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Hypogeusia as a complication of uvulopalatopharyngoplasty and use of taste strips as a practical tool for quantifying hypogeusia.

Hypogeusia is an uncommon complication of uvulopalatopharyngoplasty (UPPP) and few reports in the literature have documented it. Excision of part of the soft palate and damage to the glossopharyngeal nerve or its lingual branch as a result of diathermy or surgery are the possible causes. The case of a 45-year-old male who suffered hypogeusia following UPPP is reported herein. He reported no improvement over a 6-month period. Quantitative assessment of his taste threshold for the 4 basic tastes using taste strips showed a score of 7/18, indicating hypogeusia. The possibility of taste disorder as a postoperative complication should be discussed before patients consent to UPPP Postoperative taste threshold assessment should be done using taste strips if the patient complains of taste disorders.

Ageusia↗

[Olfactory disorders due to medications: analysis and review of the literature].

INTRODUCTION: Olfactory disorders caused by medicinal drug intake are an uncommon occurrence. However, such an etiology should be systematically taken into account and investigated, as olfactory loss may be reversible once the particular treatment has been stopped. CURRENT KNOWLEDGE AND KEY POINTS: An analysis of the literature shows that of the large number of drugs that are apparently responsible for olfactory disorders, this adverse side effect has in fact only been observed in animal study populations, and no clinical case report has been made on the subject. The real toxicity to man is therefore only hypothetical. Of the 150,000 cases recorded in the pharmacovigilance centers in France, only 68 have reported olfactory complications (0.05% of cases), and only 22% of the medical files on this disorder reach a satisfactory level of plausibility. Cardiovascular drugs are mainly implicated in the development of olfactory disorders. Of these, certain drugs in particular should be mentioned: conversion enzyme (ACE) inhibitors which are responsible for taste disorders, some betablockers, and a calcium antagonist (a dihydropyridine derivative). Olfactory disorders have also been reported following administration of drugs used in anesthesia, in cancerology, endocrinology (carbimazole), in immunology (interferon), in the treatment of infectious diseases (ciprofloxacine, dioxycycline, terbinafine), and in rheumatology (D-penicillamine). FUTURE PROSPECTS AND PROJECTS: It is frequently difficult to establish a direct relationship between drug exposure and an olfactory disorder, and it is often not easy to determine with any certainty the causative role of the drug in the development of this disorder.

Animals↗

Taste function after section of chorda tympani nerve in middle ear surgery.

OBJECTIVE: To investigate prospectively the clinical manifestations and the functional recovery of taste after section of chorda tympani nerve (CTN) during middle ear surgery, the subjective and objective study on the patients was performed. METHODS: Thirty-five patients underwent surgery with unilateral (n=32) or bilateral (n=3) section of CTN between January 2000 and April 2002. The patients were asked about taste symptoms before surgery and 2 weeks and 2 years after surgery. The CTN function was also measured with electrogustometry (EGM) at the same time points. RESULTS: In unilateral section of CTN, 19/32 (59.4%) complained of taste disorder and 11/32 (34.4%) tongue numbness. Most of these taste symptoms disappeared within 2 years although the EGM threshold did not recover. 16/17 patients (94.1%) who used to cook everyday had little difficulty in flavoring dishes. In bilateral section of CTN, the patients had no problem of taste at 2 years after surgery, either. CONCLUSION: These findings help explain the potential complications to the patients before surgery, although the number of cases was small in this series.

Adolescent↗

Taste disturbance in two patients after dental anesthesia by inferior alveolar nerve block.

