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The outcome of olfactory impairment in patients with otherwise paucisymptomatic coronavirus disease 2019 during the pandemic

Published online by Cambridge University Press:  22 April 2021

M Jalessi
Affiliation:
Skull Base Research Centre, Tehran, Iran
S H Bagheri
Affiliation:
ENT Department and Head and Neck Research Centre, Tehran, Iran
Z Azad*
Affiliation:
Skull Base Research Centre, Tehran, Iran
F D Firouzabadi
Affiliation:
ENT Department and Head and Neck Research Centre, Tehran, Iran
E Amini
Affiliation:
Skull Base Research Centre, Tehran, Iran
R Alizadeh
Affiliation:
ENT Department and Head and Neck Research Centre, Tehran, Iran
S Chaibakhsh
Affiliation:
Eye Research Centre, The Five Senses Health Institute, Hazrat Rasoul Hospital, Iran University of Medical Sciences, Tehran, Iran
B Ghalehbaghi
Affiliation:
ENT Department and Head and Neck Research Centre, Tehran, Iran
C Hopkins
Affiliation:
Guy's and St Thomas’ Hospital, King's College, London, UK
M Farhadi
Affiliation:
ENT Department and Head and Neck Research Centre, Tehran, Iran
*
Author for correspondence: Dr Zahra Azad, Skull Base Research Center, Hazrat Rasoul Hospital, Niayesh St, Sattarkhan Ave, Tehran1445613131, Iran E-mail: zahraazadmd@gmail.com Fax: +98 216 652 5329

Abstract

Objective

This study aimed to measure the duration and recovery rate of olfactory loss in patients complaining of recent smell loss as their prominent symptom during the coronavirus disease 2019 outbreak.

Method

This was a prospective telephone follow-up observational study of 243 participants who completed an online survey that started on 12 March 2020.

Results

After a mean of 5.5 months from the loss of smell onset, 98.3 per cent of participants reported improvement with a 71.2 per cent complete recovery rate after a median of 21 days. The chance of complete recovery significantly decreased after 131 days from the onset of loss of smell (100 per cent sensitive and 97.7 per cent specific). Younger age and isolated smell loss were associated with a rapid recovery, whereas accompanying rhinological and gastrointestinal symptoms were associated with longer loss of smell duration.

Conclusion

Smell loss, occurring as a prominent symptom during the coronavirus disease 2019 pandemic, showed a favourable outcome. However, after 5.5 months from the onset, around 10 per cent of participants still complained of moderate or severe hyposmia.

Type
Main Articles
Copyright
Copyright © The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Dr Z Azad takes responsibility for the integrity of the content of the paper

