Otolaryngeal manifestations are the common symptoms of COVID 19. Patients present with dry cough, sore throat, difficulty in breathing, running nose, nasal congestion and even dizziness. Usually, all Upper respiratory tract symptoms appear in the initial stages. In fact, they could be present even before the molecular confirmation of SARS- CoV2. Apart from these, one common symptom which was quite uncommon in the pre-COVID 19 era but has become very common in COVID affected patients is Anosmia / Hyposmia (loss of sense of smell) often accompanied by loss of taste. Isolated sudden Anosmia is commonly observed in younger patients suffering from COVID 19. Countries severly affected by SARS-CoV-2 like Italy, UK,South Korea have presented data that a significant number of patients with COVID 19 were affected by anosmia ( loss of smell). In fact, South Korea reported that 30% of its affected patients had anosmia. Also there are man reports / publications which say that COVID 19 may present with isolated anosmia without any other symptoms. These patients could be hidden carriers and a source of rapid spread of COVID 19. Why does Anosmia (loss of smell) occur in COVID 19? SARS-CoV 2 (the corona virus which causes COVID 19) enters the cells of the nasal epithelium by using the ACE2 (Angiotensin Converting Enzyme 2) receptor via binding with the spike protein. The TMPRSS2 ( Transmembrane Protease Serine 2), an enzyme encoded by the TMPRSS2 gene helps to prime this spike protein. ACE2 is a protein on the surface of many types of cells including the nose, throat and bronchial airways. It is thus basically a entry point or a cellular doorway for the corona virus which causes COVID 19. Similiarly the TMPRSS2 enzyme is also present on the surface of these cells. The expression of ACE2 and TMPRSS2 is very high in the Olfactory Surface Epithelium (OSE) of the nose and therefore it allows a wide viral entry. Subsequently, this can lead to peripheral nerve injury causing Anosmia (loss of sense of smell). This mechanism itself suggests that in such patients who suffer from Anosmia on being infected with the SARS-CoV2 virus, the viral load may be very high and even though there are no other symptoms, these patients may turn out to be superspreaders of infection. It is to be noted that studies wherein virological assessment of such patients(patients with mild symptoms and anosmia and taste disturbances) has been performed, confirm high levels of viral shedding. Hence self isolation of such patients is highly recommended. The pattern of expression of ACE2 and TMPRSS2, the sudden onset of anosmia(loss of smell) and the relatively fast recovery of the same goes in favour of the fact that anosmia(loss of smell) caused by COVID 19 is not caused by damage to the CNS(Central Nervous System) but probably as a result of smell information that gets blocked before it reaches the brain. If the CNS was affected, the symptom would have a gradual onset and a slower recovery. Also, it would be expected to be present with other complex versions of anosmia like parosmia or phantosmia which have not been reported .The fast recovery of this symptom (anosmia) points to a peripheral cause wherein the Olfactory sensory neurons are not permanently damaged. Now there are two considerations: 1. Anosmia as a sole initial presentation, 2. Anosmia which occurs later in the course of the disease (2 nd / 3 rd week) which usually coincides with the healing of the patient experiencing mild symptoms. If the patient presents with isolated anosmia, it can be the initial & or sole manifestation of the disease. & for reasons described earlier , the patient can be a highly potential carrier of the infection. In such cases, the patient and their contacts should be counseled and quarantined for the next 14 days. As of now, the ICMR guidelines do not give us permission to recommend COVID 19 testing in these patients. No medicinal treatment is required as this anosmia recovers on its own. All of the patients I have seen have recovered within 7 to 14 days. The maximum time taken for recovery of this symptom is reported as 4 to 6 weeks. Olfactory neurons have regenerative capabilities that other CNS nerves in the body do not have. The time & degree of regeneration however depends on the extent of damage and also the cause and I may say from the reports available till date that majority of the sudden anosmia cases caused due to COVID 19 , have recovered completely. Steroid are NOT recommended for isolated anosmia due to COVID 19 as it may exacerbate the ongoing inflammation. It is intresting to note that despite similiarity between SARS-CoV and SARS CoV 2, anosmia has never been described in SARS . As of now, we are only just in the learning phase of this disease. Only a serious follow up of this clinical observation will help us understand the sudden rise of anosmia in parallel to the SARS-CoV-2 outbreak. To conclude: 1. Sudden onset anosmia with or without loss of taste is definitely a symptom of COVID 19. 2. No medicinal treatment required except for multivitamin / zinc supplements as it recovers on its own. 3. ICMR guidelines do not include anosmia as a symptom for prescribing test for COVID 19. 4. However, counseling of the patient and isolation of their patients and their contacts is strictly required.