We report two cases of temporary taste disturbance after inferior alveolar nerve block. The first patient to present with this rare complication of anesthesia for dental surgery was a 41-year-old woman. She lost the sense of taste on the left side of her tongue after local anesthesia for treatment of a left mandibular molar and first visited our outpatient clinic complaining of taste disorder 3 months later. Electrogustometry (EGM) and filter paper disk (FPD) testing revealed a taste disturbance in the innervation area of the left chorda tympani nerve and atrophy of the fungiform papillae on the left side of the tongue was observed. Eleven months after the dental treatment, the fungiform papillae and the results of EGM were normal. The second patient, a 22-year-old woman, received local anesthetic for extraction of a right mandibular molar and subsequently developed loss of taste on the right side of the tongue. When she visited our outpatient clinic 3 months later, atrophy of the fungiform papillae on the right side was observed. Her gustatory sense began to improve 4 months after the dental surgery and was normal at 13 months. From these findings we conclude that taste disturbance on the same side as the inferior alveolar nerve block in each case was due to direct injury to the chorda tympani and lingual nerves during administration of the local anesthetic. The results of EGM and FPD testing were diagnostic: atrophy of the fungiform papillae on the same side and disappearance of taste on the same side in the intravenous taste test provided complementary diagnostic information. The outcome was satisfactory in both cases.

Adult↗

Assessment of patients with taste and smell disorders.

The evaluation of patients with taste and smell complaints is difficult without standardized quantitative methods of assessment. This paper summarizes recent developments in the evaluation of chemosensory patients. Evaluation must begin with a careful medical history, since certain questions can help in establishing an etiology. Several recent advances have been made in the development of standardized tests for the assessment of taste and olfactory function. Smell can be evaluated with a combination of butanol threshold and odor identification (University of Connecticut test battery) and with the University of Pennsylvania Smell Identification Test (UPSIT). Scores obtained from 91 patients show good correlation between these two testing procedures. Both tests provide normative data for comparison, with the UPSIT including both age- and sex-related norms. Traditional evaluation of taste deficits with threshold procedures has been questioned. Measures of suprathreshold taste intensity require the anchoring of taste judgements to another, presumably normal, modality. This has been approached using magnitude matching, in which taste and auditory loudness are judged on the same scale. Spatial testing of the tongue and soft palate can reveal pathology of the gustatory nerves or their central connections. Further understanding of taste and olfactory dysfunction will be facilitated by the development of standardized methods of evaluation.

Humans↗

Genetic and pathological taste variation: what can we learn from animal models and human disease?

The study of patients with taste disorders (i.e. 'experiments of nature') suggests that the old tongue maps (e.g. sweet on the tip, bitter on the back) that often appear in textbooks are wrong. If they were correct, severing the taste nerves that innervate the front of the tongue would result in a loss of the ability to taste sweet, etc. This does not occur. Severing these nerves has little effect on everyday taste experience because taste nerves inhibit one another. Damaging one nerve abolishes its ability to inhibit others and the release-of-inhibition compensates for the damage. There is sometimes a clinical cost for this redundancy; release-of-inhibition can produce taste phantoms. Genetic variation in taste ability occurs across and within species. For example, about 25% of humans are relatively unresponsive to a variety of sweet and bitter compounds (non-tasters) while another 25% are unusually responsive (supertasters). Supertasters have about four times as many taste buds as non-tasters and have smaller and more densely packed fungiform papillae. Since there are pain fibres associated with taste buds, supertasters are unusually responsive to the oral burn of spices.

Animals↗

[Bilateral ageusia after left insular and opercular ischemic stroke].

Gustatory disorders after ischemic stroke is an uncommon event, generally occurring unilaterally, ipsilateral or contralateral to the stroke depending on the site of the lesion. We report a patient who developed bilateral agueusia after a unilateral insular stroke. This 70-year-old right-handed man developed a sudden onset left opercular syndrome in March 1999 with right hemiphyosethesia. Magnetic resonance imaging revealed a left insular and opercular stroke. Anarthria, swallowing and sensorial disorders regressed in a few weeks, but taste disturbances led to a 6 kg weight loss. After six months, the symptoms disappeared. To our knowledge, 32 cases of taste disorders after stroke have been reported. For most of the cases, the agueusia was unilateral. Our case illustrated the predominance of the left cortical hemisphere for taste perception in the right-handed subject.

Aged↗

Neurochemical markers of human fungiform papillae and taste buds.

