Anosmia in COVID-19 Patients: Can We Predict the Severity of Chest Manifestations?

Hendawy, Ehsan; El-Anwar, Mohammad Waheed; Elghamry, Reda M.; Abdallah, Amany M.; Ibrahim, Amin M.

doi:10.1055/s-0042-1758716

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International Archives of Otorhinolaryngology

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Original Research • iao 27 (1) • Jan-Mar 2023 • https://doi.org/10.1055/s-0042-1758716 copy

Anosmia in COVID-19 Patients: Can We Predict the Severity of Chest Manifestations?

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Anosmia is one of the common symptoms of COVID-19, the link between severity of chest infection and anosmia was investigated by few studies.

Objectives

To find an association between anosmia and severity of chest infection.

Methods

An analysis of patients admitted to isolation hospital of our university with confirmed polymerase chain reaction positive testing for COVID-19, between March 2021 until September 2021. We called all patients who reported anosmia during their time of illness and asked them about anosmia. We examined their chest CT. A statistical analysis was done.

Results

A total of 140 patients completed the study; 65% were female and 56.4% had complete anosmia. Anosmia was significantly associated with loss of taste. Smell returned in 92.5% of anosmic patients. Duration of smell loss was ~ 2 weeks in 40.5%. The most common symptoms associated with anosmia were running nose, sore throat, fever, and cough. Loss of smell was significantly associated with mild chest disease. 73.4% of anosmic patients had mild chest infection, 21.5% of them had moderate infection, and 5.1% had severe chest infection.

Conclusion

The pattern of anosmia in COVID-19 patients has some common similarities in general; the way it starts, the associated symptoms, the time until smell returns and, the most important, the severity of chest infection. As anosmia is significantly associated with mild chest infection. the presence of anosmia could be an independent predictor of good COVID-19 outcome as reflected by a lower disease severity and less frequent ICU admissions.

Keywords
anosmia; COVID-19; chest disease

	n = 140	%
Age (years old):
20–40	87	62.1%
41–60	36	25.7%
61–70	17	12.1%
Gender:
Male	49	35.0%
Female	91	65.0%
Complete loss of smell: Yes	79	56.4%
Sudden loss of smell Yes	77	55.0%
Change in smell: Yes	7	5.0%
Sudden loss of taste: Yes	61	43.6%
Complete loss of taste: Yes	66	47.1%
Change in taste: Yes	18	12.9%
Symptoms & signs
Fever	80	57.1%
Shivering	19	13.6%
Cough	67	47.9%
Sore throat	61	43.6%
Running nose	53	37.9%
Difficult breathing	41	29.3%
Fatigue	61	43.6%
Headache	51	36.4%
Diarrhea	28	20.0%
Others	5	3.6%

Parameter	Loss of smell		Test
	Present	Absent	χ²	p-value
	n = 79 (%)	n = 61 (%)	χ²	p-value
Gender:
Male	22 (27.8%)	23 (41.1%)	2.579	0.108
Female	57 (72.2%)	33 (58.9%)	2.579	0.108
Age group (years old):
20–40	57 (72.2%)	29 (51.8%)	4.058^¥ ¥ Chi-squared for trend test X2 chi-squared test p < 0.05 is statistically significant * p ≤ 0.001 is statistically highly significant	0.032*
41–60	15 (19.0%)	19 (33.9%)
61–70	7 (8.9%)	8 (14.3%)
Chronic diseases	22 (27.9%)	27 (44.3%)	4.08	0.043*
Fever	35 (44.3%)	45 (73.8%)	12.201	< 0.001**
Shivering	18 (22.8%)	1 (1.6%)	11.949	0.678
Cough	34 (43.0%)	33 (54.1%)	1.687	0.14
Sore throat	44 (55.7%)	17 (27.9%)	10.841	< 0.001**
Running nose	44 (55.7%)	9 (16.1%)	24.526	< 0.001**
Difficult breathing	16 (20.3%)	25 (35.7%)	24	0.045*
Fatigue	39 (49.4%)	22 (36.1%)	2.477	0.116
Headache	35 (44.3%)	16 (41.0%)	7.143	0.008*
Diarrhea	22 (27.8%)	6 (9.8%)	6.97	0.008*
Other symptoms	5 (6.3%)	0 (0%)	Fisher	0.068
Chest affection:
Mild	58 (73.4%)	33 (54.1%)	6.135^¥ ¥ Chi-squared for trend test X2 chi-squared test p < 0.05 is statistically significant * p ≤ 0.001 is statistically highly significant	0.01 3*
Moderate	17 (21.5%)	20 (32.8%)
Severe	4 (5.1%)	8 (13.1%)
COR (95%CI) moderate	0.48	(0.22–1.05)
COR (95%CI) severe	0.28	(0.08–1.02)
ICU admission:
Yes	8 (10.1%)	33 (54.1%)	32.138	< 0.001**
Loss of taste
Yes	65 (82.3%)	1 (1.6%)	Fisher	< 0.001**
Mortality	0 (0%)	5 (8.2%)	Fisher	0.014*

	β	Wald	p-value	AOR	95%CI
	β	Wald	p-value	AOR	Lower	Upper
Absence of chronic disease	1.252	6.971	0.008*	3.44	1.381	8.866
Fever	1.737	12.149	< 0.001**	5.68	2.139	15.086
Running nose	2.460	21.455	< 0.001**	11.706	4.133	33.150
Headache	1.816	10.692	0.001**	6.145	2.070	18.246
Diarrhea	1.252	6.109	0.013*	4.602	1.372	15.438

Parameter	Return smell		Test
	Returned	Did not return	χ²	p-value
	n = 73 (%)	n = 6 (%)	χ²	p-value
Severity of chest infection:
Mild	53 (72.6%)	5 (83.3%)	0.453^¥ ¥ Chi-squared for trend test X2 chi-squares test *p < 0.05 is statistically significant.	0.501
Moderate	16 (21.9%)	1 (16.7%)
Severe	4 (5.5%)	0 (0.0%)
Gender:
Male	20 (27.4%)	2 (33.3%)	Fisher	0.669
Female	53 (72.6%)	4 (66.7%)
Age group (years old):
20–40	54 (74.0%)	3 (50.0%)			0.277^¥ ¥ Chi-squared for trend test X2 chi-squares test *p < 0.05 is statistically significant.	0.599
41–60	12 (16.4%)	3 (50.0%)
61–70 years	7 (9.6%)	0 (0.0%)
Chronic diseases	18 (24.7%)	4 (66.7%)	4.08	0.048*

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[1] Address for correspondence Ehsan Hendawy, MD, Department of Otorhinolaryngology, Head-Neck Surgery, University of Zagazig, Zagazig, Egypt, Postal Code: 44511 (e-mail: ehsanhendawy@gmail.com).