11/54. Taste disorder involving Hunter's glossitis following total gastrectomy. 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. ( info) |
12/54. Taste disturbance after tonsillectomy. Of the 3583 outpatients treated at our taste disorder clinic over a period of 15 years, 11 (0.31%) complained of taste disorder after tonsillectomy. The cause of taste disorder was identified in 8 of the 11 cases: in 3 cases it was caused by direct or indirect damage to the lingual branch of the glossopharyngeal nerve; in 2 cases it was attributable to medication taken by the patient after tonsillectomy; and in 3 cases taste disturbance was caused by a lack of dietary zinc, even though this was identified at the time of tonsillectomy. These findings indicate the importance of (i) informing patients when consent for tonsillectomy is obtained that there is a risk of postoperative taste disorder; (ii) measuring the patient's taste threshold and serum zinc level preoperatively; and (iii) obtaining a thorough drug history, including details of non-prescription medications habitually taken by the patient. ( info) |
13/54. Course of recovery from taste receptor disturbance. The course of recovery from taste receptor disturbance was studied in 119 patients with moderate-to-severe taste receptor disturbance that was cured or improved with zinc therapy. Taste receptor disturbance was idiopathic in 45 patients, drug-induced in 38 and due to zinc deficiency in 36. Recovery of taste, evaluated by filter paper disk testing and electrogustometry, followed 1 of 3 patterns: (i) in 54 (45.4%) of the 119 cases, taste improved simultaneously in the anterior (innervated by the chorda tympani nerve) and posterior (innervated by the glossopharyngeal nerve) portions of the tongue; (ii) in 53 (44.5%) of the cases, taste improved in the posterior portion first; and (iii) in 12 (10.1%) of the cases, taste improved in the anterior portion first. zinc therapy was more effective in patients with the "posterior" pattern of recovery, and these patients also recovered the ability to sense sweet and bitter tastes earlier than other tastes. These results indicate that recovery of taste begins on the posterior portion of the tongue, which has an abundance of taste buds. The results of electrogustometry were not helpful in assessing recovery from taste disturbance, but testing for taste using the filter paper disk method on the posterior portion of the tongue was useful for identifying the onset of recovery. ( info) |
14/54. 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. ( info) |
15/54. Buccal mucosal cancer patient who failed to recover taste acuity after partial oral cavity irradiation. PURPOSE: We report a patient who suffered from prolonged loss of taste acuity after partial oral cavity irradiation. methods: The electric taste threshold (ETT) of each point in the oral cavity was measured with an electric gustometer to evaluate quantitative local taste acuity. A subjective total taste acuity (STTA) scale was used to evaluate subjective total taste acuity. CASE: A 61-year-old male patient with right buccal mucosal cancer underwent radiation therapy more than 11 years ago, and has suffered from loss of taste acuity since then. He received electron beam irradiation to part of the oral cavity and right upper neck, mainly the right buccal mucosa near the retromolar trigone and a metastatic right submandibular node. He did not receive irradiation to the anterior portion of the tongue or left side of the posterior portion of the tongue. His ETT scores for each point were equal to or greater than 26, and his STTA score was grade 3. CONCLUSION: The present case implies that radiation damage to part of the oral cavity can cause the loss of subjective total taste acuity. ( info) |
16/54. Metallic taste: an unusual reaction to botulinum toxin A. BACKGROUND: Botulinum neurotoxin formulations are safe and effective agents for the treatment of facial rhytides. OBJECTIVES: A patient is described who complained of metallic taste after each treatment with botulinum toxin A (BTX-A). RESULTS: The sensation of metallic taste diminished after successive treatments with BTX-A, despite adequate dosing for cosmetic purposes. CONCLUSION: Metallic taste is associated with the use of numerous medications; however, the pathogenesis remains unclear. Alteration in zinc metabolism, which may occur with BTX-A administration, has been suggested as a possible mechanism. Although this is the first known report of dysgeusia after BTX-A, physicians and patients may be reassured that the taste alteration was self-limited and was not significantly problematic for the patient in our case. ( info) |
