Trastornos del gusto: actualización y aproximación clínica / Taste disorders: update and clinical approach

Resumen Los trastornos del gusto constituyen un grupo de alteraciones relativamente frecuentes en la práctica clínica. Son de etiología diversa, pudiendo afectar la vía gustativa en distintos niveles, manifestándose, clínicamente, con alteraciones cuantitativas y/o cualitativas de la sensibilidad gustativa. En gran parte de los casos se puede lograr un diagnóstico etiológico con una anamnesis adecuada, examen físico y exploraciones complementarias básicas. No obstante, existe poco entendimiento de su patogénesis, así como limitadas opciones terapéuticas, lo que implica la falta de algoritmos de diagnóstico y tratamiento completamente validados. El objetivo de la presente revisión es otorgar una actualización y un abordaje práctico de los trastornos del gusto.

Abstract Taste disorders represent a group of alterations relatively frequent in clinical practice. They have a diverse etiology, and they can affect the gustatory pathway at different levels, clinically manifesting with quantitative/qualitative alterations on taste sensitivity. In most of cases it is possibly to achieve an etiologically diagnosis with appropriate anamnesis, physical exploration, and basic complementary tests. However, their pathogenesis is not well understood, and they have limited therapeutic options, which determines a lack of well-validated diagnosis and treatment algorithms. The objective of this review is to provide and update and a practical approach to taste disorders.

Post-traumatic taste disorders: a case series.

Since 1800s there are reports of post-traumatic anosmia, but few studies investigated post-traumatic gustatory deficit and adopted validated evaluation tests. Peripheral and/or central mechanisms may be involved in the genesis of post-traumatic gustatory dysfunction. Beyond a reduction/loss (hypogeusia/ageusia) of gustatory function following a trauma, qualitative taste changes (dysgeusia) may occur. Especially when persistent, taste deficits might be particularly relevant for patient's quality of life and activities of daily life, but knowledge on this topic is limited. Fifty-three consecutive patients with previous head trauma were recruited. Every patient underwent a careful history taking and thorough olfactory and gustatory chemosensory testing by Sniffin'Sticks Extended test, Whole Mouth Test and Taste Strips Test. All patients had olfactory abnormalities (hyposmia: n = 10, functional anosmia: n = 43), while 10 of them (19%) showed taste deficits (dysgeusia: n = 3, dysgeusia with hypogeusia: n = 1, hypogeusia: n = 5, ageusia: n = 1). Here, we report clinical and neuroimaging data and detailed description of four meaningful cases representing central and peripheral injury patterns. Chemosensory evaluation might be useful to explore taste disorder, a still neglected and underestimated sequela of head trauma.

Comparative evaluation of gustatory function between postmenopausal women and age-matched men.

OBJECTIVE: The aim of the study was to compare the gustatory function between postmenopausal women and age-matched men. SUBJECTS AND METHODS: During a period of 4 months, 30 postmenopausal women and 30 age-matched men were prospectively evaluated for gustatory function. Each subject was given a symptoms questionnaire for self-assessment of taste function. Then, whole mouth taste test was performed in which the quality identification and intensity ratings of taste solutions were measured. RESULTS: Regarding correct quality identification, the results were statistically non-significant (P > 0.05). As far as the intensity judgments are concerned, significant difference exists between postmenopausal women and age-matched men. Intensity of taste perception for sucrose was significantly lower in postmenopausal women than intensity of taste perception for other tastes (P < 0.05). One of the noticeable findings is that 15 (50%) postmenopausal women reported a change in dietary habits; all expressed liking for sweeter food. CONCLUSION: Postmenopausal women appeared to have a reduced perception of sucrose, which can alter eating habits, such as intake of more sweet foods, whereas no significant difference is observed in taste perception of NaCl, citric acid and quinine hydrochloride between postmenopausal women and age-matched men. Fifteen (50%) postmenopausal women stated fondness for sweet taste.

A composite index for determining the impact of oral ulcer activity in Behcet's disease and recurrent aphthous stomatitis.

