Chemosensory Loss during a Traumatic Brain Injury Suggests a Central Pathway for the Rehabilitation of Anosmia.

Currently, no method has been developed for rehabilitating olfaction in anosmic patients following a traumatic brain injury (TBI). Here a method for rehabilitation is described which is based on a recent finding that the human posterior pyriform cortex (PPC) generates predictive odor "search images" in advance of an encounter with an olfactory stimulus. The search image enhances perceptual sensitivity and allows the odor it represents to be identified without input occurring from the olfactory receptors or bulbs. Furthermore, based on the finding here that anosmics with a TBI often have normal trigeminal and gustatory function, it is proposed that normality in these chemosensory systems may indicate that key cortical regions including the PPC are intact in anosmics and capable of processing olfactory information. In addition, the results of chemosensory tests of the olfactory, gustatory, and intranasal trigeminal systems of 18 patients with a TBI are given that identify which patients would most likely benefit from the rehabilitation procedure.

Taste-Elicited Activity in Facial Muscle Regions in 5-8-Week-Old Infants.

The state of development of the sense of taste in humans during the first few months of life is only partially understood. Since taste plays a critical role in the feeding and nutrition of infants a better understanding of taste development during early life is required. Currently, information about the sense of taste in pre-verbal infants is obtained by analysis of videotaped facial expressions using the Baby FACS coding system. A potentially more objective faster procedure for assessing facial expressions not investigated in infants is electromyography (EMG). The method has been successfully used to study taste-elicited responses in the mid-face muscle regions of the levator labii and zygomaticus major of 6-9-year-olds and in a range of facial muscle regions in adults. Accordingly, this study aimed to investigate taste in young infants using EMG to 1) measure activity simultaneously in 4 facial muscle regions in response to 3 common tastants and 2) determine whether the activities of one or more muscle regions is needed to provide evidence of perception of a tastant by an infant. The results indicated that multiple facial muscle regions responded simultaneously but differentially to non-sweet and sweet tastants and recordings of activities from 3 or 4 regions simultaneously indicated that almost 100% of infants responded to the unpleasant tastes of quinine and citric acid, and 80% to sucrose.

Smell and Taste Disorders Resulting from Cancer and Chemotherapy.

Malnutrition is common in both adult and pediatric patients undergoing treatment for cancer. Patients commonly attribute difficulties maintaining food intake to an altered taste developed during treatment. This review summarizes what is known about taste and smell dysfunction in patients with undergoing chemotherapy as their main treatment modality. Self-reported taste and smell alterations are prevalent in upwards of 86% of cancer patients. There is some evidence for decreased taste sensitivity in cancer patients when assessed using common gustatory tests. In some patients, taste and smell alterations may continue well after their cancer treatment has been completed. Such disorders can increase distress, reduce appetite and contribute towards poor nutritional status in cancer patients. There remain no effective interventions for improving the appetite or nutritional intake of patients with cancer experiencing taste and smell changes. There is a lack of consistency in assessment methodologies for measuring taste and smell changes in cancer patients and we therefore recommend that future work use well-established methods. Research should also take into account the role of food hedonics, food flavor and texture in assessing the association between taste dysfunction, poor oral intake and malnutrition in cancer patients. Both adult and child cancer patients should be counselled on the potential impact taste and smell dysfunction can have on their appetite and oral intake.

Reduced taste function and taste papillae density in children with chronic kidney disease.