References

Ibekwe, TS, Fasunla, AJ, Orimadegun, AE. Systematic review and meta-analysis of smell and taste disorders in COVID-19. OTO Open 2020;4:113CrossRefGoogle ScholarPubMed
World Health Organization. Global surveillance for COVID-19 caused by human infection with COVID-19 virus: interim guidance. In: https://apps.who.int/iris/handle/10665/331506 [6 March 2020]Google Scholar
Hopkins, C, Surda, P, Kumar, N. Presentation of new onset anosmia during the COVID-19 pandemic. Rhinology 2020;58:295–8CrossRefGoogle ScholarPubMed
Mao, L, Wang, M, Chen, S, He, Q, Chang, J, Hong, C et al. Neurological manifestations of hospitalized patients with COVID-19 in Wuhan, China: a retrospective case series study. JAMA Neurol 2020;77:683–90CrossRefGoogle Scholar
von Bartheld, CS, Hagen, MM, Butowt, R. Prevalence of chemosensory dysfunction in COVID-19 patients: a systematic review and meta-analysis reveals significant ethnic differences. ACS Chem Neurosci 2020;11:2944–61CrossRefGoogle ScholarPubMed
Pang, KW, Chee, J, Subramaniam, S, Ng, CL. Frequency and clinical utility of olfactory dysfunction in COVID-19: a systematic review and meta-analysis. Curr Allergy Asthma Rep 2020;20:76CrossRefGoogle ScholarPubMed
World Health Organization. (2020). Public health surveillance for COVID-19: interim guidance. In: https://apps.who.int/iris/handle/10665/333752 [7 August 2020]Google Scholar
Agyeman, AA, Chin, KL, Landersdorfer, CB, Liew, D, Ofori-Asenso, R. Smell and taste dysfunction in patients with COVID-19: a systematic review and meta-analysis. Mayo Clin Proc 2020;95:1621–31CrossRefGoogle ScholarPubMed
Printza, A, Constantinidis, J. The role of self-reported smell and taste disorders in suspected COVID-19. Eur Arch Otorhinolaryngol 2020;277:2625–30CrossRefGoogle Scholar
Tong, JY, Wong, A, Zhu, D, Fastenberg, JH, Tham, T. The prevalence of olfactory and gustatory dysfunction in COVID-19 patients: a systematic review and meta-analysis. Otolaryngol Head Neck Surg 2020;163:311CrossRefGoogle ScholarPubMed
Foster, KJ, Jauregui, E, Tajudeen, B, Bishehsari, F, Mahdavinia, M. Smell loss is a prognostic factor for lower severity of COVID-19. Ann Allergy Asthma Immunol 2020;125:481–3.CrossRefGoogle Scholar
Yan, CH, Faraji, F, Prajapati, DP, Ostrander, BT, DeConde, AS. Self-reported olfactory loss associates with outpatient clinical course in COVID-19. Int Forum Allergy Rhinol 2020;10:821–31CrossRefGoogle ScholarPubMed
Mullol, J, Alobid, I, Mariño-Sánchez, F, Izquierdo-Domínguez, A, Marin, C, Klimek, L et al. The loss of smell and taste in the covid-19 outbreak: a tale of many countries. Curr Allergy Asthma Rep 2020;20:15CrossRefGoogle ScholarPubMed
Meng, X, Deng, Y, Dai, Z, Meng, Z. COVID-19 and anosmia: a review based on up-to-date knowledge. Am J Otolaryngol 2020;41:102581CrossRefGoogle ScholarPubMed
Welge-Lüssen, A, Wolfensberger, M. Olfactory disorders following upper respiratory tract infections. Adv Otorhinolaryngol 2006;63:125–32Google ScholarPubMed
Lv, H, Zhang, W, Zhu, Z, Xiong, Q, Xiang, R, Wang, Y et al. Prevalence and recovery time of olfactory and gustatory dysfunctions of hospitalized patients with COVID-19 in Wuhan, China. Int J Infect Dis 2020;100:507–12CrossRefGoogle Scholar
Izquierdo-Domínguez, A, Rojas-Lechuga, M, Chiesa-Estomba, C, Calvo-Henríquez, C, Ninchritz-Becerra, E, Soriano-Reixach, M et al. Smell and taste dysfunctions in COVID-19 are associated with younger age in ambulatory settings-a multicenter cross-sectional study. J Investig Allergol Clin Immunol 2020;30:346–57CrossRefGoogle Scholar
