Cases reported "Taste Disorders"

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1/14. Severe gustatory disorder caused by cisplatin and etoposide.

    A 48-year-old woman with small-cell lung cancer received combined chemotherapy consisting of cisplatin (CDDP) and etoposide (Vp-16). Although the gustatory threshold in the glossopharyngeal nerve area was normal (14 dB) before chemotherapy, it rose to 22 dB on day 8 of chemotherapy, and it could not be measured, because of severe gustatory disorder, from day 15 to day 29. In the chorda tympani nerve area, the threshold was normal until day 15, but it could not be measured on day 29. This gustatory disorder continued for 2 more months, until the time of the patient's discharge. Although gustatory disorder caused by anticancer drugs has been reported as a rare side effect, this may be because it has been reported as appetite loss, and it may happen more frequently than reported cases would suggest. As gustatory disorder reduces the patient's quality of life, the presence of this side effect should be given more serious consideration.
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2/14. Changes in gustatory sense during pregnancy.

    Changes in gustatory sense were investigated in 97 pregnant women and in 30 healthy, non-pregnant women who served as controls. All 97 pregnant women completed a questionnaire regarding taste changes and 32 of them underwent serial tests of gustatory function, including electrogustometry and testing with filter paper disks placed over the areas of the chorda tympani nerve and glossopharyngeal nerve. All gustatory testing was performed by the same person. In addition, serum levels of trace elements were measured in 72 of the pregnant women. Of the 97 pregnant women, 90 (92.8%) reported in the questionnaire that they had experienced some type of change in taste during pregnancy, usually a change in sour taste (59 women; 65.6%). pregnant women had higher gustatory thresholds than non-pregnant women, with an especially marked decrease in gustatory function being noticed in the first trimester. Although serum zinc levels decreased in pregnant women between the second and third trimesters, zinc levels were in the normal range in the early stage of pregnancy. Thus, it is difficult to explain dysgeusia in the early stage of pregnancy as being associated with a deficiency of zinc. The decrease in gustatory function during the first trimester is considered to be due to the notable changes in secretion of hormones that occur during this stage.
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3/14. 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.
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4/14. 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.
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5/14. 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.
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6/14. 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.
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7/14. 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.
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8/14. herpes zoster oticus associated with facial, auditory and trigeminal involvement.

    We report a case of herpes zoster oticus with involvement of the mandibular division of the trigeminal nerve and loss of taste sensation in the anterior two third of the tongue. Infranuclear facial palsy and sensorineural deafness were also present.
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9/14. Hemiageusia, hemianaesthesia and hemiatrophy of the tongue.

    A patient with a submandibular gland carcinoma was found clinically to have a unilateral chorda tympani, lingual and hypoglossal nerve deficit. This unique neurological entity of loss of taste sensation of one-half of the tongue (hemiageusia), hemianaesthesia and hemiatrophy of the tongue, has not previously been reported.
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10/14. Hypoplasia of the nose and eyes, hyposmia, hypogeusia, and hypogonadotrophic hypogonadism in two males.

    Two males, 9-11 and 29-31 years of age, with severe hypoplasia of the nose, hypoplasia of the eyes, sensory abnormalities of taste and smell, and hypogonadism were studied. The nasal septum, cribriform plates and foramina of the vomeronasal (vn) nerves were demonstrated in both; the capsule of the vn organ was shown in one. Their nasal skeleton, demonstrated by tomoradiography, had grown in early embryological form. The nose was not patent in either patient. In both, the cranial vaults, orbits, epipharynges, and oral cavities were indented toward the hypoplastic nasal composite and the peripheral dimensions of their faces were normal for their respective ages. Each patient had impaired visual function with cataracts and colobomata. Each was unable to recognize the smell of any vapor (Type I hyposmia), and had severe impairment of recognition of any tastant (recognition hypogeusia); detection of vapors and of tastants were in appropriate anatomical areas. Each was unable orally to recognize standard plastic forms (astereognosis) though each could recognize the forms manually. Each patient had bilateral inguinal hernias, one or two undescended testes, and hypogonadotrophic hypogonadism. These patients do not fall within the spectrum of arrhinencephaly because of the presence of medial structure of attachment of the falx cerebri and because of their normal intelligence. Distinction of patients with this pattern of abnormalities from arrhinencephaly is important by reason of their potentiality of normal mental development. We hypothesize that their abnormalities resulted from an embryological disruption that occurred in the first trimester of pregnancy. The embryogenesis of the nasal composite is presumed to have been adequate for reciprocal induction of the anlagen of the forebrain. Development of their faces to normal peripheral dimensions indicates that the nasal composite is not essential for gross facial enlargement.
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