How common are taste and smell abnormalities in COVID-19? A systematic review and meta-analysis

Abstract

Objective: Olfactory and gustatory dysfunction (OGD) are important early clinical symptoms of COVID-19. We aim to calculate the pooled prevalence of these symptoms and discuss the likely implications on clinical practice such as their use as screening tools and potential prognosis indicators.

Methods: Using a combination of keywords and medical subject headings, we searched for observational studies in the following five databases: Medline/PubMed, Scopus, Cochrane Library, Web of Science, and Google Scholar. Two authors independently screened and selected the final articles according to the inclusion criteria. Two investigators independently assessed the risk of bias in individual studies using the Newcastle-Ottawa Scale. Heterogeneity and publication bias were also assessed. The reported outcome of the pooled analysis was the prevalence of OGD calculated using a random-effect model. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were followed to report results.

Results: Seventeen studies with a total sample size of 4149 were included in this meta-analysis. Out of these, 2106 and 2676 patients reported some degree of olfactory and/or gustatory dysfunction with COVID-19, respectively. The reported outcomes were in terms of pooled prevalence, with gustatory dysfunction being 57.33% and olfactory dysfunction being 59.69%, a significantly high occurrence.

Conclusion: There is a high occurrence of smell and taste impairment in COVID-19. Given the lack of objective testing for detecting OGD in most studies, the high prevalence found is likely to be an underestimation of the true prevalence. This implies that physicians must use them as reliable early indicators of COVID-19 and employ them before using expensive tests.

Keywords: COVID-19; Gustatory dysfunction; Meta-analysis; Olfaction disorders; Smell; Taste.

Figure 1

PRISMA flow diagram showing inclusion of studies.

Figure 2

Forest plot illustrating the meta-analysis of the pooled prevalence of gustatory dysfunction in patients with COVID-19.

Figure 3

Forest plot illustrating the meta-analysis of the pooled prevalence of olfactory dysfunction in patients with COVID-19.

Figure 4

A. Subgroup analysis for the prevalence of olfactory dysfunction assessed using validated methods in patients with COVID-19. B. Subgroup analysis for the prevalence of olfactory dysfunction assessed using non-validated methods in patients with COVID-19.

Figure 5

Sensitivity analysis for the prevalence of gustatory dysfunction in patients with the COVID-19 after removing studies with a small sample size (<100 participants).