The presence of distribution of several neurochemical markers in human fungiform papillae and taste buds were investigated by the immunohistochemical technique. The gustatory cells of the taste buds are in synaptic contact with sensory nerve endings, and considering the taste buds strictly as specialized sensory organs, the amounts and distribution of some of the neurochemical markers were different to what we expected. For example, few structures showed immunoreactivity to the tachykinins substance P (SP), calcitonin gene-related peptide (CGRP), and neurokinin A (NKA) also for the peptides vasoactive intestinal polypeptide (VIP), neuropeptide tyrosine (NPY) and galanin, low amounts of immunoreactivity occurred. On the other hand, using antibodies to protein gene product 9.5 (PGP 9.5), protein S-100, and glutamate, numerous nerve fibres and/or immunoreactive cells were found in the fungiform papillae, in the epithelium, in the connective tissue and around blood vessels, as well as in or near taste buds. Incubation with the antibodies against somatostatin, enkephalin, bombesin, peptide histidine isoleucine amide (PHI), cholecystokinin (CCK)/gastrin and dopamine-beta-hydroxylase (DBH) was negative for the fungiform papillae. In conclusion, the present study has shown several immunoreactive structures using antibodies against certain neurochemical markers. Further investigations will hopefully correlate these morphological findings with functional taste perception data. Future studies of patients with taste disorders or other pathological changes correlated with taste and tongue will also be of utmost importance.

Antibodies↗

[Taste affection and its causes].

Basic anatomophysiological evidence underlying sense of taste, main causes of taste disorders, guides for practitioners how to detect these disorders and differentiate them with physicians of allied specialities, make prognosis and design policy of the disease treatment are reviewed.

Cranial Nerve Diseases↗

[Gustatory disturbances as sideeffect of medical treatment (author's transl)].

A review of the pharmacological induced taste disorders is given. Many patients complain only of a spontaneous metallic, bitter or salty sensation in their mouths. More serious is the development of a dissociated hypogeusia or even an ageusia. 7 cases with gustatory disturbances caused by orally given medicine are presented. The phenylbutazone, oxyphedrine, carbamazepine, Muskel-Trancopal comp. (Chlormezanon, Paracetamol) and Lioresal (baclofen) were accused to have caused a partial or complete loss of taste. After the treatment had been discontinued it took weeks or even months for a complete recovery.

Acetaminophen↗

[Enteral nutrition and changes in taste in diabetic patients: a double-blind prospective study].

The authors present a prospective double blind test aimed at objectively determining the acceptance of flavoured orally administered enteric diets specific to patients with glucose metabolism alterations (Glucerna and Precitene Diabet), in the light of the taste disorders described in such patients. Sixty-two patients were studied, 32 diabetics and 32 control patients, who were given a sample of each product; the level of acceptance was quantified on a modified wine-tasting scale. The average taste of the diabetics was 12.1 points (SD = 4.34) for Glucerna, and 10.1 (SD = 3.91) for the Precitene Diabet. In the control patients, the scores were 12.7 (SD = 3.78) and 13.2 (SD = 3.23) respectively. Multiple regression analysis did not reveal significant differences in taste according to age, sex or place of origin. Average taste among the diabetic patients as a whole with both products was 11.2 points and, for the nondiabetics, 12.92. The model detected significant differences (p = 0.01) between the two groups. The average taste of the diabetics was less than that of the non-diabetics, irrespective of all the remaining variables examined, including the type of preparation. These results confirm the lower oral acceptance in diabetic patients, possibly associated with disorders in the sense of taste, showing the utility of the modified wine-tasting scale as a test in evaluating the acceptance of enteric diets which must be administered orally.

Adolescent↗

Anorexia nervosa responding to zinc supplementation: a case report.

An emaciated 16-year-old female with anorexia nervosa was hospitalized for treatment of vomiting, epigastralgia and diarrhea. The finding of a taste disorder, low serum alkaline phosphatase activity and relatively low serum zinc level strongly suggested a zinc deficiency. Zinc was initially administered intravenously (40 mumol/day) for 7 days, then orally (15 mg elemental zinc/day) for about 60 days. Her digestive symptoms disappeared after the second day of intravenous treatment and she began to gain weight. She rapidly regained her normal weight after one month of receiving the oral zinc supplementation. Both exocrine pancreatic function and intestinal absorption were improved by the prolonged oral administration of zinc. In such cases zinc supplementation may be a therapeutic option in addition to psychologic and other approaches to management.

Adolescent↗