BACKGROUND: Taste loss may contribute to the loss of appetite in children with chronic kidney disease (CKD) and other serious medical conditions that result in malnutrition. Traditional methods for measurement of taste loss commonly use aqueous tastant solutions that can induce nausea, vomiting, or even pain in the mouth. An alternative is to measure fungiform papillae density on the anterior tongue since this correlates with taste sensitivity. Here we aimed to develop a non-invasive method for assessing papillae density on the anterior tongue and to use the method to determine if CKD patients [estimated glomerular filtrate (eGFR < 60 ml/min/1.73 m(2))] have a lower density than clinical controls (CC)(eGFR > 89 ml/min/1.73 m(2)). METHODS: Thirty-five healthy adults participated in the development of a method, which was assessed by 24 children, 12 of whom were CKD patients and 12 were clinical controls. RESULTS: Similar papillae densities were found using invasive and non-invasive methods (F(1,34) = 0.647, p = 0.427). The CKD group had a significantly lower papillae density (X(2) = 7.17, p = 0.007) and poorer taste sensitivity than the CC group (p = 0.0272), and the density correlated significantly with eGFR (r = 0.56, p < 0.01). CONCLUSIONS: Loss of taste in children with CKD is due to the reduced number of papillae and their taste-sensing receptor cells.

Taste and smell dysfunction in childhood cancer survivors.

INTRODUCTION: Reduced or altered taste and smell function may occur as a side-effect of cancer therapy. This can lead to altered nutrient and energy intake. Some studies have suggested that taste and smell dysfunction can persist many years after treatment completion but this has not been previously assessed in survivors of childhood cancer. The aim of this study is to determine if taste and smell dysfunction is present in childhood cancer survivors (CCS). Food preference and Quality of Life was also assessed. METHODS: Fifty-one child cancer survivors (mean age: 19.69±7.09years), more than five years since treatment completion, (mean: 12.4years) were recruited from the long term follow-up clinics at two Sydney-based children's hospitals. Taste function was assessed using a 25 sample taste identification test comprising five concentrations each of sweet, salty, sour and bitter tastes and water. Smell function was assessed by determining the ability of participants to identify 16 common odorants. The participants' Quality of Life was assessed using the Functional Assessment of Anorexia Cachexia scale and food preferences were assessed using a 94-item food liking tool. RESULTS: Taste dysfunction was found in 27.5% of participants (n=14), and smell dysfunction in 3.9% (n=2) of participants. The prevalence of taste dysfunction was higher than that seen in the non-cancer population. The child cancer survivors' appeared to "like" the less healthy food groups such as flavoured beverages, takeaway and snacks over healthier food groups such as vegetables and salad. No correlation was found between those with a taste dysfunction and their food "likes". CONCLUSION: A high level of taste dysfunction was found in CCS though there did not appear to be an issue with smell dysfunction. Further work is also needed to assess whether a taste dysfunction do play a role in the dietary habits of CCS.

Changes in fungiform papillae density during development in humans.

The anterior region of the human tongue ceases to grow by 8-10 years of age and the posterior region at 15-16 years. This study was conducted with 30 adults and 85 children (7-12 year olds) to determine whether the cessation of growth in the anterior tongue coincides with the stabilization of the number and distribution of fungiform papillae (FP) on this region of the tongue. This is important for understanding when the human sense of taste becomes adult in function. This study also aimed to determine whether a small subpopulation of papillae could be used to predict the total number of papillae. FP were photographed and analyzed using a digital camera. The results indicated that the number of papillae stabilized at 9-10 years of age, whereas the distribution and growth of papillae stabilized at 11-12 years of age. One subpopulation of papillae predicted the density of papillae on the whole anterior tongue of 7-10 year olds, whereas another was the best predictor for the older children and adults. Overall, the population, size, and distribution of FP stabilized by 11-12 years of age, which is very close to the age that cessation of growth of the anterior tongue occurs.

Chemosensory function and food preferences of children with cystic fibrosis.

