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Purpose: The aim of the study was to investigate whether olfactory fluctuations (OF) are pronounced in patients with sinonasal olfactory dysfunction (OD). Methods: The retrospective investigation included patients aged 18 years or older, who consulted a tertiary referral center for olfactory loss. Patients with normal smell function were excluded. Patients answered a structured questionnaire about their olfactory symptoms, with specific questions related to the presence of OF and its average frequency, amplitude, duration, time since most recent OF, and associated symptoms of self-reported OF. Patients also underwent clinical evaluation including a structured medical history and physical examination including nasal endoscopy. In addition, we assessed orthonasal olfactory function using Sniffin' Sticks, and gustatory function using "taste sprays". Results: Participants included 131 men and 205 women (n = 336), aged 18 to 86 years (mean 50, SD 16). Patient-reported fluctuations occurred most frequently in sinonasal (38%), idiopathic (29%), and postviral (29%) OD. Amplitude of OF was highest in postviral OD (p = 0.009). Average frequency, duration, and the time since the most recent fluctuation were not significantly different between groups (all p's > 0.42). Odor discrimination (p = 0.002) and identification (p = 0.017) scores were higher among those individuals with OF. Conclusion: Amplitude of OF may help distinguish postviral from other causes of OD, especially in patients presenting with equivocal symptoms of sinonasal disease. [ABSTRACT FROM AUTHOR]

Keywords: Smell; Taste; Anosmia; Hyposmia; Gustatory; Dysgeusia; Loss; COVID-19; Coronavirus; Dear editor EN Smell Taste Anosmia Hyposmia Gustatory Dysgeusia Loss COVID-19 Coronavirus Dear editor 2397 2398 2 07/07/20 20200801 NES 200801 Jerome R. Lechien and Julien W. Hsieh contributed to the paper and are joint as co-first authors. Dear Editor, We thank Dr Bigiani [[1]] for this letter entitled "Gustatory dysfunctions in COVID-19 patients: possible involvement of taste renin-angiotensin system (RAS)" which is related to our paper [[2]]. References 1 Bigiani A. Gustatory dysfunctions in COVID-19 patients: possible involvement of taste renin-angiotensin system (RAS). [Extracted from the article]