Dear Editor,

We thank our colleagues for their constructive discussion on our recently published study [1]. Regarding prevalence, indeed, growing literature yields a variable frequency of loss of smell (LOS) in COVID‐19 patients that may hypothetically be due to differences in the location and amount of viral load, to the different immune response between younger mild‐symptomatic outpatients (higher prevalence) and more severely affected inpatients (lower prevalence) [1, 2] and to the variable methods of measurement.

Likewise, there may be a mismatch between self‐reported and objective LOS, both over‐ and under‐estimation [3]. Standardized objective measurements are necessary for an accurate description of the syndrome, but we believe self‐reported LOS analysis is very relevant, and pragmatically more useful in a real‐life setting.

As for the low prevalence and/or lack of association of nasal obstruction with LOS, several previous reports [2, 4] agree with our findings, suggesting that it is likely that olfactory neuroepithelium damage is responsible for this sensory loss. Certainly, further investigation is warranted to confirm this [5].

Finally, we agree that we assumed a recall bias regarding our historical control sample of influenza. Unfortunately, during the maximum incidence of COVID‐19, there were not enough truly reliable SARS‐CoV‐2 polymerase chain reaction negative patients nor admissions for other respiratory infections in our centres.

亲爱的编辑，

我们感谢我们的同事对我们最近发表的研究 [ 1 ] 进行的建设性讨论。事实上，关于患病率，越来越多的文献得出了 COVID-19 患者嗅觉丧失 (LOS) 的不同频率，这可能是由于病毒载量的位置和数量的差异，以及年轻的轻度症状门诊患者之间的不同免疫反应（患病率较高）和受影响更严重的住院患者（患病率较低）[ 1, 2 ] 以及可变的测量方法。

同样，自我报告和客观 LOS 之间可能存在不匹配，无论是高估还是低估 [ 3 ]。标准化的客观测量对于准确描述该综合征是必要的，但我们认为自我报告的 LOS 分析非常相关，并且在现实生活中更实用。

至于鼻阻塞与 LOS 的低患病率和/或缺乏关联，之前的几份报告 [ 2, 4 ] 同意我们的研究结果，这表明嗅觉神经上皮损伤可能是造成这种感觉丧失的原因。当然，需要进一步调查来证实这一点[ 5 ]。

最后，我们同意我们假设对我们的流感历史控制样本存在召回偏差。不幸的是，在 COVID-19 的最高发病率期间，我们中心没有足够多的真正可靠的 SARS-CoV-2 聚合酶链反应阴性患者，也没有因其他呼吸道感染而入院。