A major problem for patients with cystic fibrosis (CF) is the maintenance of adequate nutrition to maintain normal growth. The hypotheses that poor nutrition could be due to smell and/or taste dysfunction has been pursued in several studies with contradictory results. None, however, investigated whether inadequate nutrition is due to CF patients having different liking for foods compared to healthy children and whether liking can be linked to specific changes in smell or taste function. Here, the relationships between food liking, BMI, and smell and taste function in 42 CF and 42 healthy 5- to 18-year olds is pursued. A three-choice 16-item odor identification test and a gustatory identification test involving five concentrations of sweet, sour, bitter, and salty tastes, were used to assess chemosensory function. Food liking was assessed using a 94-item questionnaire. Patients identified significantly fewer odors than controls (89.8% vs. 95.7% correct; P < 0.001). However, only a few patients were affected and their loss of olfactory function was not substantial and unlikely to affect their liking for foods. Taste identification was similar for the two groups (patients 92.6% vs. controls 94.2% correct). There was no correlation between age and odor identification ability, but taste performance improved with age (r = 0.39, P < 0.05), suggesting cognition was the cause. Patients liked several types of foods and high-fat foods more than the controls. Both groups had a similar liking for low-fat foods and both liked high-fat foods more than low-fat foods. No significant relationships existed between FEV(1) and smell or taste function or liking for foods, the BMI of the groups were similar and there was no relationship between BMI and smell or taste function. The results indicate that the abnormal eating behavior reported for many CF patients is not due to changes in chemosensory function which remains normal in most CF patients at least to 18 years of age.

Smell and taste function in children with chronic kidney disease.

Loss of appetite and poor growth are common in children with chronic kidney disease (CKD), and changes in smell and/or taste function may be responsible, but the hypothesis has not been proven. This aims of this prospective age- and gender-controlled study were to determine whether: (1) changes in smell and taste function occur in children with CKD; (2) smell or taste dysfunction are associated with estimated glomerular filtration rate (eGFR); (3) there is an association between smell or taste loss and body mass index (BMI). The study cohort consisted of 72 children of whom 20 were CKD stage 3-5 patients, 12 were CKD stage 2 patients, 20 were clinical controls (CC) and 20 were healthy children (HC). The CKD patients and clinical controls were recruited from Sydney Children's Hospital and The Children's Hospital, Westmead, and healthy controls were recruited from a local school. Scores for each group from taste and smell chemosensory function tests were compared, and their relationship with renal function and BMI investigated. The CKD stage 3-5 group had a significantly lower taste identification score (85.6%, P < 0.001) than the CC (94.8%) and HC (94.8%) groups, with almost one third of the children in the CKD stage 3-5 group exhibiting taste loss. Decreased taste function was associated with decreased eGFR (r = 0.43, P < 0.01), but no association between BMI and taste function was found (r = 0.001, P > 0.9). Odour identification scores were not different; however, there was a positive relationship with BMI (r = 0.427, P = 0.006). We conclude that a loss of taste can occur in children with CKD and that when it occurs, it worsens as eGFR declines and is found early in kidney disease.

Temporal processing of olfactory stimuli during retronasal perception.

Odorants can be perceived via the nose during an inhalation or sniff (orthonasal perception) and via the mouth, nasopharynx and nasal cavity during mastication or drinking (retronasal perception). Previous data suggest that orthonasal perception provides a more efficient route with greater difficulty being reported when detecting [Halpern BP. Retronasal and orthonasal smelling. Chemosense 2004;6:1-7; Voirol E, Daget N. Comparative study of nasal and retronasal olfactory perception. Lebensmittel-Wissenschaft Technol 1986;19:316-9] and identifying [Heilmann S, Hummel T. A new method for comparing orthonasal and retronasal olfaction. Behav Neurosci 2004;118:412-9; Sun BC, Halpern BP. Identification of air-phase retronasal and orthonasal odorant pairs. Chem Senses 2005;30:1-14] single odorants retronasally. Whether the poorer sensitivity obtained via the retronasal route is largely due to the greater adsorption of odorants by the nasopharyngeal mucus compared to the nasal mucus thereby reducing their peak concentration and/or slowing their passage, has not been resolved. Importantly, the question of whether solubility of odorants in mucus or water predicts the outcomes for perception of stimuli presented via the retronasal route has not been resolved. Accordingly, the present study investigates this question by determining whether the solubility of an odorant in mucus predicts which component of a binary odour mixture is perceived first during retronasal perception. The results indicate that solubility in mucus rather than solubility in water is a better predictor of which odour will be perceived first and identified more readily during the retronasal perception of a binary mixture. In addition, lower intensity levels of single odorants occurred via the retronasal route suggesting that adsorption was greater via this route. Whether this was due to nasopharyngeal mucus having a greater adsorptive area or different composition compared to the orthonasal pathway is not known.

