Effect of vaccination on coronavirus disease 2019-related olfactory dysfunction

Abdulaziz Alhazmi; Hussam Darraj; Abdulrahman Aqeel; Ghadah Khormi; Alshomokh Hakami; Abdulaziz Kariri; Afnan Siddiq; Ali Sahli; Rahaf Othathi; Ibrahim Sumaily

doi:10.4103/sjoh.sjoh_58_22

ORIGINAL ARTICLE

Year : 2023 | Volume : 25 | Issue : 1 | Page : 1-6

Effect of vaccination on coronavirus disease 2019-related olfactory dysfunction

Abdulaziz Alhazmi¹, Hussam Darraj², Abdulrahman Aqeel², Ghadah Khormi², Alshomokh Hakami², Abdulaziz Kariri², Afnan Siddiq², Ali Sahli², Rahaf Othathi², Ibrahim Sumaily³
¹ Department of Microbiology and Parasitology, College of Medicine, Jazan University, Jazan, Saudi Arabia
² Medical Intrern, Students, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
³ Department of ENT, King Fahd Central Hospital, Jazan, Saudi Arabia

Date of Submission	04-Dec-2022
Date of Decision	23-Dec-2022
Date of Acceptance	25-Dec-2022
Date of Web Publication	29-Mar-2023

Correspondence Address:
Dr. Ibrahim Sumaily
Department of ENT, King Fahd Central Hospital, Jazan
Saudi Arabia

Source of Support: None, Conflict of Interest: None

DOI: 10.4103/sjoh.sjoh_58_22

Abstract

Background: Hyposmia and anosmia are the reduced ability and inability to perceive odors, respectively. Coronavirus disease 2019 (COVID-19) is caused by a novel coronavirus that was first detected in late 2019 in China and has spread globally since mid-February 2020. Olfactory dysfunction (OD), such as anosmia or hyposmia, is an important early indicator of COVID-19. Objective: This study aimed to compare the incidence and duration of COVID-19-related hyposmia before and after vaccination. Design: This was cross-sectional study. Setting: Jazan region, February–July 2022. Patients and Methods: Data were collected from the adult population of the Jazan region using a self-administered questionnaire in the Arabic language. Data are presented as frequencies and percentages for categorical variables. Analysis of variance was used to compare means between groups while the Chi-square test was used for the comparison of categorical variables. Statistical significance was set at P < 0.05. Main Outcome Measures: The incidence and duration of COVID-19-related OD before and after vaccination. Sample Size: The sample size was 466. Results: Of the 510 respondents, 466 met the study criteria. OD just after receiving the vaccines was reported by 53 (12.2%) participants. COVID-19 was confirmed in 268 participants (52.5%; 118 men and 150 women); of these, 163 (60.8%) had OD and 144 (53.7%) reported taste dysfunction. OD was more frequent in women than in men (66.7% vs. 53.4%, P = 0.03) and was the only symptom in 10 respondents (3.7%). OD was less frequent in postvaccination infection (54.9% vs. 73.8%, P = 0.003). Moreover, the OD duration was significantly shorter in postvaccination COVID-19 infection (improvement in the 1^st week, 66.3% vs. 33.9%, P = 0.001). Conclusions: Among patients with COVID-19, OD occurs less frequently in men and after vaccination, and the duration is shorter after vaccination. Limitations: This study was limited by the small sample size, cross-sectional design, and small number of respondents with common chronic diseases such as diabetes and hypertension.

Keywords: Anosmia, coronavirus disease 2019, olfactory dysfunction, vaccine

How to cite this article:
Alhazmi A, Darraj H, Aqeel A, Khormi G, Hakami A, Kariri A, Siddiq A, Sahli A, Othathi R, Sumaily I. Effect of vaccination on coronavirus disease 2019-related olfactory dysfunction. Saudi J Otorhinolaryngol Head Neck Surg 2023;25:1-6

How to cite this URL:
Alhazmi A, Darraj H, Aqeel A, Khormi G, Hakami A, Kariri A, Siddiq A, Sahli A, Othathi R, Sumaily I. Effect of vaccination on coronavirus disease 2019-related olfactory dysfunction. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2023 [cited 2023 Jun 4];25:1-6. Available from: https://www.sjohns.org/text.asp?2023/25/1/1/372817

