Recovery rates of persistent post‐COVID‐19 olfactory dysfunction using psychophysical assessment: A longitudinal cohort study

Persistent olfactory dysfunction (OD) following loss of smell associated with SARS‐CoV‐2 infection is a major feature of long COVID. Perspectives on the prevalence of persistent OD predominantly rely on self‐reported olfactory function. Few studies have tracked longitudinal rates of recovery using psychophysical assessment among patients presenting for evaluation of persistent OD beyond a window of acute recovery. Data anchored in standardized testing methods are needed to counsel patients who fail to acutely regain their sense of smell. This study aims to quantify the degree of persistent OD in post‐COVID‐19 patients who experience subjective and psychophysical OD. We grouped participants presenting for OD evaluation into cohorts based on both subjective and psychophysical olfactory status at a baseline assessment and assessed their olfactory abilities with a visual analogue scale and the Sniffin' Sticks extended test at baseline and 1‐year time points. Participants had confirmed a history of COVID‐19 by lab evaluation or clinical diagnosis if lab evaluation was not available. Baseline olfactory evaluation was completed by 122 participants, 53 of whom completed the 1‐year follow‐up assessment. Among participants presenting with perceived OD, 74.5% had confirmed psychophysical OD at baseline, with 55.1% at 1‐year follow‐up. Participants had reliable trends in self‐rated versus psychophysically tested olfactory function at both time points. The total threshold, discrimination, and identification (TDI) score improved by +3.25 points in the cohort with psychophysical OD (p= 0.0005), with this improvement largely attributable to an increase in median threshold scores (+2.75 points; p= 0.0004). OD persists in a significant number of patients who fail to acutely recovery their sense of smell after COVID‐19, with many demonstrating lingering deficits at 1‐year. Improvements in threshold, but not discrimination or identification, most significantly mediate improvement of total TDI score at follow‐up. 19.4% of individuals with persistent psychophysical olfactory dysfunction (OD) at a baseline assessment at least 3 months after acute loss of smell experience olfactory normalization at 1‐year follow‐up.Improvement in total threshold, discrimination, and identification score for patients with subjective and psychophysical OD appears to be mediated by increases in median threshold scores.Prevalence of persistent OD as part of long‐COVID is further reinforced via psychophysical assessment when trended longitudinally across olfactory subdomains. 19.4% of individuals with persistent psychophysical olfactory dysfunction (OD) at a baseline assessment at least 3 months after acute loss of smell experience olfactory normalization at 1‐year follow‐up. Improvement in total threshold, discrimination, and identification score for patients with subjective and psychophysical OD appears to be mediated by increases in median threshold scores. Prevalence of persistent OD as part of long‐COVID is further reinforced via psychophysical assessment when trended longitudinally across olfactory subdomains.