A Nationwide survey of safety protocols and chemosensory assessments by Japanese clinicians pre- and post-COVID-19 pandemic

OBJECTIVE

There has been an increase of attention and awareness of smell and taste loss due to the impact of COVID-19. However, little is known about the influence of COVID-19 on the number of psychophysical tests performed, the timing of these tests, or the protection protocols employed to protect against virus transmission. This study aimed to explore the changes in examination approaches, types of tests employed, and safety measures adopted by clinicians before and after the COVID-19 pandemic.

METHODS

A survey was distributed to 404 institutes of the Oto-Rhino Laryngological Society of Japan, consisting of otolaryngologists working in university hospitals, general hospitals, and private clinics. The anonymous online survey contained questions related to safety measures and chemosensory assessments performed before and after the COVID-19 pandemic. Specifically, participants were queried on the number and types of examinations conducted, the type of examiners who performed them, the timing of tests in suspected and non-suspected COVID-19 cases, modifications made due to the pandemic, and the protective measures adopted during chemosensory examinations.

RESULTS

Of the 201 respondents, representing a 50 % response rate, 49 % were from general hospitals, 48 % from university hospitals, and 3 % from private clinics. The study found a slight decrease in the overall number of chemosensory tests conducted post-COVID-19. In terms of who performed the test, there were no differences pre- and post- COVID-19. Most examinations (52-68 %) for suspected COVID-19 cases were performed 1-2 months after the onset of symptoms. Modifications in testing rooms and personal protective equipment (PPE) were reported by the majority of institutions post-pandemic. While different examination rooms or PPE were not commonly used based on a patient's previous COVID-19 diagnosis, changes were observed in testing practices. Most examinations were conducted in rooms with windows or fans, and PPE usage was high; surgical masks, eye visors or face shields, and disposable gloves being commonly used. Virus transmission from patient to examiner was reported in only one case during T&T olfactometer examination.

CONCLUSION

We investigated the impact of the COVID-19 pandemic on the number of olfactory and gustatory tests performed, the type of examiner, the examination room, and the use of PPE and found no significant difference before and after the COVID-19 pandemic on these factors. Adherence to a protection protocol involving the proper use of PPE in controlled environments enabled the continuation of olfactory and gustatory tests during the pandemic.

Diagnosis and treatment of taste disorders in Japan

Though 270,000 patients with complaints of taste abnormalities visited medical institutions annually in 2019 survey, there are no drugs for the treatment of taste disorders that are covered by health insurance in Japan. In the survey, the number of patients with taste disorders was correlated with age, and the need for medical treatment for taste disorders is expected to increase in the future because of the super-aging society. The pathophysiology of taste disorders varies widely. There is an obvious need to decide the site and the causes of the disorder and understand the mechanism, by performing various examinations. It needs to first adjust the causative systemic diseases and medications in the treatment for taste disorder. Damage of taste cells due to zinc deficiency is the main pathophysiological mechanism of taste disorders, and zinc supplementation is a standard treatment in Japan. Oral zinc therapy is the treatment for taste disorders due to zinc deficiency or idiopathic taste disorder; though a double-blind study was conducted, it was considered low-level evidence in a clinical review. In Japan, the off-label use of polaprezinc for taste disorders was approved in 2011, and zinc acetate hydrate was approved for hypozincemia in March 2017, making it easier to use oral zinc therapy in general. In some cases, psychotherapy or herbal medicine therapy has been used with remarkable success, although its effectiveness has not been clearly tested. It might be expected to offer some help to patients. In the treatment of elderly patients with taste disorders, physicians need to consider the difference between "age-related changes in taste in healthy people" and "taste disorders in elderly persons", and they should separate them. Aggressive treatment is desirable regardless of age, because no significant difference in the efficacy of various treatments was found between patients older and younger than 65 years.

A clinical survey on patients with taste disorders in Japan: A comparative study

OBJECTIVE

To investigate changes in the clinical state of taste disorders between 1990, 2003, and 2019 using the same methodology as that in previous studies.

MATERIALS AND METHODS

In June 2019, we mailed a questionnaire to 1100 otolaryngologists belonging to the Japan Society of Stomato-pharyngology and investigated three question categories: "Institution", "Number of patients for 3 months", and "Treatment". In addition, we analyzed some results by the class of institution.

