Self-reported symptom study of COVID-19 chemosensory dysfunction in Malaysia
Published in Scientific Reports, 2022
Shen-Han Lee 1,*, Zhi Xiang Yeoh 1, Ida Sadja’ah Sachlin 1, Norzi Gazali 1, Shahrul Aiman Soelar 2, Chee Yoong Foo 3, Lee Lee Low 4, Sharifah Baizura Syed Alwi 4, Tengku Mohamed Izam Tengku Kamalden 5, Jothi Shanmuganathan 6, Masliza Zaid 7, Chun Yiing Wong 8, Hock Hin Chua 9, Suhaimi Yusuf 11, Dzawani Muhamad 12, Philip Rajan Devesahayam 12, Hong Bee Ker 13, Zulkiflee Salahuddin 14, Mahiran Mustafa 15, Halimuddin Sawali 16, Heng Gee Lee 17, Sobani Din 18, Nor Arisah Misnan 19, Amran Mohamad 20, Mohd Noor Ismail 21, Chenthilnathan Periasamy 22, Ting Soo Chow 23, Elang Kumaran Krishnan 24, Chee Loon Leong 25, Linda Pei Fang Lim 26, Nor Zaila Zaidan 27, Mohd Zambri Ibrahim 28, Suhaila Abd Wahab 29, Siti Sabzah Mohd Hashim 1; Malaysian COVID-19 Anosmia Research Group a
1 Department of Otorhinolaryngology, Hospital Sultanah Bahiyah, Alor Setar, Kedah, Malaysia.
2 Clinical Research Centre, Hospital Sultanah Bahiyah, Kedah, Malaysia.
3 Real World Insights, IQVIA Asia Pacific, Petaling Jaya, Malaysia.
4 Department of Medicine, Hospital Sultanah Bahiyah, Kedah, Malaysia.
5 Department of Otorhinolaryngology, Hospital Sultan Ismail, Johor, Malaysia.
6 Department of Otorhinolaryngology, Hospital Sultanah Aminah, Johor, Malaysia.
7 Department of Medicine, Hospital Sultanah Aminah, Johor, Malaysia.
8 Department of Otorhinolaryngology, Hospital Umum Sarawak, Sarawak, Malaysia.
9 Department of Medicine, Hospital Umum Sarawak, Sarawak, Malaysia.
10 Department of Otorhinolaryngology, Hospital Tengku Ampuan Afzan, Pahang, Malaysia.
11 Department of Medicine, Hospital Tengku Ampuan Afzan, Pahang, Malaysia.
12 Department of Otorhinolaryngology, Hospital Raja Permaisuri Bainun, Perak, Malaysia.
13 Department of Medicine, Hospital Raja Permaisuri Bainun, Perak, Malaysia.
14 Department of Otorhinolaryngology, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia.
15 Department of Medicine, Hospital Raja Perempuan Zainab II, Kelantan, Malaysia.
16 Department of Otorhinolaryngology, Hospital Queen Elizabeth, Sabah, Malaysia.
17 Department of Medicine, Hospital Queen Elizabeth, Sabah, Malaysia.
18 Department of Otorhinolaryngology, Hospital Sungai Buloh, Selangor, Malaysia.
19 Department of Medicine, Hospital Sungai Buloh, Selangor, Malaysia.
20 Department of Otorhinolaryngology, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia.
21 Department of Medicine, Hospital Sultanah Nur Zahirah, Terengganu, Malaysia.
22 Department of Otorhinolaryngology, Hospital Pulau Pinang, Penang, Malaysia.
23 Department of Medicine, Hospital Pulau Pinang, Penang, Malaysia.
24 Department of Otorhinolaryngology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
25 Department of Medicine, Hospital Kuala Lumpur Hospital, Kuala Lumpur, Malaysia.
26 Department of Otorhinolaryngology, Hospital Melaka, Melaka, Malaysia.
27 Department of Medicine, Hospital Melaka, Melaka, Malaysia.
28 Department of Otorhinolaryngology, Hospital Tuanku Fauziah, Perlis, Malaysia.
29 Department of Medicine, Hospital Tuanku Fauziah, Perlis, Malaysia.
30 Hospital Enche’ Besar Hajjah Khalsom, Johor, Malaysia.
31 Department of Otorhinolaryngology, Hospital Tuanku Ja’afar, Negeri Sembilan, Malaysia.
32 Department of Medicine, Hospital Tuanku Ja’afar, Negeri Sembilan Malaysia.
a A list of authors and their affiliations appears at the end of the paper.
