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Based on the experience of the Olfactogustometry Laboratories in Halle and in Poznan, a proposal of clinical terminology and systematization of smell and taste disorders has been presented. Individual interpretation of the data from anamnesis in relation to the findings of the olfactogustometric investigations were stressed as indispensable.
Smell and taste disorders are common in the general population, yet little is known about their nature or cause. This article describes a study of 750 patients with complaints of abnormal smell or taste perception from the University of Pennsylvania Smell and Taste Center, Philadelphia. Major findings suggest that: chemosensory dysfunction influences quality of life; complaints of taste loss usually reflect loss of smell function; upper respiratory infection, head trauma, and chronic nasal and paranasal sinus disease are the most common causes of the diminution of the sense of smell, with head trauma having the greatest loss; depression frequently accompanies chemosensory distortion; low body weight accompanies burning mouth syndrome; estrogens protect against loss of the sense of smell in postmenopausal women; zinc therapy may provide no benefit to patients with chemosensory dysfunction; and thyroid hormone function is associated with oral sensory distortion. The findings are discussed in relation to management of patients with chemosensory disturbances.
We studied the therapeutic efficacy of zinc picolinate in patients with zinc-deficient and idiopathic taste disorders. Efficacy was assessed in a double-blind study. The following findings were obtained: 1. There was a significant difference between the zinc picolinate and placebo groups in the grade of improvement shown by the filter-paper disk method. 2. There was a significant difference between the zinc picolinate and placebo groups in the serum zinc concentration. 3. There was no significant difference between the two groups in the degree of total subjective recovery or the grade of improvement, as shown by in the whole mouth method. 4. We conclude that the administration of zinc picolinate is effective for patients with zinc-deficient and idiopathic taste disorders.
We treated five patients with Hunter's glossitis following total gastrectomy. The major complaints of the patients were taste disorder and abnormal glossal sensation. In all five cases, the patient's tongue was red and smooth, and laboratory testing showed the presence of macrocytic anemia and decreased serum concentration of vitamin B12 (cyanocobalamin). Gustometry was carried out in four cases and the results documented the presence of taste disorder. All five patients were treated by administration of vitamin B12, which led to improvements in the appearance of the tongue, the patients' subjective complaints and the results of taste testing. When patients present with a red, smooth tongue, Hunter's glossitis (which can easily be improved by administration of vitamin B12) should be considered in the differential diagnosis.
Clinical assessment of the patient who has smell and taste disorders requires understanding of the etiology of the olfactory and gustatory disorders. Available clinical tests of olfactory and gustatory systems allow detecting and measuring the degree of the sensory loss, but are unable to determine the cause and give neither prognostic information nor therapeutic guidance. With physical examination, however, clinical history can help to establish the diagnosis and guide the treatment if available. A clinician evaluating a patient who has smell and taste loss must understand that "taste" complaints usually are symptoms of an olfactory dysfunction. The distinction between true gustatory loss (bitter, sweet, salty, sour, or umami) and olfactory loss, the inability to perceive complex flavors of food, will help clarify the patient's diagnosis. Easy-to-administer tests are available for olfactory (eg, UPSIT) and gustatory testing (eg, spatial tests, taste sticks, tasting tablets). In rare circumstances, imaging studies (eg, MRI, CT) are indicated.
A total of 73 patients with an idiopathic zinc-deficiency taste disorder completed a double-blind, placebo-controlled trial of the efficacy of zinc picolinate. Patients in the zinc treatment group (n = 37) received 29 mg of zinc picolinate orally by capsule 3 times a day for 3 months. No significant difference was noted between the treatment and placebo groups in terms of improvement in subjective symptoms or whole-mouth taste sensation. However, assessment of taste using the filter paper disk method showed significantly better improvement for the group given zinc, and the serum zinc level was also significantly higher in this group than in the placebo control group.
BACKGROUND: The number of medical expert opinions dealing with smell and taste disorders has continuously increased in recent years. However, an overview of the specific problems and results of those expert opinions has not been published until now. INDIVIDUALS AND METHODS: Olfaction was assessed by multiple subjective tests in 145 individuals with chemosensory dysfunction caused by trauma or occupational and environmental exposures. Additionally, a gustatory test, nasal endoscopy, anterior rhinomanometry, and radiography of the paranasal sinuses were performed. Malignering was diagnosed on a trial of multiple symptoms. Retronasal olfaction was tested using the Güttich gustatory olfaction test. RESULTS: Most of the medical expert opinions have been ordered by professional associations (42%) and insurance companies (28%). Compensation for olfactory dysfunction was claimed after trauma (64%), occupational exposure (23%) rhinosurgical procedures (8%), and laryngectomy (5%). Anosmia or hyposmia was claimed by 66% and 24% of all individuals, respectively. According to the results of the chemosensory tests, 41% of patients suffered from anosmia and 40% had hyposmia. Malignering was registered in 14%. CONCLUSIONS: The study shows that the "characteristic case" is a male in the late fourties, complaining of anosmia initially noticed after an occipital or frontobasal head trauma. The assessment of olfactory deficits related to toxic or chemical occupational exposure is difficult when a latency between the occupational exposure and the onset of chemosensory dysfunction is present. Moreover, interactions between the occupational exposure and nicotine or alcohol abuse must be taken into consideration. Claims for medical liability arose in 3% of the study group after septoplasty and sinus surgery.
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Gustatory problems have deleterious consequences to systemic health, nutritional status and quality of life. Chemosensory dysfunction is most often secondary to one of only a few causes: viral infection, toxic chemical exposure, head trauma, as well as medication-related and idiopathic conditions. Many gustatory disorders are secondary to a wide variety of diseases. History taking may provide clues to these and other problems. Therapy should not begin until a standardized test has been given that established impairment of the sense of taste. Treatment of underlying diseases may restore chemosensory function. Reference is made to the need for adequate psychic guidance of patients with chemosensorial problems. If restoration of their sense of taste is unlikely, patient should be cautioned to take steps to ensure safety in regard to such dangers and spoiled foods.
Clinically significant taste loss is less common than abnormal tastes (dysgeusias). Both may be caused by a previous viral upper respiratory infection, head trauma, iatrogenic causation (medication, irradiation, surgery), neurologic or psychiatric disorders, toxic chemical exposure, systemic conditions, xerostomia, severe nutritional deficiencies, and some oral or dental disorders. Beyond treatment targeted toward causative conditions, there is no proven intervention to either enhance taste acuity or abolish dysgeusia. The prevalence of oral burning sensations has been estimated at 2.6% for the general population. The burning typically increases throughout the day, and may be associated with taste alterations and psychological effects. Differential diagnoses considered include psychiatric illness, menopause, nutritional disorders, oral and dental conditions, and diabetes mellitus. Low doses of tricyclic antidepressants may be effective in some patients with idiopathic oral burning, and spontaneous remissions without intervention have been reported.
Gustatory responses to the basic taste substances (sweet, salty, sour and bitter) were studied in hypothyroid and hyperthyroid subjects. The intensity and hedonic responses were evaluated using "category scaling" for 7 concentrations of glucose, sodium chloride, citric acid and quinine sulphate. The intensity and hedonic values decrease in hyperthyroidism for salt and bitter solution, and sourness is perceived as more unpleasant. In hypothyroid subjects intensity and hedonic value decreases for sweetness, the pleasant responses to salt and bitter increase, though intensity perception decreases for bitter solutions.