Rojas-Lechuga, MJ, Izquierdo-Domínguez, A, Chiesa-Estomba, C, Calvo-Henríquez, C, Villarreal, IM, Cuesta-Chasco, G et al. Chemosensory dysfunction in COVID-19 out-patients. Eur Arch Otorhinolaryngol 2021;278:695702CrossRefGoogle ScholarPubMed
Amer, MA, El-Sherif, HS, Abdel-Hamid, AS, El-Zayat, S. Early recovery patterns of olfactory disorders in COVID-19 patients; a clinical cohort study. Am J Otolaryngol 2020:41;102725CrossRefGoogle ScholarPubMed
Paderno, A, Mattavelli, D, Rampinelli, V, Grammatica, A, Raffetti, E, Tomasoni, M et al. Olfactory and gustatory outcomes in COVID-19: a prospective evaluation in nonhospitalized subjects. Otolaryngol Head Neck Surg 2020;163:1144–9CrossRefGoogle ScholarPubMed
World Health Organization. Laboratory testing strategy recommendations for COVID-19: interim guidance. In: https://apps.who.int/iris/handle/10665/331509 [21 March 2020]Google Scholar
Bagheri, SH, Asghari, A, Farhadi, M, Shamshiri, AR, Kabir, A, Kamrava, SK et al. Coincidence of COVID-19 epidemic and olfactory dysfunction outbreak in Iran. Med J Islam Repub Iran 2020;34:446–52Google ScholarPubMed
Seok, J, Shim, YJ, Rhee, C-S, Kim, J-W. Correlation between olfactory severity ratings based on olfactory function test scores and self-reported severity rating of olfactory loss. Acta Otolaryngol 2017;137:750–4CrossRefGoogle ScholarPubMed
Campiglio, L, Priori, A. Neurological symptoms in acute COVID-19 infected patients: a survey among Italian physicians. PLoS One 2020;15:e0238159CrossRefGoogle ScholarPubMed
Jalessi, M, Farhadi, M, Kamrava, SK, Amintehran, E, Asghari, A, Hemami, MR et al. The reliability and validity of the persian version of sinonasal outcome test 22 (snot 22) questionnaires. Iran Red Crescent Med J 2013;15:404–8.CrossRefGoogle ScholarPubMed
DeConde, AS, Mace, JC, Bodner, T, Hwang, PH, Rudmik, L, Soler, ZM, et al. SNOT-22 quality of life domains differentially predict treatment modality selection in chronic rhinosinusitis. Int Forum Allergy Rhinol 2014;4:972–9CrossRefGoogle ScholarPubMed
National Committee on COVID-19 Epidemiology, Ministry of Health and Medical Education, IR Iran. Daily Situation Report on Coronavirus disease (COVID-19) in Iran; March 14, 2020. Arch Acad Emerg Med 2020;8:e24Google Scholar
Lee, DY, Lee, WH, Wee, JH, Kim, J-W. Prognosis of postviral olfactory loss: follow-up study for longer than one year. Am J Rhinol Allergy 2014;28:419–22CrossRefGoogle ScholarPubMed
Lechien, JR, Chiesa-Estomba, CM, De Siati, DR, Horoi, M, Le Bon, SD, Rodriguez, A et al. Olfactory and gustatory dysfunctions as a clinical presentation of mild-to-moderate forms of the coronavirus disease (COVID-19): a multicenter European study. Eur Arch Otorhinolaryngol 2020;277:2251–61CrossRefGoogle ScholarPubMed
Klopfenstein, T, Toko, L, Royer, PY, Lepiller, Q, Gendrin, V et al. Features of anosmia in COVID-19. Med Mal Infect 2020;50:436–9CrossRefGoogle ScholarPubMed
Beltrán-Corbellini, A, Chico-García, JL, Martínez-Poles, J, Rodríguez-Jorge, F, Natera-Villalba, E, Gómez-Corral, J et al. Acute-onset smell and taste disorders in the context of COVID-19: a pilot multicentre polymerase chain reaction based case–control study. Eur J Neurol 2020;27:1738–41CrossRefGoogle ScholarPubMed
Vaira, LA, Deiana, G, Fois, AG, Pirina, P, Madeddu, G, De Vito, A et al. Objective evaluation of anosmia and ageusia in COVID-19 patients: single-center experience on 72 cases. Head Neck 2020;42:1252–8CrossRefGoogle ScholarPubMed
Lee, Y, Min, P, Lee, S, Kim, SW. Prevalence and duration of acute loss of smell or taste in COVID-19 patients. J Korean Med Sci 2020;35:e174CrossRefGoogle ScholarPubMed