17/54. Lexical-gustatory synaesthesia: linguistic and conceptual factors. This study documents an unusual case of developmental synaesthesia, in which speech sounds induce an involuntary sensation of taste that is subjectively located in the mouth. JIW shows a highly structured, non-random relationship between particular combinations of phonemes (rather than graphemes) and the resultant taste, and this is influenced by a number of fine-grained phonemic properties (e.g. allophony, phoneme ordering). The synaesthesia is not found for environmental sounds. The synaesthesia, in its current form, is likely to have originated during vocabulary acquisition, since it is guided by learned linguistic and conceptual knowledge. The phonemes that trigger a given taste tend to also appear in the name of the corresponding foodstuff (e.g. /I/, /n/ and /s/ can trigger a taste of mince /mIns/) and there is often a semantic association between the triggering word and taste (e.g. the word blue tastes "inky"). The results suggest that synaesthesia does not simply reflect innate connections from one perceptual system to another, but that it can be mediated and/or influenced by a symbolic/conceptual level of representation. ( info) |
18/54. Atypical keratosis obturans. keratosis obturans is a rare condition characterized by the accumulation of desquamated keratin material in the bony portion of the external auditory canal. Classically, it is reported to present with severe otalgia, conductive deafness and global widening of the canal. A case of keratosis obturans is described in which the principal symptom was a metallic taste and the main finding was extensive erosion of the hypotympanum with exposure of the facial nerve and the annulus of the tympanic membrane. This presenting symptom and resorption pattern are atypical of keratosis obturans and have not been documented previously. ( info) |
19/54. Taste and smell disturbance with the alpha-adrenoceptor agonist midodrine. OBJECTIVE: To report a case of a disturbance of taste and smell associated with the alpha-adrenoceptor agonist midodrine. CASE SUMMARY: A 64-year-old white man with autonomic failure was started on midodrine 5 mg/day as treatment for orthostatic hypotension. After 3 months, the dose was increased to 12.5 mg/day, whereupon he noted a new onset of taste and smell disturbance. These symptoms made eating so unpleasant that the man greatly reduced his food intake, leading to significant weight loss. In addition, he experienced well-recognized adverse effects of midodrine, such as scalp pruritus, after the dose increase. All symptoms resolved with a dose reduction of midodrine (to 5 mg/day), and the patient increased his food intake, resulting in a return to his initial body weight. DISCUSSION: midodrine is commonly associated with dose-dependent adverse effects, such as scalp pruritus and cutis anserina. Disorders of taste and smell have not been previously reported with midodrine, although it has been suggested that other sympathomimetic drugs may have effects on the olfactory threshold. Severe disorders of taste and smell may impact not only on a patient's quality of life, but also on their physical well-being, with significant weight loss being reported in this case. According to the Naranjo probability scale, this patient's taste and smell disturbance was probably associated with midodrine. CONCLUSIONS: The use of midodrine may be associated with taste and smell disturbance. This case suggests that such an association is likely to be dose dependent. ( info) |
20/54. Patterns of sensory recovery in the lingual nerve after surgical trauma. OBJECTIVE: To examine the pattern of sensory recovery in the lingual nerve following injury, with an emphasis on qualitative changes. methods: Using data from one patient with prolonged dysaesthesia after surgical trauma to the lingual nerve, we correlated changes in perceived sensory function during recovery with results from qualitative and quantitative taste tests, and patient-reported quality-of-life measures. RESULTS: Recovery of quantitative taste testing as measured by automated electrogustometry, and qualitative whole of mouth taste testing, preceded perceptual recovery of taste. On the other hand, taste acuity as measured by regional qualitative taste testing tended to lag behind perceptual recovery. The pattern of recovery in the different qualitative taste sensations suggests variation in sensitivity of the nerve fibres responsible for carrying taste sensation, with the fibres relating to bitter and sour taste being the last to recover. CONCLUSION: To our knowledge, taking into account the limitations of this study, this picture of differential recovery of taste function in the lingual nerve has not been previously reported. ( info) |