Olfactory and Oral Manifestations of COVID-19: Sex-Related Symptoms-A Potential Pathway to Early Diagnosis

Abstract

Objective: The coronavirus disease 2019 (COVID-19) pandemic poses a threat to global health. Early diagnosis is an essential key to limit the outbreak of the virus.

Study design: Case series, study conducted between March 25, 2020, and April 15, 2020.

Setting: Ambulatory, nonhospitalized patients who were quarantined in a designated hotel for COVID-19 patients and were recruited by an advertisement at the hotel.

Subjects and methods: In total, 140 patients participated in a web-based questionnaire assessing initial symptoms of common viral diseases, olfactory and taste functions, xerostomia, and orofacial pain.

Results: A total of 58 men and 70 women participated. Initial symptoms were cough (59.4%), weakness (47.7%), myalgia (46.9%), fever (42.2%), headache (40.6%), impaired sense of smell (38.3%), impaired sense of taste (32.8%), sore throat (26.6%), runny nose (26.6%), and nasal congestion (22.7%). All symptoms were more frequent among women; however, only runny nose was statistically significant (P = .018). The most common combination of symptoms was cough and weakness (37.5%). A total of 25.8% reported olfactory and taste dysfunctions in the absence of other symptoms. In a comparison between the sexes, cough and runny nose were the most common combination in women (P = .018). A total of 38.3% of patients reported olfactory dysfunction as an initial symptom. Anosmia and facial pain were more common among women (P < .001 and P = .01, respectively), and 56% of patients reported xerostomia.

Conclusion: A considerable number of patients presented with olfactory and oral disorders. Interestingly, women presented with a different cluster of symptoms than men, which may suggest a new clinical approach to diagnosing COVID-19 disease.

Keywords: COVID-19; anosmia; coronavirus; dysgeusia; xerostomia.

Figure 1.

Pain locations (facial and masticatory muscle pain). (A) Facial pain. (B) Left side masticatory muscle pain. (C) Right side masticatory muscle pain.

Figure 2.

Combinations of initial symptoms. The grid in the lower part maps the combination of symptoms examined (x-axis); the corresponding value on the y-axis is the overall prevalence in the sample (black solid line), prevalence among men (blue dot-dashed line), and prevalence among women (red dashed line). The upper panel reports that Fisher’s odds ratio test for the null odds ratio of men vs women is 1. For example, the far-left column shows the prevalence of patients who experienced both cough and weakness: ≈35% overall, ≈33% of women, and ≈41% of men. Odds ratio with P≈ .4. Sixty most frequent combinations are displayed; in 5 combinations, women had significantly increased odds compared to men with P < .05 (gray vertical lines).

Figure 3.

Twenty-three symptom combinations with significant odds ratio (P < .05) between men and women. The 128 patients reported 88 unique combinations of symptoms; in 23, there was a significant difference in odds between women and men. The corresponding P values are annotated and aligned with each combination.