[Impaired gustatory sensitivity of the tongue to table salt as a risk factor of arterial hypertension]

The study included 630 patients with verified diagnosis of arterial hypertension (AH) in whom 24 hr AP monitoring was performed, threshold gustatory sensitivity of the tongue to table salt (TGS) measured, and habit to add salt to the cooked food evaluated. Measurement of Na in daily urine of 442 patients was followed by estimation of salt consumption. The results were compared with those obtained in 100 patients with newly diagnosed AH. The control group comprised 288 subjects. TGS in AH patients was significantly higher than in controls and directly related to clinical features of the disease, high AP values, age, smoking habits, hypercholesterolemia, abdominal-type obesity, and hereditary predisposition. TGS positively correlated with daily urinary excretion of NaCl (r = 0.4-0.7; p < 0.05-0.01). High TGS decreased under effect of hypotensive therapy.

A primary large cholesterol cyst of the mastoid presenting with dysgeusia

The occurrence of postoperative secondary cholesterol cysts in the mastoid has been previously reported, however the occurrence of a primary large cholesterol cyst in the mastoid with bony destruction of the facial nerve has rarely been reported. The case report of a 17-year-old female patient with a primary large cholesterol cyst with dysgeusia is presented. Computed tomography and magnetic resonance imaging findings for the lesion distinguish a cholesterol granuloma, cholesteatoma and vascular tumor. The patient underwent a canal wall down mastoidectomy with mastoid obliteration. A dehiscent portion of the mastoid segment of the facial nerve was visible within the cavity; the gross finding of the facial nerve was edematous in appearance. Five years later, there has been no recurrence of disease.

Smell and taste dysfunction following minor stroke: a case report

Smell (olfactory) and taste (gustatory) are key senses in the regulation of nourishment and individual safety. Olfactory and gustatory dysfunctions have been infrequently reported together in patients following stroke (Landis et al., 2006; Leopold et al., 2006). This case report details two patients who experienced smell and taste dysfunction following minor stroke events. Symptoms reported included hyposmia (diminished sense of smell) and anosmia (complete loss of smell), and dysgeusia (distorted taste). Patients' sense of smell and taste were assessed in an ambulatory care stroke prevention clinic eight months following their strokes. Patient A presented with minor stroke due to a lesion in the anterior circulation, patient B with a lesion in the posterior circulation. Both patients reported intense olfactory and gustatory dysfunction immediately following their strokes. Examination revealed a general inability to detect subtle odours and the ability to identify only 'sweet' tastes for both patients. In addition, both patients reported heavily salting or sweetening their food to mask the distorted and unpleasant taste, which also impacted comorbid conditions such as hypertension and diabetes. Patients and their spouses reported a decrease in their appreciation of family-related activities due to the patients' olfactory and gustatory dysfunction. Patients reported weight loss, lack of energy and strength, likely due to poor nutrition. Olfactory and gustatory dysfunctions are potentially deleterious outcomes following minor stroke and should be assessed by health care professionals prior to patient discharge. Assistance may be required to promote the health and well-being of patients and their carers if smell and taste are impacted by the stroke event.

Apolipoprotein E epsilon4 genotype and gender: effects on memory

OBJECTIVE

Episodic recognition memory for odors and visual was assessed in apolipoprotein E (ApoE) epsilon4-positive and epsilon4-negative men and women diagnosed with Alzheimer disease (AD) and a healthy age- and gender-matched comparison group.

METHODS

A total of 38 AD patients and 38 age- and gender-matched healthy older adults completed a recognition memory task involving three categories of stimuli: odors, faces, and symbols.

RESULTS

In the healthy comparison group, men who were epsilon4 negative outperformed epsilon4-positive men in recognition memory for odors and committed fewer false-positive errors. However, there were no significant differences between epsilon4-negative and epsilon4-positive women in the comparison group. No significant gender or ApoE status differences were detected in recognition memory for faces or symbols in the comparison group. In patients with AD, epsilon4-negative women outperformed epsilon4-positive women in recognition memory for odors and committed significantly fewer false-positive errors. However, there were no significant differences between epsilon4-positive and epsilon4-negative men. There were no significant gender or ApoE status differences in recognition memory for faces or symbols in AD patients.