Introduction

Anosmia and hyposmia are the inability and reduced or altered ability to perceive odors, respectively. They may be accompanied by changes in taste perception and are sometimes associated with respiratory viral infections, including coronavirus infections.^[1] Sinonasal diseases, head trauma, and infections are major causes of anosmia.^[2] Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus first detected in late 2019 in China, has spread worldwide since mid-February 2020. Although the majority of patients with coronavirus disease 2019 (COVID-19) have mild symptoms, about 5% develop viral pneumonia and multi-organ failure.^[3] The World Health Organization declared a COVID-19 pandemic in March 2020.^[4] The first case of COVID-19 in Saudi Arabia was reported on March 2, 2020.^[5] The major symptoms of COVID-19 are fever, cough, and difficulty in breathing.^[6] Olfactory dysfunction (OD), such as anosmia or hyposmia, is common in upper respiratory infections and indicates the infection and dysfunction of the olfactory epithelium lining the superior recess of the nasal cavity.^[7],[8] SARS-CoV infection has been linked to OD,^[9] and OD in otherwise asymptomatic individuals may be an early indicator of SARS-CoV-2 infection. Olfactory neurons are particularly vulnerable to damage due to the viral load in the nasal cavity. Moreover, they are considered an entry point for the dissemination of the virus to the neural cells in the central nervous system; dissemination to the periphery is through transneuronal channels. Initially, a quarter of patients with COVID-19 reported an impaired sense of smell,^[10] and anosmia was not widely recognized as a symptom of COVID-19. Thereafter, anecdotal evidence suggests that anosmia is much more common and that COVID-19 causes olfactory impairment. Although anosmia is frequently reported in association with other symptoms of COVID-19, one in six individuals with new-onset anosmia described it as the sole symptom.^[11] In previous studies, depending on the location, demographics, SARS-CoV-2 variant, and method of diagnosis, the incidence of smell and/or taste impairment in patients with COVID-19 ranged from 5% to 98%; most studies reported an OD rate of 20%–80%.^[12],[13] In this study, we aimed to determine the incidence and duration of COVID-19-related OD before and after vaccination.

Patients and Methods

Study design

This observational cross-sectional study aimed to determine the incidence and duration of COVID-19-related OD among the adult population of the Jazan region before and after vaccination. Jazan is one of the 13 major regions in Saudi Arabia, with an urban population of 1.568 million according to the last census, of whom >39,000 are diabetic. We focused on adults of both sexes with diabetes aged 16–75 years in the Jazan region.

Data collection

To collect data, we used a self-administered questionnaire in the Arabic language that included the consent of the respondents. The required time to complete the survey was approximately 5–10 min. The questionnaire had four sections. Each section is designed to assess a specific item related to a specific objective of the study. The first section collected data related to sociodemographic factors, while the second and third sections assessed health status, smell and taste symptoms, and factors such as neurological disease, medication, radiochemotherapy, and COVID-19 virus associated with OD. The fourth section assessed the effect of the COVID-19 vaccine on OD.

Statistical analyses

Data are presented as frequencies and percentages for categorical variables. Analysis of variance was used to compare means between different groups, while the Chi-square test was used to compare categorical variables. Statistical significance was set at P < 0.05. All statistical calculations were performed using Statistical Package for the Social Science (SPSS) version 23 for Microsoft Windows (IBM, Armonk, NY, USA).

Ethical considerations

The study protocol was approved by the Internal Review Board of Jazan University.

Approval No.:REC-43/10/235. informed consent for participation was obtained from each participant before administering the online questionnaire. Each participant was provided with a serial number. Participation in the study was entirely voluntary, and participants could withdraw from the study if they wished.

Results

Out of 510 respondents, 466 met the study criteria. We excluded 35 respondents who had premorbid OD, 7 who were non-Saudi, and 2 with incomplete data. Olfaction was affected just after receiving the vaccine in 53 (12.2%) participants. COVID-19 was confirmed in 268 participants – 118 men and 150 women. No significant association was observed between COVID-19 and age, sex, systemic diseases, chronic sinusitis, allergic rhinitis, history of sinonasal surgery, or chemoradiotherapy [Table 1].

