Nasal Cavity Likely Site of COVID-19 Infection in Most Patients Interview with:

Ahmad R. Sedaghat, MD, PhD, FACS Associate Professor Department of Otolaryngology - Head and Neck Surgery University of Cincinnati College of Medicine Cincinnati, OH, USA

Dr. Sedaghat

Ahmad R. Sedaghat, MD, PhD, FACS
Associate Professor
Department of Otolaryngology – Head and Neck Surgery
University of Cincinnati College of Medicine
Cincinnati, OH, USA What is the background for this study?

Response: The novel coronavirus, SARS-CoV-2, which causes COVID-19 infects the respiratory tract.  As a rhinologist, I am an expert in diseases of the nose and paranasal sinuses, and as the nose and paranasal sinuses (sinonasal cavities) are a major component of the upper airway, we decided to do a systematic review of the scientific literature on the role of the sinonasal cavities in COVID-19. What are the main findings?

Response: The main findings are that the nasal cavities play a major role in COVID-19.  The nasal cavity is likely the initial site of infection in the vast majority of individuals.  At the same time, virus production from the nose is likely the major source for transmission since virus shedding from the nose occurs in large quantities and tends to happen at the beginning of the disease when many are asymptomatic and therefore not quarantining.  Virus shedding from the nose may also occur after symptom resolution as well.

At the same time, COVID-19 is, with one very interesting exception, very rarely associated with nasal symptoms.  This is actually one convenient aspect of COVID-19, especially since the pandemic is occurring during the spring allergy season.  Unlike seasonal allergies, COVID-19 is not prominently associated with nasal blockage, mucus production or sneezing.  However, recent research out of France has shown that the unique symptom complex of sudden onset loss of one’s sense of smell without any concomitant nasal blockage is highly predictive of having COVID-19.  Patients experiencing this sudden loss of sense of smell otherwise had either no or mild symptoms of COVID-19, such that they had no idea that they had COVID-19.  These findings suggest that a sudden loss of one’s sense of smell without nasal blockage could be used for public health purposes to identify asymptomatic carriers who may otherwise go about “business as usual” while unsuspectingly transmitting the disease to others. What should readers take away from your report? 

Response:  The most important take-away of immediate applicability is that individuals who experience a sudden loss of the sense of smell should self-quarantine under the assumption of having COVID-19 until testing can be performed.  However, we are increasingly understanding the important role of the nasal cavity in COVID-19, from infection to disease transmission and with increasing knowledge, novel insights may be gained with respect to prevention of infection or reducing infectiousness. What recommendations do you have for future research as a result of this work?

Response: There are still many biologic and epidemiological relationships that need to be explored with respect to the nose and COVID-19.  For example, why is smell loss the only symptom that occurs in relation to the nose?  And how predictive is sudden smell loss with respect to where in the COVID-19 disease course are patients and how severe will be the disease?  These are just some of many questions that need to be further explored. Is there anything else you would like to add?

Response: No disclosures.

This study was also performed by Dr. Isabelle Gengler, MD and Dr. James Wang, MD, PhD in the Department of Otolaryngology – Head and Neck Surgery at the University of Cincinnati College of Medicine and UC Health, as well as Dr. Marlene Speth, MD in the Department of Otolaryngology at the Kantonsspital Aarau in Aarau, Switzerland.   


Gengler, I., Wang, J.C., Speth, M.M. and Sedaghat, A.R. (2020), Sinonasal pathophysiology of SARS‐CoV‐2 and COVID‐19: a systematic review of the current evidence. Laryngoscope Investigative Otolaryngology. Accepted Author Manuscript. doi:10.1002/lio2.384



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Last Updated on May 12, 2020 by Marie Benz MD FAAD