CONCLUSION

The results demonstrate that recognition memory for olfactory stimuli may be particularly impaired in healthy older men with the epsilon4 allele. In patients with AD, odor memory impairments may be less severe in women who are negative for the epsilon4 allele. The results offer new insight into how recognition memory is affected by gender, the epsilon4 allele, and the modality of the stimulus to be remembered in healthy older adults and patients with AD.

Lack of support for the inability to taste phenylthiocarbamide as an endophenotypic marker in patients with schizophrenia and their first-degree relatives

OBJECTIVE

This study sought to replicate recent findings that both patients and relatives are significantly more likely to be phenylthiocarbamide (PTC) nontasters than healthy controls, and that within the patient group, nontasters have more severe positive and/or negative symptoms than tasters. Associations between PTC-tasting status and olfactory identification scores also were examined.

METHOD

PTC perception and olfactory identification were assessed in 48 patients with schizophrenia or schizoaffective disorder, 28 first-degree relatives, and 32 healthy volunteers.

RESULTS

The three groups did not differ in PTC taste sensitivity. Findings did not change after: a sensitivity analysis that re-categorized participants who "possibly" tasted PTC, excluding Caucasian participants, or restricting the sample of patients to only those with schizophrenia. Among the patients, tasters and nontasters did not differ with regard to positive, negative, or general psychopathology symptoms. In the combined sample and the three groups separately, there were no associations between PTC-tasting status and olfactory identification scores.

CONCLUSIONS

This study, conducted specifically as an attempt to replicate previously reported findings, failed to provide support for PTC perception as an endophenotypic marker for schizophrenia. Further research is warranted.

Unpleasant sweet taste: a symptom of SIADH caused by lung cancer

A 56 year old woman with large cell lung carcinoma complained of an unpleasant sweet taste (dysgeusia). She developed hyponatraemia caused by the syndrome of inappropriate antidiuretic hormone secretion (SIADH). Dysgeusia disappeared when serum sodium normalised and recurred when hyponatraemia relapsed. Dysgeusia was the initial and only symptom of SIADH in this case.

Diagnosis of systemic sarcoidosis prompted by orofacial manifestations

BACKGROUND

Sarcoidosis is a multifactorial systemic inflammatory disorder of unknown origin characterized by many potential signs and symptoms, as well as by the presence of noncaseating granulomas in the organs involved. Sarcoidosis also may manifest in the oral and maxillofacial region.

CASE DESCRIPTION

The authors describe a patient with xerostomia, dysgeusia, oral burning, xerophthalmia and bilateral parotid enlargement. She was diagnosed as having systemic sarcoidosis on the basis of the histologic findings of a biopsy of the labial minor salivary gland, as well as subsequent diagnostic evalutons.

CONCLUSION AND CLINICAL IMPLICATIONS

Enlargement of major salivary glands may be the first sign of sarcoidosis in a patient with few other symptoms or clinical findings suggestive of the disease. This case emphasizes the importance of including sarcoidosis in the differential diagnosis of bilateral parotid swelling associated with xerostomia. It also highlights the dentist's potential role in the diagnosis and dental treatment of patients with systemic sarcoidosis.

A case of Cronkhite-Canada syndrome with taste disturbance as a leading complaint

Cronkhite-Canada syndrome was first described in 1955. The clinical features of this rare syndrome of unknown etiology include nonhereditary gastrointestinal polyposis together with diarrhea, nail dystrophy, alopecia, and hyperpigmentation of the skin. This syndrome has been divided into five clinical types based on initial symptoms. We describe a case of Cronkhite-Canada syndrome presenting with taste disturbance as the major symptom, present a comprehensive review of the literature concerning this rare syndrome, and suggest therapeutic treatment options.

Simple Partial Seizures with Hemisensory Phenomena and Dysgeusia: An Insular Pattern

Insular seizures are rarely described, in part owing to the complex anatomy of this brain region. We present a patient with simple partial seizures, recorded intracranially, originating in the right insula and characterized by dysgeusia and contralateral somatosensory phenomena. This rare clinical pattern seems to be characteristic of the insula and may be undetectable with surface EEG.

Detection and recognition thresholds to the 4 basic tastes in Mexican patients with primary Sjögren's syndrome

BACKGROUND

Primary Sjögren's syndrome (pSS) is a chronic autoimmune disease characterized by inflammatory lymphocytic infiltration of the salivary glands, leading to dryness of the mouth (xerostomia). It has been postulated that xerostomia is the preceding stage for the development of alterations in taste acuity (dysgeusia) in this type of patients.