RESULTS

The rate of patients who complained of taste disorders in the 2019 survey (220/100,000 persons/year) was twice that of the 1990 survey (110/100,000 persons/year), and slightly higher than that of the 2003 survey (192/100,000 persons/year). The rate of female patients was higher than that of male patients in all age groups. The number of patients was correlated with age up to 70 years of age in both genders. The rates of performing taste tests to assess taste function in the 2019 survey were significantly decreased compared with a 2003 survey (electrogustometry: p<0.001, filter paper disk method: p<0.05 in university). The rate of examination of the serum zinc in the 2019 survey was increased compared with the 1990 survey (p<0.001). Zinc oral therapy was used for the treatment of taste disorders in 239/299 (79.9%) patients/institutes for 3 months. In addition, 213 institutions (69.6%) answered that zinc oral therapy was efficacious for taste disorders.

CONCLUSION

The patients who complained of taste disorder have increased. The zinc administration is an appropriate clinical treatment for taste disorders in Japan. To enhance treatment for taste disorders, simpler methods for assessing taste function need to be developed, and the pathological mechanisms of taste disorders other than zinc deficiency need to be clarified.

Change of somatosensory function of the tongue caused by chorda tympani nerve disorder after stapes surgery

OBJECTIVES

Patients after middle ear surgery often complain of taste disturbance and a lingual numbness. The purpose of this study was to objectively assess changes in the somatosensation of the tongue and taste function in patients undergoing stapes surgery.

STUDY DESIGN

Prospective study.

METHODS

Symptoms of taste disturbance and tongue numbness after surgery were investigated before and after surgery in 41 patients (13 males, 28 females; mean age 41.8 years) who underwent stapes surgery. Twenty-eight patients (9 males, 19 females; mean age 43.1 years) underwent sensory and taste function tests before and after surgery. Sensory function of the tongue was measured at the operated side and the nonoperated side using the 2-point discrimination test and an electrostimulator test. Taste function was assessed with electrogustometry (EGM).

RESULTS

The chorda tympani nerve (CTN) was gently touched or stretched in all patients. Postoperative thresholds on the operated side were significantly higher than preoperative thresholds in all tests in the patients who underwent all three kinds of tests. Tongue somatosensory symptoms improved significantly earlier than the taste disturbance postoperatively, and the sensory thresholds returned to the baseline along with recovery of symptoms.

CONCLUSION

These findings suggest that dysfunction of the CTN occurred following surgery even when the CTN was preserved, and that the sensory nerve threshold of the tongue correlated with the symptom of lingual numbness. The CTN may play a role not only in taste function but also in the somatosensory function of the tongue.

LEVEL OF EVIDENCE

4. Laryngoscope, 128:701-706, 2018.

[Time course of changes in gustatory function test results and subjective symptoms, and predictive factors for response in patients with taste disorder receiving 24-week zinc replacement treatment]

In a taste disorder, an agreement between patients' complaints and gustatory function test results is not necessarily found both at the initial hospital visit and during the course of treatment; therefore, it is difficult to assess treatment responses and review treatment strategies based on the assessed treatment responses. The present study investigated the time course of changes in disc gustometry results and subjective symptom scores measured at 4-week intervals in 44 patients with a taste disorder who were considered eligible for zinc replacement treatment and who received polaprezinc at a dose of 150 mg/day (equivalent to a 34 mg/day dose of zinc) for up to 24 weeks. The study also examined the potential differences in treatment outcomes according to the predictive factors for response such as patient background and assessed disc gustometry results during the course of treatment. Results indicated that disc gustometry results and subjective symptom scores showed different time courses of changes. The response rate as measured by disc gustometry was 47.7% at week 12 of treatment, and showed a subsequent slow increase to 56.8% at week 24. On the other hand, subjective symptom scores showed a time-proportional improvement up to week 24. Among the patients included in the present study, a clear difference was found according to the presence or absence of an improving trend as determined by disc gustometry at week 12 of treatment, although there were no differences in ultimate treatment responses, including categories of taste disorder, according to patient background. Patients showing a trend toward improvement had significantly better treatment responses in terms of both ultimate response rates and subjective symptom scores, whereas patients showing no trend toward improvement were less likely to respond to the subsequent 12-week continued treatment.