* Corresponding author: shen-han.lee@cantab.net
Alterations in the three chemosensory modalities—smell, taste, and chemesthesis—have been implicated in Coronavirus Disease 2019 (COVID-19), yet emerging data suggest a wide geographic and ethnic variation in the prevalence of these symptoms. Studies on chemosensory disorders in COVID-19 have predominantly focused on Caucasian populations whereas Asians remain understudied. We conducted a nationwide, multicentre cross-sectional study using an online questionnaire on a cohort of RT-PCR-confirmed adult COVID-19 patients in Malaysia between 6 June and 30 November 2020. The aim of our study was to investigate their presenting symptoms and assess their chemosensory function using self-ratings of perceived smell, taste, chemesthesis, and nasal blockage. In this cohort of 498 patients, 41.4% reported smell and/or taste loss when diagnosed with COVID-19, which was the commonest symptom. Blocked nose, loss of appetite, and gastrointestinal disturbances were independent predictors of smell and/or taste loss on multivariate analysis. Self-ratings of chemosensory function revealed a reduction in smell, taste, and chemesthesis across the entire cohort of patients that was more profound among those reporting smell and/or taste loss as their presenting symptom. Perceived nasal obstruction accounted for only a small proportion of changes in smell and taste, but not for chemesthesis, supporting viral disruption of sensorineural mechanisms as the dominant aetiology of chemosensory dysfunction. Our study suggests that chemosensory dysfunction in COVID-19 is more widespread than previously reported among Asians and may be related to the infectivity of viral strains.
Study Registration: NMRR-20-934-54803 and NCT04390165.
Malaysian COVID-19 Anosmia Research Group
Nurul Asyikin Bachok 30, Linger Sim 8, Tiana Ti 9, Teng Huei Lee 8, Siti Nurul Aliaa Mohd Nor 8, Kim Siang Tay 9, Abirami Gouri Pagan 9, Anura Aman 10, Kamariah Mohamed Awang 10, Jamal Nasser Salleh 10, Harridas Manickam 10, Nursyamimi Mohamad Zaki 10, Cheng Keat Moh 12, Ruthran Thurairaju 12, Ho Hwee Yee 12, Nabilah Abd Aziz 12, Rosdi Ramli 14, Rosli Mohd Noor 14, Anilawati Mat Jelani 15, Mohd Fakri Alimi Mustapha 14, Abdul Aziez Ab Aziry 14, Kribananthan Lohanadan 16, Siti Farhana Abdul Razak 16, Yen Tsen Saw 17, Jason Henn Leong Kong 17, Carren Sui Lin Teh 18, Kuldip Kaur Prem Singh 19, Arvindan Karunakaran 18, Nesha Rajendram 18, Nik Khairani Nik Mohd 20, Nurul Amilin Ja’afar 20, Siti Sarah Che Mohd Razali 20, Shamesh Baskaran 22, Farrah Hani Hassan 24, Kalaiselvi Thuraisingam 24, Hanisah Hithayathullah 24, Prempreet Kaur Manjeet Singh 24, Shen-Han Lee 1, Nadiah Hanim Zainul 4, Man Chek Ooi 1, Siti Aishah Mahadzir 1, Nurul Afifah Mohd Yusoff 1, Anees Fatimah Mohamad Illiayas 1, Yi Shan Tan 4, Ibtisam Ismail 2, Huan Keat Chan 2, Jeyasakthy Saniasiaya 31, Tiang Koi Ng 32, Kuganathan Ramasamy 31 & Fatin Farha Mohd Saifuddin 29
Copyright © The Authors 2022
DOI: 10.1038/s41598-022-06029-6
Recommended citation: Lee SH, Yeoh ZX, Sachlin IS, Gazali N, Soelar SA, Foo CY, Low LL, Alwi SB, Kamalden TM, Shanmuganathan J, Zaid M, Wong CY, Chua HH, Yusuf S, Muhamad D, Devesahayam PR, Ker HB, Salahuddin Z, Mustafa M, Sawali H, Lee HG, Din S, Misnan NA, Mohamed A, Ismail MN, Periasamy C, Chow TS, Krishan EK, Leong CL, Lim LPF, Zaidan NZ, Ibrahim Z, Abd Wahab S, Mohd Hashim SS, Malaysian COVID-19 Anosmia Research Group . (2022). "Self-reported symptom study of COVID-19 chemosensory dysfunction in Malaysia." Scientific Reports. 12(1):2111.
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