Hopkins, C, Surda, P, Whitehead, E, Kumar, BN. Early recovery following new onset anosmia during the COVID-19 pandemic - an observational cohort study. J Otolaryngol Head Neck Surg 2020;49:26CrossRefGoogle ScholarPubMed
Vaira, LA, Hopkins, C, Salzano, G, Petrocelli, M, Melis, A, Cucurullo, M et al. Olfactory, and gustatory function impairment in COVID-19 patients: Italian objective multicenter-study. Head Neck 2020;42:1560–9CrossRefGoogle ScholarPubMed
Lechien, JR, Cabaraux, P, Chiesa-Estomba, CM, Khalife, M, Hans, S, Calvo-Henriquez, C et al. Objective olfactory evaluation of self-reported loss of smell in a case series of 86 COVID-19 patients. Head Neck 2020;42:1583–90CrossRefGoogle Scholar
Kosugi, EM, Lavinsky, J, Romano, FR, Fornazieri, MA, Luz-Matsumoto, GR, Lessa, MM et al. Incomplete and late recovery of sudden olfactory dysfunction in COVID-19. Braz J Otorhinolaryngol 2020;86:490–6CrossRefGoogle ScholarPubMed
Dell'Era, V, Farri, F, Garzaro, G, Gatto, M, Aluffi Valletti, P, Garzaro, M. Smell and taste disorders during COVID-19 outbreak: cross-sectional study on 355 patients. Head Neck 2020;42:1591–6CrossRefGoogle ScholarPubMed
Chung, TWH, Sridhar, S, Zhang, AJ, Chan, KH, Li, HL, Wong, FKC et al. olfactory dysfunction in coronavirus disease 2019 patients: observational cohort study and systematic review. Open Forum Infect Dis 2020;7:112CrossRefGoogle ScholarPubMed
Paderno, A, Schreiber, A, Grammatica, A, Raffetti, E, Tomasoni, M, Gualtieri, T et al. Smell and taste alterations in COVID-19: a cross-sectional analysis of different cohorts. Int Forum Allergy Rhinol 2020;10:955–62CrossRefGoogle ScholarPubMed
Freni, F, Meduri, A, Gazia, F, Nicastro, V, Galletti, C, Aragona, P et al. Symptomatology in head and neck district in coronavirus disease (COVID-19): a possible neuroinvasive action of SARS-CoV-2. Am J Otolaryngol 2020;41:102612.CrossRefGoogle ScholarPubMed
Sakalli, E, Temirbekov, D, Bayri, E, Alis, EE, Erdurak, SC, Bayraktaroglu, M. Ear nose throat-related symptoms with a focus on loss of smell and/or taste in COVID-19 patients. Am J Otolaryngol 2020;41:30–4CrossRefGoogle ScholarPubMed
Cervilla, MT, Gutierrez, I, Romero, M, Garcia-Gomez, J. Research Square. Olfactory dysfunction quantified by olfactometry in patients with SARS-Cov-2 infection. 2020. In: https://www.researchgate.net/publication/342429355_Olfactory_dysfunction_quantified_by_olfactometry_in_patients_with_SARS-Cov-2_infection [19 April 2021]CrossRefGoogle Scholar
Gorzkowski, V, Bevilacqua, S, Charmillon, A, Jankowski, R, Gallet, P, Rumeau, C et al. Evolution of olfactory disorders in COVID-19 patients. Laryngoscope 2020;130:2667–73CrossRefGoogle ScholarPubMed
Boscolo-Rizzo, P, Borsetto, D, Fabbris, C, Spinato, G, Frezza, D, Menegaldo, A et al. Evolution of altered sense of smell or taste in patients with mildly symptomatic COVID-19. JAMA Otolaryngol Head Neck Surg 2020;1:811Google Scholar
Salmon Ceron, D, Bartier, S, Hautefort, C, Nguyen, Y, Nevoux, J, Hamel, AL et al. Self-reported loss of smell without nasal obstruction to identify COVID-19. The multicenter Coranosmia cohort study. J Infect 2020;81:614–20CrossRefGoogle ScholarPubMed
Jalessi, M, Barati, M, Rohani, M, Amini, E, Ourang, A, Azad, Z et al. Frequency and outcome of olfactory impairment and sinonasal involvement in hospitalized patients with COVID-19. Neurol Sci 2020;41:2331–8CrossRefGoogle ScholarPubMed
D'Ascanio, L, Pandolfini, M, Cingolani, C, Latini, G, Gradoni, P, Capalbo, M et al. Olfactory dysfunction in COVID-19 patients: prevalence and prognosis for recovering sense of smell. Otolaryngol Head Neck Surg 2021;164:82–6CrossRefGoogle ScholarPubMed