Tests for screening olfactory and gustatory function in school-age children.

OBJECTIVE: Determine the suitability of three tests based on the identification of familiar odors and tastes for the clinical assessment of olfaction and gustation in children. STUDY DESIGN AND SETTING: A total of 232 children aged 5 to 7 years from Sydney public schools and 56 adults aged 18 to 51 years participated in a cross-sectional study. RESULTS: The children demonstrated they can identify the majority of the 16 test odorants and 4 common tastes that describe gustatory function. The response distributions obtained for each test provide the basis for a set of normative data for young children. CONCLUSION: Olfactory and gustatory function can be determined in school-age children using the three tests described. SIGNIFICANCE: Currently no satisfactory clinical tests of olfaction and gustation for children or normative data are available. The present study resolves these shortcomings and provides normative data that can be used in the diagnosis of olfactory and gustatory impairment in school-age children.

Olfactory function in Australian aboriginal children and chronic otitis media.

Chronic suppurative otitis media (CSOM), a severe form of middle ear infection, affects most Australian Aboriginal children with up to 50% in some communities suffering hearing loss as a consequence. To date, there is no information on whether repeated exposure to the pathogens that characterize CSOM and that are present in the upper respiratory airway affect olfactory function. Accordingly, this study aimed to determine whether 1) there was a high prevalence of olfactory loss in Aboriginal children and 2) hearing loss is a predictor of olfactory loss. Two hundred and sixty one 9- to 12-year-old Aboriginal children from 16 rural communities reported to have high prevalences of CSOM and hearing loss were assessed for olfactory loss using a 16-odor identification test and hearing loss. One child was found to be anosmic, 4 were slightly hyposmic, and 42 had hearing loss. No relationship was found between olfactory loss and hearing loss. The test-retest reliability of the 16-odor identification test was 0.98. It was concluded that CSOM does not appear to affect olfactory function in the long term and that hearing loss in Aboriginal children is not a predictor of olfactory loss.

Facial electromyography: responses of children to odor and taste stimuli.

The study investigated the potential for facial electromyography (EMG) to be used as a clinical tool for measuring the responses of children to pleasant and unpleasant smell and taste stimuli. Responses in the zygomaticus major and levator labii muscles to 4 odorants and 4 tastants were recorded from 34 children aged 6-9 years. The results indicated that EMG activities in the 2 muscles discriminated between pleasant and unpleasant stimuli within each modality in a manner that indicated that the children perceived the hedonic qualities of the stimuli in a manner similar to that reported for adults. Importantly, there was unanimous agreement across the children as regards the differential nature of the activities exhibited. These outcomes together with the results of earlier facial expression studies suggest that facial EMG may provide an objective procedure that could be suitable for the clinical assessment of taste and smell function in newborns and young infants.

Olfactory function in children assessed with psychophysical and electrophysiological techniques.

The olfactory information processing abilities of children undergo changes during early life. The aims of the present study were to describe these changes and to probe for their electrophysiological correlates. These aims were investigated in two experiments. In Experiment 1, responses of 146 subjects (3-12 years) were tested with psychophysical tools. Approximately 2/3 of the subjects completed the olfactory tests ("Sniffin' Sticks"). In Experiment 2, 12 additional subjects (3-10 years) were tested with electrophysiological tools. Event-related potentials (ERPs) were recorded in response to olfactory stimulation with H(2)S. Results from Experiment 1 indicated that data from the group of 3-5-year olds were very unreliable, with 44% of incomplete measures rendering the tests unsuitable for routine use with 3-5-year olds. From an age of 6 years on the results suggested that the development of olfactory function was well advanced with a significant increase found only for odor identification, but not for odor thresholds, or odor discrimination. Results from Experiment 2 indicated an increase of the P2 latency with age, although the small sample size has to be considered in the interpretation of these data. While more research is needed, these results may be interpreted such that children attach more meaning to odorous stimuli with age.

