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Coronavirus disease 2019: olfactory and gustatory function, negative impact of personal protective equipment on communication, and an antigen testing complication

Published online by Cambridge University Press:  21 August 2020

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Abstract

Type
Editorial
Copyright
Copyright © JLO (1984) Limited, 2020

Following growing anecdotal evidence suggesting an increasing incidence of cases of anosmia during the current pandemic, on 18th May the UK government added anosmia and ageusia to the list of symptoms of coronavirus infection.Reference Hopkins, Surda and Kumar1,Reference Kirschenbaum, Imbach, Ulrich, Rushing, Keller and Reimann2 There is now considerable evidence that a new onset of altered sense of smell or taste is related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.Reference Lechien, Chiesa-Estomba, Place, Van Laethem, Cabaraux and Mat3

An objective evaluation of olfactory and gustatory function in the first days of infection is almost impossible, as affected individuals are generally in home quarantine. In this month's issue of The Journal of Laryngology & Otology, Petrocelli et al. utilise a recently validated self-administered psychophysical test, which can be performed remotely in the assessment of early-stage coronavirus disease 2019 (Covid-19) patients.Reference Petrocelli, Ruggiero, Baietti, Pandolfi, Salzano and Salzano4 While there have now been many publications describing self-reported anosmia in Covid-19, the development and validation of a home assessment test to define psychophysical thresholds has been something olfactologists have unsuccessfully aimed to achieve for many years, and the authors are to be congratulated for having utilised these tests in 300 patients. In their study, 70 per cent of patients presented with an olfactory and/or gustatory disturbance, 47 per cent with complete anosmia and 38 per cent with ageusia.Reference Petrocelli, Ruggiero, Baietti, Pandolfi, Salzano and Salzano4

In a study by Hampton et al., healthcare workers were assessed for their ability to interpret speech with and without personal protective equipment (PPE).Reference Hampton, Crunkhorn, Lowe, Bhat, Hogg and Afifi5 A significant difference in speech discrimination scores was found between normal and PPE wearing subjects in operating theatre simulated background noise levels (70 dB). The authors concluded that wearing PPE can impact communication in healthcare environments. This has necessitated novel adaptations to overcome communication barriers while wearing PPE (e.g. hearing technologies and high-technology electronic devices).6,Reference Mathews, Blencowe, Adcock, Gane, Nangalia and Patel7 In an attempt to minimise surgical error through miscommunication, Wilkinson et al. sought to introduce a simple sign language system that could be used as an adjunct during surgical tracheostomies.Reference Wilkinson, Irvine and Valsamakis8

Finally, a manuscript by Mughal et al. draws attention to a complication of viral swab nasopharyngeal antigen testing, describing the premature engagement of a viral swab breakpoint, resulting in a retained swab in the nasal cavity that required retrieval.Reference Mughal, Luff, Okonkwo and Hall9

References

Hopkins, C, Surda, P, Kumar, N. Presentation of new onset anosmia during the COVID-19 pandemic. Rhinology 2020;58:295–8CrossRefGoogle ScholarPubMed
Kirschenbaum, D, Imbach, LL, Ulrich, S, Rushing, EJ, Keller, E, Reimann, RR et al. Inflammatory olfactory neuropathy in two patients with COVID-19. Lancet 2020;396:166CrossRefGoogle ScholarPubMed
Lechien, JR, Chiesa-Estomba, CM, Place, S, Van Laethem, Y, Cabaraux, P, Mat, Q et al. Clinical and epidemiological characteristics of 1420 European patients with mild-to-moderate coronavirus disease 2019. J Intern Med 2020. Epub 2020 Apr 30CrossRefGoogle ScholarPubMed
Petrocelli, M, Ruggiero, F, Baietti, AM, Pandolfi, P, Salzano, G, Salzano, FA et al. Remote psychophysical evaluation of olfactory and gustatory functions in early-stage coronavirus disease 2019 patients: the Bologna experience of 300 cases. J Laryngol Otol 2020;134:571576CrossRefGoogle ScholarPubMed
Hampton, T, Crunkhorn, R, Lowe, N, Bhat, J, Hogg, E, Afifi, W et al. The negative impact of wearing personal protective equipment on communication during coronavirus disease 2019. J Laryngol Otol 2020;134:577581CrossRefGoogle ScholarPubMed
NIHR. Improving communication while wearing PPE. In: https://www.uclhospitals.brc.nihr.ac.uk/news/improving-communication-while-wearing-ppe [30 July 2020]Google Scholar
Mathews, JA, Blencowe, NS, Adcock, S, Gane, S, Nangalia, V, Patel, A et al. ‘Theatre Comm’ - optimising communication in surgical theatres during COVID-19. Br J Surg 2020. Epub 2020 Jul 28CrossRefGoogle ScholarPubMed
Wilkinson, S, Irvine, E, Valsamakis, T. Coronavirus disease 2019 communication: novel sign language system to aid surgical tracheostomy whilst wearing a respirator. J Laryngol Otol 2020;134:642645CrossRefGoogle Scholar
Mughal, Z, Luff, E, Okonkwo, O, Hall, CEJ. Test, test, test – a complication of testing for coronavirus disease 2019 with nasal swabs. J Laryngol Otol 2020;134:646649CrossRefGoogle Scholar