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Practice 10-Minute Consultation

Anosmia and loss of smell in the era of covid-19

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m2808 (Published 21 July 2020) Cite this as: BMJ 2020;370:m2808

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  1. Abigail Walker, ear, nose, and throat specialist registrar1,
  2. Gillian Pottinger, GP partner2,
  3. Andrew Scott, patient representative,
  4. Claire Hopkins, professor of rhinology and consultant ear, nose, and throat surgeon3
  1. 1Department of Otolaryngology, University Hospital Lewisham, London, UK
  2. 2Garforth Medical Centre, Leeds, UK
  3. 3Department of Otolaryngology, Guy’s and St Thomas’ NHS Foundation Trust
  1. Correspondence to A Walker abiwalker{at}doctors.org.uk

What you need to know

  • Half of patients with covid-19 may lose sense of smell; guidance states that a new change or loss in sense of smell should prompt a period of self-isolation

  • Nine in 10 patients can expect substantial improvement in their sense of smell within four weeks

  • Most patients with loss of smell do not require further investigations or referral, although their covid-19 status should be established if possible

  • Treatment involves reassurance, olfactory training, safety advice, and topical corticosteroids—but oral prednisolone should be avoided where acute covid-19 infection is suspected

A 46 year old ophthalmologist presents with a two week history of loss of sense of smell and taste. He believes he may have been exposed to covid-19 but, at the time, did not meet the criteria for testing.

With the discovery of covid-19 and as the clinical syndromes associated with this virus have been defined, many areas of practice require updating. This article is a guide to assessment and management of patients with loss of smell based on review of the current literature and guidelines from the British Rhinology Society and ENT UK, the professional membership body representing ear, nose, and throat surgery in the UK.1

What you should cover

Olfactory dysfunction is common: estimates of point prevalence in the general population before the covid-19 pandemic suggest that 19.1% of adults (80% in people over 75) suffer from complete or partial loss of smell.2

Causes can be broadly subdivided into conductive (physical barriers to odorants reaching the olfactory system) and sensorineural (failure of the olfactory system to detect odorants). Causes are outlined in table 1, with the more common causes in the top half of the table and less common causes in the bottom half. A comprehensive history is invaluable, especially if consultations are performed remotely.

View this table:
Table 1

Causes of loss of smell

Points to …

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