Asymmetric suppression of components in binary aldehyde mixtures: behavioral studies in the laboratory rat.

The aim of the present study was to assess component interaction in the perception of the 2 aldehydes butanal and heptanal when presented in binary mixtures to rats. A further aim was to develop a behavioral paradigm for testing suppression of components in mixtures using rodent subjects. Thirsty rats were initially trained to discriminate between the 2 aldehydes butanal and heptanal in an olfactometer using a go/no-go discrimination task. This involved rats learning to place their noses in a sniff port where odors were presented and to lick a tube for water reward when one of the aldehydes was presented (S+) while withholding licking at the tube to the other, unrewarded, aldehyde (S-). A mixture condition was then introduced into the task, whereby a proportion of trials involved presentation of a combination of the 2 aldehydes as an additional unrewarded condition. Rats readily learned to withhold licking on trials when the mixture was presented. The concentration of the nonrewarded (S-) aldehyde in the mixture was then systematically decreased, whereas the concentration of the S+ component was held constant. This eventually caused the S+ component in the mixture to suppress detection of the S-, as shown by an increasing number of lick responses (false alarms) on trials when the mixture was presented. These suppressing effects occurred well above the detection threshold for the S- aldehyde presented alone. Results showed asymmetric suppression in the mixture condition such that butanal suppressed detection of heptanal at much lower concentrations than vice versa. A second experiment showed that when both butanal and heptanal were present in a binary mixture at the same concentration (10(-6) volume %), then rats responded to the mixture as if only butanal was present. These findings are discussed in terms of butanal having higher mobility and being able to compete more effectively than heptanal for occupation of shared receptor sites.

The capacity of humans to identify components in complex odor-taste mixtures.

Despite the fact that humans experience mixtures of odors and tastes each time they eat, little is known of their capacity to detect the individual components of foods. To investigate this capacity, 43 subjects were trained to identify three odors and three tastes and were required to indicate which of these could be identified in stimuli consisting of one to six components. Although the odor and taste components of most binary mixtures were identified, subjects encountered substantial difficulties with more complex mixtures with only two components being identified in the four- to six-component mixtures. In general, tastes were more easily identified than smells and were the only stimuli identified in the five- to six-component mixtures. Several mechanisms are proposed to account for the poor identification of components.

Rapid quantitative assessment of fungiform papillae density in the human tongue.

Fungiform papillae density, which can be used in a variety of circumstances as an indicator of taste function [L.M. Bartoshuk, V.B. Duffy, I.J. Miller, PTC/PROP tasting: anatomy, psychophysics and sex effects, Physiol. Behav. 56 (1994) 1165-1171; I.J. Miller, F.E. Reedy, Variation in human taste bud density and taste intensity perception, Physiol. Behav. 47 (1990) 1213-1219; J.R. Zuniga, N. Chen, C.L. Phillips, Chemosensory and somatosensory regeneration after lingual nerve repair in humans, J. Oral Maxillofac. Surg. 55 (1997) 2-13], was measured on the dorsal surface of the anterior tongue of living humans using a digital camera and a videomicroscope. Both procedures provided similar results, with the camera providing a more rapid, portable and flexible imaging procedure. Subsequently, the camera was successfully used to identify small regions of the anterior tongue which provide reliable measures of fungiform papillae density that correlate highly with the total number of fungiform papillae on the anterior tongue.

Perception of temporal order and the identification of components in taste mixtures.

