Luigi Angelo Vaira1*, MD; Giovanni Salzano2, MD; Marzia Petrocelli3, MD; Giovanna Deiana4, MD; Francesco Antonio Salzano5, MD; Giacomo De Riu1MD, FEBOMFS.
1 Maxillofacial Surgery Operative Unit, University Hospital of Sassari, Viale San Pietro 43/B, 07100 Sassari, Italy.
2 Maxillofacial Surgery Operative Unit, University Hospital of Naples “Federico II”, Via Pansini 5, 80131 Naples, Italy.
3 Maxillofacial Surgery Operative Unit; Bellaria and Maggiore Hospital, AUSL Bologna, Italy.
4 Department of Medical, Surgical and Experimental Sciences, University of Sassari, Viale San Pietro, 07100 Sassari, Italy.
5 Department of Medicine, Surgery and Dentistry, “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi (Salerno), Italy
*Corresponding Author:
Luigi Angelo Vaira
Viale San Pietro 43/B
e-mail: luigi.vaira@gmail.com
tel.: +393401846168
fax: +39079229002
Keywords: COVID-19; anosmia; ageusia; gustatory function; olfactory function.
Abstract
Background. Chemosensitive disorders are very frequent in the
early stages of COVID-19 and in paucisymptomatic cases. These patients
are typically placed in home quarantine. This study has the aim of
validating a new olfactory and gustatory objective evaluation test in
these patients.
Methods. Thirty-three home-quarantined COVID-19 patients have
undergone a self-administered chemosensitive test the day before the
control swab. On this occasion, the patients underwent
operator-administered already validated tests. The results were finally
compared.
Results. The differences between the results of the two tests
were not significant for both the olfaction (P = 0.201) and the taste (P
= 0.180).
Conclusion. The olfactory and gustatory evaluation by
self-administered test can be considered a valid tool, fundamental for
obtaining objective qualitative and quantitative data on the extent of
chemosensitive disorders in home-quarantined COVID-19 patients.
INTRODUCTION
Olfactory and gustatory dysfunctions are proving to be frequent symptoms
of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
infection. The first European reports on coronavirus disease 19
(COVID-19) patients are detecting a frequency of these symptoms ranging
between 19.4% and 88% [1-5]. Particularly, chemosensitive
dysfunctions appear to be common in the early stages of infection from
severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and in
paucisymptomatic patients [1,2]. However, all the reports published
so far are anamnestic or observational and the literature lacks
objective studies that evaluate the gustatory and olfactory function in
these patients. Assessing the patient in the hospital is difficult due
to the entry restrictions into the COVID-19 Departments and to the fact
that the most serious cases that require hospitalization, are generally
uncooperative. Moreover, hospitalized patients are generally in the late
stages of the infection and it would instead be interesting to acquire
objective information on asymptomatic or initial cases, in order to find
trigger symptoms that can allow early identification and isolation of
suspect cases. Generally, the latter patients are in home quarantine.
Therefore, checking and evaluating them at home presents almost
insurmountable logistical problems during an emergency health situation
like the one we are facing. An objective and validated self-administered
test would be a valuable tool for the remote evaluation of these
patients.
Psycho-physiological tests represent a workhorse in the objective
evaluation of the olfactory and gustatory functions as they are easy to
perform, standardized, validated and repeatable [6,7]. These tests
are generally based on the blindness of the assessed patient, which
guarantees the reliability and validity of the results. Clearly, this
basic principle cannot be insured if the subject, in home isolation, is
asked to self-administer the test.
The aim of this work is to overcome this bias, developing a new
self-administered psycho-physiological olfactory and gustatory test that
could be used to evaluate COVID-19 patients in home quarantine.
The same group of patients, after the completion of the proposed
self-administered test, underwent direct clinical evaluation with widely
used and validated tests for anosmia and ageusia. Then, the results of
both kind of tests were statistically compared to validate the
self-administered evaluation protocol.
MATERIALS AND METHODS
The study was conducted between April 9th and 10th 2020, on home-quarantined SARS-CoV-2 positive
patients, followed by the Surveillance and Prevention Department of the
University of Sassari, University of Salerno and Bellaria-Maggiore
Hospital of Bologna. All patients belonged to the healthcare staff of
the involved hospitals (i.e. doctors, nurses, auxiliary staff).
The inclusion criteria were: home quarantined adults, age >
18 years old, rhino-pharyngeal swab positive for SARS-CoV-2 infection,
scheduled control swab, voluntary participation in the study.
Previous surgery or radiotherapy in the oral and nasal cavities,
pre-existing manifestation of smell and taste alterations, history of
head trauma, allergic rhinitis, chronic rhinosinusitis and psychiatric
or neurological disorders were considered as exclusion criteria.
The study protocol was approved by an independent ethics committee (n°
378-2020-OSS-AUSLBO).
The day before the scheduled control swab, patients in home quarantine
were asked to participate in the study. In case of acceptance, some
general information was collected for all subjects: gender, age, job
position, comorbidity or conditions that could be cause of exclusion,
which symptoms presented and when these symptoms started, when
positivity to the first nasopharyngeal swab was confirmed. All patients
were carefully investigated for the previous or current presence of
chemosensitive disorders during the SARS-CoV-2 infection. Finally, the
test methodology was explained and patients were asked to collect 7
common household odorants and prepare the 4 basic flavored necessary
solutions, thus contacting the operator again to perform the telephone
test.
The next morning at the hospital, before the control swab, patient’s
chemosensitive functions were directly evaluated by a different trained
operator.