OBJECTIVES

To determine detection and recognition thresholds to the 4 basic tastes (sweet, salty, sour and bitter) in pSS patients and compare them to a control group. To determine if the long-term consumption of chile peppers and spicy Mexican diets had an effect on the taste perception and acuity of the pSS patients.

SETTING

This study was done in the Department of Food Science and Technology of the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), a third-level hospital in Mexico City.

SUBJECTS

The patient group consisted of 21 Mexican females (mean +/- s.d., age: 53.1 +/- 9.8 y) diagnosed with pSS (time of duration of the disease, 8.6 +/- 6.6 y, median 7 y, range 1-25 y) who were recruited at the outpatient service of the Department of Immunology and Rheumatology of the INCMNSZ. The control group consisted of 20 healthy nonsmokers age-matched Mexican women (50.3 +/- 11.9 y) most of them personnel of the INCMNSZ, and some friends and nonblood relatives to the patients (sisters-in-law) who volunteered to participate in the study.

INTERVENTIONS

Detection and recognition thresholds were determined by the method of least noticeable differences on three occasions during three nonconsecutive days. Saliva production was determined by Saxon's test on two separate occasions.

RESULTS

Although saliva production was severely reduced in pSS patients (1.35 +/- 0.55 ml/2 min, P<0.001) compared to controls (6.26 +/- 2.41 ml/2 min), all subjects recognized the 4 basic tastes when these were tested at suprathreshold concentrations. The detection thresholds for the sweet, sour and bitter tastes were higher in pSS patients, as well as the recognition thresholds for the salty, sour and bitter tastes. A relationship between time of evolution of the disease and saliva production with individual thresholds could not be established.

CONCLUSIONS

pSS patients exhibited different degrees of dysgeusia depending on the taste being studied, that is, they were mildly dysgeusic for the sweet and salty tastes and clearly dysgeusic for the sour and bitter tastes. Although both pSS patients and controls had consumed 'typical Mexican diets' their entire lives, our results showed that the consumption of chile peppers and spicy foods did not have any effect on the taste perception and acuity of the pSS patients.

Dysgeusia due to an orthodontic wire: a case report

A 14-year-old female developed gustatory disorder due to an orthodontic wire having pierced the right trigonal retromolar. The patient's complaints included traction pain on the right lower jaw, numbness on the right front half of the tongue and hypogeusia with the exception of sweet tastes. Possible causes of dysgeusia in this case were: (i) direct mechanical compression of a gustatory nerve by the orthodontic wire; and (ii) disturbance of blood supply to a gustatory nerve by edema that developed in nerve tissues around the wire. The patient's retention of a normal threshold for the recognition of sweet tastes is not fully understood.

Electron microscopic observations of glossal circumvallate papillae in dysgeusic patients

A number of reports have been published describing the ultrastructure of normal taste buds but few have discussed their pathology, particularly in patients with gustatory abnormalities. We therefore conducted an electron microscopic study of biopsy specimens of glossal circumvallate papillae from patients with dysgeusia. We found depletion of microvilli and dense substance in the taste pores, vacuolation and hyaline degeneration of the taste bud cells and condensation of nuclear material and cytoplasm in cells of indeterminate histological type. In one patient with idiopathic dysgeusia, disruption of subsurface cisternae contiguous with the nerve endings was evident in Type II cells. In another patient, who had undergone radiotherapy, the number of cored vesicles in Type III cells was reduced.

[Semiologic study of chronic perennial and permanent paranasal sinus dysfunction. Prevalence of symptoms]

Rhino-sinus dysfunction is associated with several symptoms: nasal obstruction, anterior and posterior rhinorrhea, episodes of sneezing, painful or heavy feeling in the face, taste and smell disorders. Certain manifestations have an impact on the pharynx, the larynx or the tracheobronchial tree. This prospective study was conducted in 449 consecutive patients who consulted over an 18-months period from November 1995 to May 1997. The objective was to determine the symptom pattern, main disease of the nasal cavities and paranasal sinuses which were involved: chronic rhinitis, anterior sinusitis, bilateral and symmetric pansinusitis with or without nasosinus polyps. In the first part of the study, the frequency of different symptoms were determined for the main nasosinus diseases. Statistical analysis of the correlations between symptoms and diseases provided a specific approach to symptoms.