Parente-Arias, P, Barreira-Fernandez, P, Quintana-Sanjuas, A, Patiño-Castiñeira, B. Recovery rate and factors associated with smell and taste disruption in patients with coronavirus disease 2019. Am J Otolaryngol 2020;42:102648CrossRefGoogle ScholarPubMed
Barillari, MR, Bastiani, L, Lechien, JR, Mannelli, G, Molteni, G, Cantarella, G et al. A structural equation model to examine the clinical features of mild-to-moderate COVID - 19: a multicenter Italian study. J Med Virol 2021;93:983–94CrossRefGoogle ScholarPubMed
Fjaeldstad, AW. Prolonged complaint s of chemosensory loss after covid-19. Dan Med J 2020;67:111Google Scholar
Le Bon, SD, Pisarski, N, Verbeke, J, Prunier, L, Cavelier, G, Thill, MP et al. Psychophysical evaluation of chemosensory functions 5 weeks after olfactory loss due to COVID-19: a prospective cohort study on 72 patients. Eur Arch Otorhinolaryngol 2021;278:101–8CrossRefGoogle ScholarPubMed
Spadera, L, Viola, P, Pisani, D, Scarpa, A, Malanga, D, Sorrentino, G et al. Sudden olfactory loss as an early marker of COVID-19: a nationwide Italian survey. Eur Arch Otorhinolaryngol 2021;278:247–55CrossRefGoogle ScholarPubMed
Moein, ST, Hashemian, SMR, Tabarsi, P, Doty, RL. Prevalence and reversibility of smell dysfunction measured psychophysically in a cohort of COVID-19 patients. Int Forum Allergy Rhinol 2020;10:1127–35CrossRefGoogle Scholar
Klopfenstein, T, Zahra, H, Kadiane-Oussou, NJ, Lepiller, Q, Royer, PY, Toko, L et al. New loss of smell and taste: uncommon symptoms in COVID-19 patients in Nord Franche-Comte cluster, France. Int J Infect Dis 2020;100:117–22CrossRefGoogle ScholarPubMed
Cocco, A, Amami, P, Desai, A, Voza, A, Ferreli, F, Albanese, A. Neurological features in SARS-CoV-2-infected patients with smell and taste disorder. J Neurol 2020. Epub 2020 Aug 7Google ScholarPubMed
Vaira, LA, Hopkins, C, Petrocelli, M, Lechien, JR, Chiesa-Estomba, CM, Salzano, G et al. Smell and taste recovery in coronavirus disease 2019 patients: a 60-day objective and prospective study. J Laryngol Otol 2020;134:703–9CrossRefGoogle ScholarPubMed
Cho, RHW, To, ZWH, Yeung, ZWC, Tso, EYK, Fung, KSC, Chau, SKY et al. COVID-19 viral load in the severity of and recovery from olfactory and gustatory dysfunction. Laryngoscope 2020;130:2680–5CrossRefGoogle ScholarPubMed
Brandão Neto, D, Fornazieri, MA, Dib, C, Di Francesco, RC, Doty, RL, Voegels, RL et al. Chemosensory dysfunction in COVID-19: prevalences, recovery rates, and clinical associations on a large Brazilian sample. Otolaryngol Head Neck Surg 2021;164:512–18CrossRefGoogle ScholarPubMed
Chiesa-Estomba, CM, Lechien, JR, Radulesco, T, Michel, J, Sowerby, LJ, Hopkins, C et al. Patterns of smell recovery in 751 patients affected by the COVID-19 outbreak. Eur J Neurol 2020;27:2318–21.CrossRefGoogle ScholarPubMed
Karimi-Galougahi, M, Safavi Naini, A, Ghorbani, J, Raad, N, Raygani, N. Emergence and evolution of olfactory and gustatory symptoms in patients with COVID-19 in the outpatient setting. Indian J Otolaryngol Head Neck Surg 2020. Epub 2020 Sep 28CrossRefGoogle ScholarPubMed
Iannuzzi, L, Salzo, AE, Angarano, G, Palmieri, VO, Portincasa, P, Saracino, A et al. Gaining back what is lost: recovering the sense of smell in mild to moderate patients after COVID-19. Chem Senses 2020;45:875–81CrossRefGoogle ScholarPubMed
Konstantinidis, I, Delides, A, Tsakiropoulou, E, Maragoudakis, P, Sapounas, S, Tsiodras, S. Short-term follow-up of self-isolated COVID-19 patients with smell and taste dysfunction in greece: two phenotypes of recovery. Orl 2020;82:295303CrossRefGoogle Scholar