Table 1: Baseline characteristics of respondents with and without coronavirus disease 2019

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Among participants with COVID-19, 163 (60.8%) experienced OD and 144 (53.7%) reported taste dysfunction. OD was more frequent in women than in men (66.7% vs. 53.4%, P = 0.03) and was the only symptom in 10 respondents (3.71%). OD was less likely to occur in patients infected with COVID-19 after vaccination than in those infected before vaccination (54.9% vs. 73.8%, P = 0.003), [Figure 1]. Although taste dysfunction was significantly associated with OD, it was not always affected. Moreover, some patients reported taste dysfunction with no OD [P = 0.000; [Table 2]].

Figure 1: Impact of vaccination on the severity of COVID-19-related olfaction dysfunction

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Table 2: Olfactory dysfunction among patients with coronavirus disease 2019 (n=268) and other patient characteristics

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The duration of OD was shorter in respondents infected with COVID-19 after vaccination; 66.3% of vaccinated respondents improved within the 1^st week, whereas only 33.9% of unvaccinated respondents improved within the same period (P = 0.001) [Figure 2]. OD improvement was significantly associated with improvement in taste dysfunction (P = 0.000). No significant association was observed between the other variables and OD duration [Table 3].

Figure 2: Impact of vaccination on the duration of COVID-19-related olfaction dysfunction

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Table 3: Duration of coronavirus disease 2019-related olfactory dysfunction (n=163)

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OD was less likely to occur in a patient who suffered from dyspnea, diarrhea, and abdominal pain in association with COVID-19 infection. In contrast, OD was more likely to be associated with fever, cough, sore throat, headache, dizziness, muscle pain, and tiredness. Further, OD resolution was not correlated with any associated symptom [Table 4].

Table 4: Associated symptoms and their relation to olfactory dysfunction

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Discussion

Numerous studies have highlighted the dysfunction of the chemical senses in patients with COVID-19. Although the usual resolution of COVID-19-related OD is within few weeks, a longer symptom duration has been reported. In a systematic review of 24 studies in 2020, 41.0% of confirmed COVID-19 cases reported OD.^[14] In Saudi Arabia, one study on 979 individuals (53% men and 47% women) recovered from COVID-19; of these, 64% and 55% experienced severe loss of smell and taste, respectively.^[15] Other studies emphasized that OD develops early in the disease, even before the diagnosis is confirmed using the polymerase chain reaction test.^[16],[17]

A considerable number of our participants reported OD just after receiving the COVID-19 vaccine. In the literature, this is reported as case reports only.^[18] This finding needs further specific evaluation, as it is helpful in more clarification of the pathophysiology of COVID-19-associated OD if confirmed.

Among patients with COVID-19, OD had a female predilection, which may be attributed to the fact that women have keener olfaction or are more attuned to olfactory clues. Some studies^[19],[20] have reported similar findings, while others^[16],[21] have shown that men are more prone to OD.

In this study, the likelihood of dysfunctions in olfaction and taste was lesser in participants diagnosed with COVID-19 after being vaccinated against it. These findings are similar to those of previous studies.^[22],[23]

The duration of COVID-19-related OD was shorter among those who were vaccinated. Further, OD improvement was associated with the resolution of taste dysfunction. However, a systematic review revealed that most patients recover their sense of smell or taste within 3 months.^[22] Several studies showed that vaccination reduced symptoms.^[22],[23]

In this study, OD was associated with fever, cough, sore throat, headache, dizziness, muscle pain, and tiredness, which is like the findings of previous studies.^{[16],[19],[20]} Participants with dyspnea, diarrhea, and abdominal pain were less likely to report OD.

Limitations

This study was limited by the small sample size, cross-sectional design, and small number of respondents with common chronic diseases such as diabetes and hypertension.

Conclusions

COVID-19-related OD is more likely to occur in women than in men. Vaccination was associated with decreased the likelihood and duration of COVID-19-related OD. Further prospective studies are needed to determine which vaccines are more effective.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

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