Taste and smell in familial dysautonomia

Familial dysautonomia (FD) is one of the classic diseases characterised by taste and smell abnormalities. However, these typical features are based on data obtained from two separate crude studies published in 1964. In the present study psychophysical-cognitive and reflex-like facial-behavioral responses to taste and smell, in nine patients with FD and 15 healthy controls, were recorded. Five taste stimulants were presented to both study groups, while a selection of common household odors was used for FD patients only. The patients with FD showed a markedly higher incidence of recognition failures for salty, bitter, sweet, and water stimuli than the controls, but rate of recognition of sour stimuli was almost identical in the two groups. Estimates by the subjects on a hedonic scale of 0 to 10 and facial display in FD indicated a relatively normal sensitivity to sour stimuli and to a lesser extent to bitter stimuli. Water, sweet, and salty stimuli evoked non-discriminatory responses. These findings indicate specific dyageusia rather than general ageusia. Smell was found to be normal. In children with taste and smell impairment, a systematic evaluative approach may help in planning palatable diets for adequate and comfortable nutrition.

From the aerospace medicine residents' teaching file

A pilot presented with a 2-month history of dysgeusia following treatment for sinusitis. This was accompanied by a 30-lb weight loss due to the abnormal taste of most foods. An extensive evaluation failed to demonstrate a cause for the malady. The clinical course and diagnostic evaluation were consistent with a diagnosis of idiopathic dysgeusia. The clinical presentation, evaluation, and diagnosis of a pilot with dysgeusia are discussed.

Clinical and physiological investigations in patients with taste abnormality

The cause of taste abnormality was investigated in 25 patients with decreased taste sensation (hypogeusia group) and 14 patients with abnormal taste sensation (dysgeusia group) by examining taste threshold, salivary flow rate, Candida cell culture, and laboratory examination of peripheral blood. The cause of hypogeusia was identified as iron deficiency in 7 patients, oral candidiasis in 6, hyposalivation (xerostomia) in 6, and psychiatric distress in 3, and could not be determined in 3 (idiopathic). Dysgeusia was associated with psychiatric distress in 8 patients, oral candidiasis in 3, drug medication in 2, and hyposalivation in 1. In the hypogeusia group, the decreased taste sensation generally corresponded with elevated taste thresholds, which decreased along with improvement of the decreased taste sensation in all except the 3 patients with psychiatric etiology and 2 of the 3 patients with idiopathic etiology. In contrast, no elevation or depression of taste thresholds were observed in the dysgeusia group, and the abnormal taste sensation did not disappear in most cases; however, drug-induced dysgeusia improved completely within 2 months after cessation of the drug administration. The serum copper and zinc levels were not decreased in any patient, but a decreased serum iron level was observed in 7 patients. Based on these results, it is concluded that abnormal taste sensation may be induced by many oral and systemic disturbances and that hypogeusia, which may be induced by deficiency of iron but not of zinc or copper, is usually accompanied by elevation of taste thresholds, while dysgeusia is not.

[Disorders of the sense of smell and taste]

Disorders of olfaction and taste are infrequent, but a complete loss of smell or taste reduces the quality of life significantly. The sensitivity of human olfaction is remarkable, even for specific stimuli: Just a few molecules are enough to induce the correct identification of sterilised and ultraheated milk. Olfaction and taste are called 'chemical senses' because in both cases the adequate stimulus consists of molecules that bind to receptors of the sensory cells. The perceptions of smell and taste are often combined. Taste differentiates only four qualities: sweet, sour, salty, and bitter. The typical flavor of food or drink is detected by olfaction. Disturbances of olfaction can be due to respiratory disorders such as nasal polyps, a deviation of the nasal septum or chronic sinusitis. Such conditions can reduce airflow through the olfactory cleft at the roof of the nasal cavity. They can be corrected by modern endoscopic surgery of the nose. Epithelial disorders involving the sensory cells are most often caused by viral infections (influenza-anosmia) or toxic destruction of the sensory epithelium (solvents or gases). Epithelial disorders can be cured only rarely by any treatment. Corticosteroids, zinc, and vitamin A are tried frequently. Neural disorders occur after frontobasal trauma and during neurological diseases such as Parkinson's or Alzheimer's disease. Disorders of olfaction can be an early sign of such neurological diseases and sophisticated examination of this sense can contribute to their early diagnosis. However, no specific treatments have yet been identified. Disorders of taste can be due to toxic, chemical or inflammatory damage to the sensory cells of the tongue.(ABSTRACT TRUNCATED AT 250 WORDS)

