study was carried out in Riyadh, Saudi Arabia, in August 2020. The Arabic survey link was distributed after obtaining IRB approval. The study was approved by the Institutional Review Board Committee in King Saud University College of Medicine Board Research on research project on 20 July 2020, with Ref. No. E-20-5095. The questionnaire contained 12 questions that assessed the presence of anosmia and hyposmia in patients with confirmed COVID-19 as well as the onset, duration of their symptoms, the severity of their case, and whether they had any comorbidities. It also included sociodemographic factors such as age and gender. We distributed an electronic self-administered questionnaire through social media platforms and personal contact persona to query patients who had a positive COVID-19 test. A total of 1005 responses were gathered over a 14-day period from August 6, 2020, to August 20, 2020. After collecting the data using Google Docs, the data were exported to Microsoft Excel, where coding was performed. We analyzed the data using IBM SPSS Statistics, version 24 (IBM Corp., Armonk, N.Y., USA).

Only Saudi adults who were confirmed to have COVID-19 were enrolled in the study. Descriptive statistics (frequencies and percentages) were used to describe the variables. Statistical analyses were carried out using the Chi-square test and were based on the type of study and outcome variables. A P < 0.05 and a (95%) confidence interval were used to report the statistical significance and precision of the results.

Regarding ethical considerations, informed consent was obtained, which indicated the purpose of the study, and the right of the participant to withdraw at any time without any obligation toward the study team. The authors have no conflicts of interest to declare.


  Results Top


Of the 1005 patients enrolled in the study, 63.5% were female. More than three quarters (76.7%) were between the ages of 18 and 38. Most of them (74.1%) were healthy, while some of them (25.9%) reported associated comorbidities [Figure 1]. Overall, approximately, three-quarters (72%) of the participants developed smell dysfunction during the diagnosis of COVID-19, with 17.3% (24% of those reported smell dysfunction) experiencing hyposmia, that is, a partial loss of smell, and 54% (76% of those reported smell dysfunction) experiencing anosmia, that is, a complete loss of smell [Figure 2].
Figure 1: Relation between comorbidities and smell dysfunction among studied cases

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Figure 2: Sense of smell in COVID-19 patients

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When comparing female and male patients, female patients showed a significantly higher incidence of smell dysfunction after being diagnosed with COVID-19 (P < 0.001). Within their respective groups, age was not significantly correlated with smell dysfunction (P = 0.239) [Table 1]. The presence of comorbidities was not putting the patients at higher risk of smell dysfunction with the exception of obesity that was found a protective factor (P = 0.043) [Figure 1]. However, further logistic regression was applied to detect confounding factors as predictors of loss of smell, in which loss of smell was entered as a dependent variable, and comorbidities were entered as covariables. The result showed nonsignificant relation between comorbidities and loss of smell.
Table 1: Demographics and smell dysfunction

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In comparing hyposmia and anosmia, patients with anosmia were more likely to notice loss of smell before the diagnosis of COVID-19 was confirmed (P = 0.001), and patients with hyposmia were more likely to experience symptoms within a shorter duration of 1 week or less (P = 0.001) [Table 2].
Table 2: Type of smell dysfunction and smell progression

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  Discussion Top


In December of 2019, many patients in China presented with fever and respiratory symptoms that were thought to be a result of pneumonia of unknown origin but were later determined to be symptoms of infection by a new strain of the coronavirus 2 (SARS-CoV2), and the disease was eventually named coronavirus disease (COVID-19). This highly contagious disease has been rapidly spreading.

Recently, COVID-19 was declared a pandemic, and many studies have investigated the symptomatology ever since. In this study, we aimed to focus on Saudi patients with COVID-19 who also experienced smell dysfunction. We hypothesized that there would be a high percentage of smell dysfunction in the Saudi population, similar to that previously reported in other populations. Our study indicates that a high prevalence of smell impairment is associated with COVID-19 infection.

The majority of respondents in this study reported smell impairment, with 54.7% reporting anosmia and 17.3% reporting hyposmia. This is consistent with previous studies.[7],[8],[9],[10] The results showed that half of the patients with smell impairment noticed impairment before confirmation of a COVID-19 diagnosis. In addition, 96.1% of the patients who had smell dysfunction due to COVID-19 were not diagnosed with smell impairment caused by any other disease before the COVID-19 era. This support that smell impairment manifests in the early stage of COVID-19 as reported in the previous studies.[8],[9],[11] Therefore, smell dysfunction can be used as a screening tool for early identification of COVID-19 to prevent and reduce the spread of the disease.[12],[13]

Smell impairments improved in most of our respondents (78%), with half of the cases of smell dysfunction lasting a week or less, and only 1% of the participants were hospitalized. Literature has reported that smell impairment occurs in mild COVID-19 cases,[14] but due to the limited number (seven participants in our data) being hospitalized with smell dysfunction, it is hard to confirm the same finding. Furthermore, most respondents reporting smell dysfunction were female, and between 18 and 39 years of age, which was similar to previous studies.[13],[14] A very small proportion of respondents were 65 years or older, as the survey was primarily distributed through social media, which is not commonly used by this age group.