BACKGROUND: Although number, frequency and healing time of oral ulcers and pain are generally used for clinical practice and studies in Behcet's disease (BD) and recurrent aphthous stomatitis (RAS), no standardized activity index is currently present to monitor clinical manifestations associated with oral ulcers. The aim of this study was to develop a standardized composite index (CI) to assess oral ulcer activity in BD and RAS. METHODS: In this cross-sectional study, 121 patients with BD and 45 patients with RAS were included. Sixty-five percentage of BD and 68.9% of RAS patients were in active stage during the previous 3 months. The developed CI included the presence of oral ulcers, ulcer-related pain and functional status and was evaluated in patients with both active and inactive disease for content validity. RESULTS: Composite index score was observed to be higher in active patients with RAS (6.94 + or - 2.19) compared with active BD patients (6.01 + or - 2.04) (P = 0.04). The number of oral ulcers and healing time of oral ulcers were significantly higher in RAS compared with BD (P = 0.018, P = 0.001 respectively). CI score correlated with the number of oral ulcers in both BD and RAS (P = 0.000, P = 0.002 respectively). CI score was '0' for inactive patients without oral ulcer in BD and RAS. CONCLUSIONS: The presented CI as an oral ulcer activity index seems to be a reliable and suitable tool for evaluating the clinical impact and disease-specific problems in BD and RAS.

The oral health status of dentate patients with chronic renal failure undergoing dialysis therapy.

OBJECTIVE: The aim of this study was to compare the oral health status of chronic renal failure (CRF) patients on renal replacement therapy with a matched reference population. DESIGN: Cross-sectional study. SUBJECTS: Forty-two dentate CRF patients--aged 25-52 years old--were matched with a reference group of 808 dentate subjects. METHODS: The oral health was assessed using decayed missing filled (DMF) indices, simplified oral hygiene index and periodontal status. An oral health questionnaire was used to assess self-reported dental problems. Student t-tests and chi-square tests were performed to compare the CRF patients with the controls. RESULTS: All index-scores in the CRF patients were comparable with the controls except for number of teeth covered with calculus that was significantly higher (P < 0.05) in CRF patients (4.1 +/- 2.6) than in controls (3.0 +/- 2.9). The self-reported oral health questionnaire revealed a trend for increased temporomandibular complaints in CRF patients (16.7%vs 5.7% in controls; P = 0.06) as well as bad taste (31.0%vs 6.8% in controls, P = 0.08). CONCLUSIONS: For most dental aspects, the oral health of CRF patients is comparable with controls.

The place of osmophobia and taste abnormalities in migraine classification: a tertiary care study of 1237 patients.

This study evaluates osmophobia and taste abnormalities in relationship to sensitivity and specificity in the classification of migraine. Consecutive International Headache Society (IHS) classified patients (n = 1237) were evaluated. Symptoms were graded from 0 to 3. Osmophobia and taste abnormalities were tested for sensitivity and specificity in migraine diagnosis. The patients were 85.4% female and their mean age was 38.1 years. Of 673 patients 24.7% complained of osmophobia, and 24.6% of 505 complained of taste abnormalities. In the absence of nausea and vomiting the combinations of two symptoms gave the following sensitivity and specificity percentages, respectively: photophobia and phonophobia, 10.6 and 84.9; photophobia and osmophobia, 1.1 and 99.0; phonophobia and osmophobia, 1.1 and 98.6; photophobia and taste abnormality, 9.6 and 99.0; phonophobia and taste abnormality, 9.6 and 98.8; and osmophobia and taste abnormality, 4.2 and 99.4. Osmophobia and taste abnormalities were demonstrated to be very specific in diagnosing migraine IHS 1.1-1.6, but very insensitive.

[Taste affection and its causes]. / Narushenie vkusa i ego prichiny.

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.

[Drug related taste disturbances: emphasis on the elderly].

