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J Neurol Surg B Skull Base . Association between Objective and Subjective Olfactory Dysfunction in SARS-CoV-2-Positive Patients Undergoing Skull Ba

tetano

Editor, Senior Moderator
J Neurol Surg B Skull Base


. 2025 May 23;87(3):345-351.
doi: 10.1055/a-2599-4262. eCollection 2026 Jun.
Association between Objective and Subjective Olfactory Dysfunction in SARS-CoV-2-Positive Patients Undergoing Skull Base Surgery

Bastien A Valencia-Sanchez[SUP] 1 [/SUP], Prishae Wilson[SUP] 1 [/SUP], Natasha N Najmi[SUP] 1 [/SUP], Alaa Alhalabi[SUP] 1 [/SUP], Kaisorn Chaichana[SUP] 2 [/SUP], Angela M Donaldson[SUP] 1 [/SUP]


Affiliations
Abstract

Objective: This study aimed to investigate the association between objective and subjective olfactory assessments in patients with recent severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection undergoing endoscopic endonasal skull base surgery (EESBS).
Design: Retrospective cohort study.
Setting: Academic medical center.
Participants: Adult patients with and without recent SARS-CoV-2 infection who underwent EESBS for sellar and parasellar lesion resection between 2020 and 2024 at the Mayo Clinic in Florida, Jacksonville, FL.
Main outcome measures: Pre- and postoperative self-reported olfactory dysfunction and University of Pennsylvania Smell Identification Test (UPSIT) scores were collected.
Results: Patients with recent SARS-CoV-2 infection had a similar rate of discrepant preoperative objective olfactory assessments (38.2%, 26/68) compared with SARS-CoV-2-negative patients (39.9%, 127/318). SARS-CoV-2-positive patients were twice as likely to report postoperative subjective olfactory dysfunction (46.2%, 12/26) compared with SARS-CoV-2-negative patients (18.1%, 23/127, p = 0.002). There was no statistically significant difference in the mean preoperative ( p = 0.162) or postoperative ( p = 0.724) UPSIT scores between both groups.
Conclusion: Patients with recent SARS-CoV-2 infection and discrepant preoperative objective olfactory assessments were twice as likely to self-report olfactory dysfunction following EESBS compared with SARS-CoV-2-negative controls. This increase in self-reported olfactory dysfunction was not accompanied by changes in objective psychophysical testing. These findings suggest that SARS-CoV-2 infection may impact subjective olfactory recovery following EESBS.

Keywords: SARS-CoV-2; UPSIT; olfaction; olfactory dysfunction; skull base surgery.

 
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