Panda, S, Mohamed, A, Sikka, K, Kanodia, A, Sakthivel, P, Thakar, A et al. Otolaryngologic manifestation and long-term outcome in mild COVID-19: experience from a tertiary care centre in india. Indian J Otolaryngol Head Neck Surg 2020;73:16Google Scholar
Klein, H, Asseo, K, Karni, N, Benjamini, Y, Nir-Paz, R, Muszkat, M et al. Onset, duration, and persistence of taste and smell changes and other COVID-19 symptoms: longitudinal study in Israeli patients. Clin Microbiol Infect. Epub 2021 Feb 16Google Scholar
Schönegger, CM, Gietl, S, Heinzle, B, Freudenschuss, K, Walder, G. Smell and taste disorders in COVID-19 patients: objective testing and magnetic resonance imaging in five cases. SN Compr Clin Med 2020. Epub 2020 Oct 24CrossRefGoogle ScholarPubMed
Al-Zaidi, HMH, Badr, HM Incidence and recovery of smell and taste dysfunction in COVID-19 positive patients. Egypt J Otolaryngol 2020;36:16CrossRefGoogle Scholar
Levinson, R, Elbaz, M, Ben-Ami, R, Shasha, D, Levinson, T, Choshen, G et al. Time course of anosmia and dysgeusia in patients with mild SARS-CoV-2 infection. Infect Dis (Lond) 2020;52:600–2CrossRefGoogle ScholarPubMed
Bilinska, K, Jakubowska, P, Von Bartheld, CS, Butowt, R. Expression of the SARS-CoV-2 entry proteins, ACE2 and TMPRSS2, in cells of the olfactory epithelium: identification of cell types and trends with age. ACS Chem Neurosci 2020;11:1555–62CrossRefGoogle ScholarPubMed
Eliezer, M, Hautefort, C, Hamel, A-L, Verillaud, B, Herman, P, Houdart, E et al. Sudden and complete olfactory loss function as a possible symptom of COVID-19. JAMA Otolaryngol Head Neck Surg 2020;146:674–5CrossRefGoogle ScholarPubMed
Brann, DH, Tsukahara, T, Weinreb, C, Lipovsek, M, Van den Berge, K, Gong, B, et al. Non-neuronal expression of SARS-CoV-2 entry genes in the olfactory system suggests mechanisms underlying COVID-19-associated anosmia. Sci Adv 2020;6:eabc5801CrossRefGoogle ScholarPubMed
Sungnak, W, Huang, N, Bécavin, C, Berg, M, Queen, R, Litvinukova, M et al. SARS-CoV-2 entry factors are highly expressed in nasal epithelial cells together with innate immune genes. Nat Med 2020;26:681–7CrossRefGoogle ScholarPubMed
D'Amico, F, Baumgart, DC, Danese, S, Peyrin-Biroulet, L. Diarrhea during COVID-19 infection: pathogenesis, epidemiology, prevention and management. Clin Gastroenterol Hepatol 2020;18:1663–72CrossRefGoogle Scholar
Uzzan, M, Soudan, D, Peoc'h, K, Weiss, E, Corcos, O, Treton, X. Patients with COVID-19 present with low plasma citrulline concentrations that associate with systemic inflammation and gastrointestinal symptoms. Dig Liver Dis 2020;52:1104–5CrossRefGoogle ScholarPubMed
Guan, W-j, Ni, Z-y, Hu, Y, Liang, W-h, Ou, C-q, He, J-x et al. Clinical characteristics of coronavirus disease 2019 in China. N Engl J Med 2020;382:1708–20CrossRefGoogle ScholarPubMed
Jin, X, Lian, J-S, Hu, J-H, Gao, J, Zheng, L, Zhang, Y-M et al. Epidemiological, clinical and virological characteristics of 74 cases of coronavirus-infected disease 2019 (COVID-19) with gastrointestinal symptoms. Gut 2020;69:1002–9CrossRefGoogle ScholarPubMed
Lee, I-C, Huo, T-I, Huang, Y-H. Gastrointestinal and liver manifestations in patients with COVID-19. J Chin Med Assoc 2020;83:521–3CrossRefGoogle ScholarPubMed
Paolo, G. Does COVID-19 cause permanent damage to olfactory and gustatory function? Med Hypotheses 2020;143:110086CrossRefGoogle ScholarPubMed
Whitcroft, KL, Hummel, T. Olfactory dysfunction in COVID-19: diagnosis and management. JAMA 2020;323:2512–14CrossRefGoogle ScholarPubMed
Kamrava, S, Jalessi, M., GhalehBaghi, S, Amini, E, Alizadeh, R, Rafiei, F et al. Validity and reliability of Persian smell identification test. Iran J Otorhinolaryngol 2020;32:6571Google ScholarPubMed