BACKGROUND: Taste disturbances are common among the elderly due to physiologic changes, diseases, and medications. As many as 11% of elderly persons using multiple drugs report taste aberrations. The main danger of taste decline and disturbance in the old is food-anhedonia, causing loss of body weight via decreased calorie and nutrient intake. GOALS: To overview drug related taste disturbances emphasizing the elderly. METHODS: Review of Hebrew and English medical literature. RESULTS: Taste-disturbances can be divided into hypogeusia [diminished sense of taste], ageusia [absence of taste], and the 2 types of dysgeusia [taste distortion]: aliageusia [food related] and phantogeusia [taste illusions]. The mechanisms by which drugs impair taste are numerous, and may be related to drug chemical structure. The treatment of taste disturbances is empiric and has limited success. Treatments include: shifting drugs within the same class, zinc replacement (proven to enhance taste sensation for sweet, bitter and salty flavors), palliative measures (use of mints, sugarless chewing-gums, and bicarbonate mouthwashes), niacin and vitamin A ameliorate hypo and dysgeusia. CONCLUSIONS: Disturbed taste sensation is common among the elderly, and should be considered whenever unexplained nutritional decline is present. Scrupulous drug screening is mandatory, and other intervention modalities can be beneficial.

[Remarks on the systematization and terminology of smell and taste disorders]. / Uwagi do systematyki i terminologii zaburzeñ wechu i smaki.

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.

[Classification and definition of smell and taste disorders]. / Einteilung und Begriffsbestimmung der Riech- und Schmeckstörungen.

The smell and taste disorders are defined in terms due to two principles - the type and site of lesion. The quantitative dysosmias (anosmia, hyposmia, hyperosmia) correspond to the quantitative dysgeusias (ageusia, hypogeusia, hypergeusia) and the qualitative dysosmias (parosmia, pseudo-osmia, phantosmia, agnosmia) correspond to the qualitative dysgeusias (parageusia, pseudogeusia, phantogeusia, agnogeusia). Due to the site of lesion we can differentiate between respiratory, epithelial, combined, neural, and central dysosmias as well as epithelial, neural, and central dysgeusias. Typical examples are demonstrated, denying other classifications and terms as not precisely enough or negligible ones.

Energy and nutrient consumption of patients with dysgeusia.

To evaluate the effects of dysgeusia (taste distortion) on nutritional status, 3-day diet records, taste and smell function, and indexes of nutritional risk were measured in 65 patients with dysgeusia and in 37 normal volunteers. The patients with dysgeusia were categorized with the use of a semiquantitative scale into four types (I to IV) on the basis of the number and types of foods or beverages perceived as distorted. Energy intake decreased significantly as the severity of dysgeusia increased, but energy intake was unaffected by hypogeusia and/or hyposmia. In patients with dysgeusia, nutrient intake was correlated with energy intake. Intake of vitamins A and C and calcium was significantly less than the RDAs. Fifty-two percent of all patients with dysgeusia had at least one index of nutritional risk, and 11 percent exhibited more than three indexes.

A classification of dysgeusia.

The results of this study indicate that patients with dysgeusia can be classified into groups on the basis of the number and kinds of foods and beverages they perceive as distorted. Furthermore, a relationship between this classification and weight loss has been demonstrated, suggesting that caloric intake is decreased, particularly in patients with Type III and IV. The symptoms of dysgeusia worsened in 41% of all patients. These patients had sought medical help more quickly than any other patients with dysgeusia. An elevation in dysgeusia type (increase in severity) occurred in only a small number of patients, and no patient exhibited any improvement in dysgeusia once it occurred. Specific types of foods and beverages were commonly distorted in these patients. To characterize these abnormalities, we used six common food groups. On occasion, patients would eliminate an entire food group from their diets; if the nutrients contained in these foods could not be obtained from other dietary sources or if the food aversion persisted long enough (16), these patients could develop nutritional deficiencies. A nutritional history, using a standard form, was selected as the method for collecting data. Classification might have been even more accurate if a standardized food array had been used as part of this study. Indeed, we have developed such an array consisting of 120 food items and have since used it in conjunction with a diet history to evaluate patients with dysgeusia. Preliminary results confirm its usefulness in the classification described in this article.(ABSTRACT TRUNCATED AT 250 WORDS)

Distribution of taste thresholds for phenylthiocarbamide among different age groups in Turkey.

The relation between age and taste threshold in populations living both in Istanbul and Resadiye, a town located in eastern part of Turkey, was investigated. In Turkey the nontaster/taster ratio has been found lower than in the other countries of Europe and Asia (3 ,4 ,8 ,9). With aging the taste sensitivity of tasters does diminish. However, the differences in the taste threshold levels of nontasters, in different age groups, have been found as being statistically not significant.