Early detection of diabetic patients at risk of developing degenerative complications using electric gustometry: a five-year follow-up study

OBJECTIVES

Taste impairment has been reported during the course of diabetes. Although a degenerative mechanism has been suspected, the natural history of taste disorders in diabetes remains unknown. The purpose of this study was to describe the five-year evolution of electric gustometry in diabetic patients compared to healthy control subjects and with reference to degenerative complications of the disease.

METHODS

Electrogustometry was studied initially and after 5 years in 73 diabetic out patients and 25 control subjects. None of them had any known cause of taste impairment other than diabetes. Diabetic patients and control subjects did not differ for demographic data and confounding factors.

RESULTS

After five years, the electrogustometric threshold (EGT) significantly increased (51 +/- 6 vs 95 +/- 11 microA; p < 0.001), whereas slight changes occurred in control subjects (23 +/- 4 vs 25 +/- 5 microA; NS). Frequency of electric hypogeusia (EGT > or = 100 microA) increased from 11 to 46% in diabetic patients (p < 0.001), but did not vary in control subjects (4%). EGT was not strongly associated with individual factors such as blood pressure, tobacco and alcohol consumption, but correlated with age (p < 0.001). In the diabetic group, higher EGT were observed in patients treated with insulin (p < 0.001). EGT and its changes were associated with degenerative complication (p < 0.001), but neither with metabolic control, nor with duration of diabetes. Using multivariate analyses, the strongest associations were found with peripheral neuropathy and microalbuminuria (28 to 45% of variance explained; p < 0.001). The predictive value of initial hypogeusia on neuropathy at follow-up was 88% for a positive test and 63% for a negative one.

CONCLUSIONS

These results suggest that the taste nerves transduction function is impaired during the course of diabetes. This impairment is associated with an increased occurrence of degenerative complications, leading to suspect a similar pathophysiological mechanism. Electric gustometry could be an interesting test for early screening for diabetes complications.

Clinical applications and mechanism of intravenous taste tests

It is well known that there are two ways to measure human blood circulation time: the arm-to-lung and the arm-to-tongue method. The decholin (20% dehydrocholic acid) test is usually used to measure the arm-to-tongue circulation time. In this study, this procedure was used to examine taste function. Findings on the clinical application of this intravenous taste test using decholin and a study on the mechanism of venous taste perception are reported here. The following method was used: Five ml of 20% decholin were injected into the right cubital vein over a 10-sec period and the latent time, the duration, the quality of the taste sensation and the region of the tongue where the taste appeared were noted. The results were as follows: 1) In dysgeusic subjects, the latent period was longer, and the duration of the taste sensation was shorter than in normal subjects (p is less than 0.01, p is less than 0.05). 2) Some of the dysgeusic subjects perceived the taste as other than bitter; their prognosis of taste dysfunction tended to be worse than that of other subjects. 3) Some of the dysgeusic subjects perceived the taste in regions of the tongue other than the bilateral edges or over the entire tongue; their prognosis of taste dysfunction tended to be worse than that of other subjects. 3) Some of the dysgeusic subjects perceived the taste in regions of the tongue other than bilateral edges or over the entire tongue; their prognosis tended to be worse than that of other subjects. In addition, photofluorograms of the tongue were taken to clarify the mechanism of intravenous taste; the time needed for fluorescence to appear in the fungiform papillae and their diffusion form in the papillae were observed and investigated.

Dysosmia and dysgeusia presenting as depression

Disorders of taste and smell are underrecognized and often misdiagnosed. Two cases are described in which patients mistakenly thought to suffer from depression actually had unnoticed drug-induced dysosmia and dysgeusia. Also reviewed are psychiatric, neurologic, and medical disorders and drugs that cause abnormalities of taste and smell, and some behavioral aspects of food aversions. Three groups, all of whom may superficially appear depressed, must be distinguished from each other: 1) patients with dysosmia or dysgeusia, 2) patients with primary neuropsychiatric illness with olfactory or gustatory hallucinations, and 3) patients with conditioned taste aversions.

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)