Dimitri Z Pitovski | PubMed Health

PubMed2004

Posttonsillectomy taste distortion: a significant complication.

OBJECTIVE/HYPOTHESIS: Tonsillectomy is among the most commonly performed procedures. As with any surgery, head and neck surgeons must be aware of possible complications and their potential affects. At our smell and taste center, we have been referred several patients in a 6-month period with the complaint of taste distortion after tonsillectomy. We report in this article a patient that complains of taste distortion after a right tonsillectomy for unilateral tonsillar hypertrophy. STUDY DESIGN: A prospective study documenting taste distortion after tonsillectomy using clinical, subjective, and objective evaluation. METHODS: The clinical course of a patient with taste distortion after a tonsillectomy is described. The gustatory function was investigated by conducting electrogustometry and spatial taste testing. Threshold measurements were determined at three left- and three right-side tongue regions: 1) the tongue tip region (innervated by the chorda tympani branch of the facial nerve), 2) the lateral margin of the tongue (anterior to the foliate papillae), and 3) the posterior tongue region (innervated by the lingual branch of the glossopharyngeal nerve). RESULTS: After a complete clinical evaluation and taste testing, it was found that the patient suffered an injury to the right lingual branch of the glossopharyngeal nerve. The close anatomic relationship between the palatine tonsil and lingual branch of the glossopharyngeal nerve makes the nerve vulnerable during tonsillectomy. This injury has caused the patient to suffer ageusia to the right posterior one third of the tongue, compensated by a contralateral phantogeusia (phantom taste) with clinical dysgeusia. The phantogeusia was abolished by application of anesthetic to the area where the phantom was perceived. We propose that the phantogeusia is the result of release-of-inhibition in the contralateral glossopharyngeal nerve. CONCLUSION: Taste distortion (including, phantogeusia and dysgeusia) after tonsillectomy is rarely reported as a complication but has a significant impact on quality of life. This article examines the taste distortion presence as a complication after tonsillectomy to make head and neck surgeons aware of this serious complication and the pathophysiology of taste distortion.

Dysgeusia↗

PubMed2002

Sodium- and potassium-activated ATPase in the mammalian vestibular system.

Autoradiographic and cytochemical procedures were employed to determine the cellular distribution of the Na,K-ATPase enzyme in the mammalian vestibular system. A light-microscope survey of vestibular tissues incubated with [(3)H]ouabain shows high densities of ouabain binding sites within the dark cell epithelium (DC) of the ampullae of the semi-circular canals, and to a lesser extent, the DC of the utricular macula. A moderate number of binding sites was found in nerve fibers penetrating the connective tissue beneath the sensory epithelium (SE) of the ampullae and the maculae. A small number of binding sites is distributed in the deep portion of the SE, both in the ampullae and in the maculae. These latter binding sites seem to be associated with nerve terminals and receptor cells. At the ultrastructural level, the vestibular dark cells exhibit extensive basolateral membrane infolding, a morphological hallmark of cells engaged in trans-epithelial ion transport. The cytochemical reaction product is K(+)-dependent, ouabain inhibitable, and is restricted to the basolateral membrane extensions, with little or no product on the luminal membrane. The extent of membrane infolding in dark cells of the utricle is less pronounced than that of the ampullar dark cells and the intensity of the cytochemical reaction appears to correlate with the extent of membrane infolding. The results support the widely held hypothesis that the vestibular dark cells play a role in endolymph production. They also suggest that the vestibular sensory epithelia may be a site of ion exchange.

Animals↗