Regarding comorbidities, most of the patients with smell impairment were healthy, although some of them reported having comorbidities with the most frequent being obesity followed by hypertension, lower airway disease, and diabetes mellitus. As smell dysfunction can affect the quality of life, further research is needed to establish the exact mechanisms of smell dysfunction in COVID-19 patients. The finding of obesity as a protective factor to have smell dysfunction can be explained by the possibility of having a confounding variable.

One of the limitations of this study was the distribution of an electronic questionnaire that took place during the quarantine associated with the COVID-19 pandemic. This affected our results because it was distributed only to people who had access to social media. It would be preferable to use another method to target all age groups. Another limitation is that patients themselves determined if they had a partial or complete loss of smell without undergoing examinations or objective smell testing; such examinations would help achieve a better understanding of the correlation, and pathogenesis of smell dysfunction in COVID-19 infection.


  Conclusion Top


COVID-19 is still a new disease with many questions that scientists are racing to answer. In this study, we sought to determine the prevalence of smell dysfunction in confirmed COVID-19 patients as well as the importance of this dysfunction. Our results revealed that approximately three-quarters (72%) of the participants with a confirmed COVID-19 diagnosis developed smell dysfunction during the infection period, which supports our hypothesis. Therefore, our findings can help in the early diagnosis and detection of COVID-19 in patients with smell dysfunction as the only symptom. Females were more likely to experience smell dysfunction than male and participants with obesity experienced smell dysfunction less than participants with other comorbidities.

Acknowledgment

We would like to thank the ENT Department at King Abdul-Aziz University Hospital, and the research center at King Saud University in Riyadh, Saudi Arabia, for supporting this study.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lechien JR, Chiesa-Estomba CM, De Siati DR, Horoi M, Le Bon SD, Rodriguez A, et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): A multicenter European study. Eur Arch Otorhinolaryngol 2020;277:1-11.  Back to cited text no. 1
    
2.
Gautier JF, Ravussin Y. A new symptom of COVID-19: Loss of taste and smell. Obesity 2020;28:848.  Back to cited text no. 2
    
3.
Moein ST, Hashemian SM, Mansourafshar B, Khorram-Tousi A, Tabarsi P, Doty RL. Smell Dysfunction: A Biomarker for COVID-19. Int Forum Allergy Rhinol 2020;10:944-50.  Back to cited text no. 3
    
4.
Yan CH, Faraji F, Prajapati DP, Boone CE, DeConde AS. Association of chemosensory dysfunction and COVID-19 in patients presenting with influenza-like symptoms. Int Forum Allergy Rhinol 2020;10:806-13.  Back to cited text no. 4
    
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Xydakis MS, Dehgani-Mobaraki P, Holbrook EH, Geisthoff UW, Bauer C, Hautefort C, et al. Smell and taste dysfunction in patients with COVID-19. Lancet Infect Dis 2020;20:1015-6.  Back to cited text no. 5
    
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Reinhard A, Ikonomidis C, Broome M, Gorostidi F. Anosmia and COVID-19. Revue Med Suisse 2020;16:849-51.  Back to cited text no. 6
    
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Roland LT, Gurrola JG, Loftus PA, Cheung SW, Chang JL. Smell and taste symptom-based predictive model for COVID-19 diagnosis. Int Forum Allergy Rhinol 2020;10:832-8.  Back to cited text no. 7
    
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Vaira LA, Deiana G, Fois AG, Pirina P, Madeddu G, De Vito A, et al. Objective evaluation of anosmia and ageusia in COVID-19 patients: Single-center experience on 72 cases. Head Neck 2020;42:1252-8.  Back to cited text no. 8
    
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Lee Y, Min P, Lee S, Kim SW. Prevalence and duration of acute loss of smell or taste in COVID-19 patients. J Korean Med Sci 2020;35:e174.  Back to cited text no. 9
    
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Sayin İ, Yaşar KK, Yazici ZM. Taste and smell impairment in COVID-19: An AAO-HNS anosmia reporting tool-based comparative study. Otolaryngol Head Neck Surg 2020;163:473-9.  Back to cited text no. 10
    
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Printza A, Constantinidis J. The role of self-reported smell and taste disorders in suspected COVID19. Eur Arch Otorhinolaryngol 2020;277:1-6.  Back to cited text no. 11
    
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Mao L, Jin H, Wang M, Hu Y, Chen S, He Q, et al. Neurologic manifestations of hospitalized patients with coronavirus disease 2019 in Wuhan, China. JAMA Neurol 2020;77:683-90.  Back to cited text no. 12
    
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Paderno A, Schreiber A, Grammatica A, Raffetti E, Tomasoni M, Gualtieri T, et al. Smell and taste alterations in COVID-19: A cross-sectional analysis of different cohorts. Int Forum Allergy Rhinol 2020;10:955-62.  Back to cited text no. 13
    
14.
Giacomelli A, Pezzati L, Conti F, Bernacchia D, Siano M, Oreni L, et al. Self-reported olfactory and taste disorders in patients with severe acute respiratory coronavirus 2 infection: A cross-sectional study. Clin Infect Dis 2020;71:889-90.  Back to cited text no. 14
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2]



 

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