The capacity of humans to identify the components of taste mixtures is limited to 3 for most people [D.G. Laing, C. Link, A. Jinks, I. Hutchinson, The limited capacity of humans to identify the components of taste mixtures and taste-odor mixtures. Perception 31 (2002) 617-635]. Here, the hypothesis that temporal processing differences have a major role in limiting capacity is investigated. Thirty two subjects were trained to identify sucrose, sodium chloride and citric acid at FIVE concentration levels and were then required to indicate (1) which tastant was perceived first and (2) the identity of each component, in binary and ternary mixtures. Within each mixture set, e.g. sucrose-citric acid, the concentrations of components were adjusted to provide some conditions where intensities and time differences in processing the individual components were minimized. With binary mixtures, changes in intensity resulted in identification of only one component when the differences were largest, and both being identified when intensities were similar. In contrast, subjects found it difficult to indicate which component was perceived first when the intensities were similar and easy when they were substantially different. The most profound effects occurred with ternary mixtures. With each of the three sets, there were several where subjects could not indicate which component was perceived first, and in 13/18 mixtures not all components were identified above chance. Indeed, the most common number of components identified was 2. However, although perception of order was lost in a number of mixtures, this did not preclude identification of one or all three components. This result contrasts with the finding with odors where total loss of order resulted in loss of identity of all components in ternary mixtures [A. Jinks, D.G. Laing, Temporal processing reveals a mechanism for limiting the capacity of humans to analyze mixtures. Cognitive Brain Res. 8 (1999) 311-325]. Thus, loss of identity with taste mixtures seems to occur to a lesser degree. Indeed suppression rather than temporal effects may be the main cause of the loss of identity of components with ternary taste mixtures.

A quantitative study of fungiform papillae and taste pore density in adults and children.

Male children (8-9 years) are reported to have a higher sensitivity than male adults to the sweet tastant sucrose when small regions of the anterior tongue are stimulated. The present study investigated the hypothesis that the higher sensitivity was due to a greater density of fungiform papillae and taste pores (buds), since it has been reported in adults that increased densities of these two structures correlates with increased taste suprathreshold sensitivity [Physiol. Behav. 47 (1990) 1213]. Quantitative measures of the number and size of papillae and pores in two areas of the tongue that had been shown to have a higher sensitivity for sucrose were achieved in 20 male children 8-9 years of age and 20 adults 18-30 years of age, using videomicroscopy and NIH Image software. Customized templates and a red food dye were used to define the equivalent tongue locations across the 40 subjects and taste pores were stained with methylene blue. Children were found to have substantially smaller papillae than adults but significantly higher papilla densities in both areas. Similar numbers of taste pores per papilla were found for both groups, resulting in children having much higher taste pore densities in each area than adults. Other differences included smaller taste pore diameters in children compared to adults, and the papillae tended to be rounder in children. Overall, the results support the hypothesis that the higher densities of fungiform papillae and taste pores in children underlie their greater sensitivity for sucrose in the two areas. In addition, the anatomical differences between adults and children indicate the sense of taste is in a state of development during mid-childhood.

Temporal perception of sweetness by adults and children using computerized time-intensity measures.

There is a general paucity of knowledge of the cognitive and perceptual abilities of children to successfully undertake chemosensory-related tasks. An example is that there are no reports of temporal perception by children in time-intensity tasks, or how their responses in these tasks compare with those of adults. The latter paradigm has the potential to reveal differences that may occur during a normal eating or drinking episode that cannot be detected with single response measures. To address this shortcoming, the present study uses a computerized time-intensity method to compare the responses of adults and 8- to 9-year-olds in several measures of sweetness with three different types of stimuli. The results show that the children gave higher estimates than adults of the maximum sweetness of sucrose in water, orange drink and custard and recorded shorter sweetness durations with orange drink and custard. Both age groups, however, responded similarly to changes in concentration and the volume of stimuli with all three sensory measures. Overall, the consistency of the data from the children and the variability, which was similar to that of the adults, indicate that the tasks involved in the time-intensity paradigm were within the cognitive ability of the children. Nevertheless, further studies are needed to determine the basis of the differences found.