Nizatidine enhances salivary secretion in patients with dry mouth

OBJECTIVE

It was reported that salivary secretion increased in 30 volunteers with administered nizatidine. The aim of the present study was to investigate whether or not nizatidine enhances salivary secretion and improves the function of salivary glands in patients with dry mouth.

METHODS

Both basal and stimulated salivary secretions were measured before and after the administration of nizatidine for a month in 18 healthy adult volunteers and 38 patients with dry mouth. In 6/38 patients, salivary gland scintigraphy was performed.

RESULTS

After the administration of nizatidine for a month, salivary secretions significantly increased in the control and dry mouth patient groups compared to the pretreatment baseline. In addition, 25 of 38 dry mouth patients showed subjective improvements of oral dryness. In 3/4 patients, the function of salivary glands was improved on salivary gland scintigraphy.

CONCLUSION

Nizatidine may reactivate salivary gland cells and be useful in the treatment of patients with dry month.

[Clinical investigation using a self-rating depression scale in subjects with psychosomatic taste disorders]

In recent years, the number of patients with psychologenesis taste disorders has increased. In this study, related psychological factors were examined in 258 patients (85 men, 173 women) using a self-rating depression scale (SDS). The results were as follows: 1) 189 patients reported normal psychological factors, 2) 173 patients reported neurotic sates, and 3) 40 patients reported positive correlations with a depressive sates, Most of the patients, self-reported results were not correlated with taste function tests. On the other hand, the patients with depression had reduced salivary secretion tests results. Only 50% of the patients with depression recovered their taste functions. These results suggest that the SDS test may be useful for diagnosing taste disorders and monitoring effects of treatment.

Treatment Outcome in Patients with Taste Disturbance

The importance of taste has been recently evaluated from the standpoint of quality of life, but few reports exist on the clinical status of taste disturbance. We classified taste disturbance by cause and studied the effect of treatment and recovery duration. Subjects were 321 patients with taste disturbance, i.e., 131 men and 190 women (mean age: 59.9 years). Electrogustometry (EGM) and filter paper disks (FPD) were used to assess taste function in all subjects. We also asked them all about the degree of symptoms using visual analog scale (VAS). Statistical analysis was done using the unpaired t-test, with p<0.05 considered significant. Patients were treated with zinc sulfate, ferrotherapy, herbal medicine, and minor tranquilizers. Causes of taste disturbance were classified into idiopathic, post-common-cold, drug-induced, psychogenic, constitutional, and iron deficiency. Idiopathic taste disturbance was the commonest cause (125 cases, 38.9%), followed by drug-induced (62 cases, 19.3%), and post common cold (38 cases, 11.8%). Drug induced and psychogenic taste disturbance have increased. Recovery from symptoms was 79/103 (76.7%) in idiopathic taste disturbance, 24/33 (72.7%) in post-common-cold, and 14/17 (82.4%) in iron deficiency. Recovery took 22.2 weeks. Recovery was 32/50 cases (62.4%) in drug induced, taking 48 weeks. For all causes, EGM and FPD results were not associated with the degree of symptoms. Both tests tended to show delayed improvement compared to symptoms. Cases taking more than 6 months from symptom onset to medical examination showed significantly lower improvement and longer recovery time than those taking 6 months on less (p = 0.04).

Taste function after section of chorda tympani nerve in middle ear surgery

OBJECTIVE

To investigate prospectively the clinical manifestations and the functional recovery of taste after section of chorda tympani nerve (CTN) during middle ear surgery, the subjective and objective study on the patients was performed.

METHODS

Thirty-five patients underwent surgery with unilateral (n=32) or bilateral (n=3) section of CTN between January 2000 and April 2002. The patients were asked about taste symptoms before surgery and 2 weeks and 2 years after surgery. The CTN function was also measured with electrogustometry (EGM) at the same time points.

RESULTS

In unilateral section of CTN, 19/32 (59.4%) complained of taste disorder and 11/32 (34.4%) tongue numbness. Most of these taste symptoms disappeared within 2 years although the EGM threshold did not recover. 16/17 patients (94.1%) who used to cook everyday had little difficulty in flavoring dishes. In bilateral section of CTN, the patients had no problem of taste at 2 years after surgery, either.

CONCLUSION

These findings help explain the potential complications to the patients before surgery, although the number of cases was small in this series.

[Clinical experiences of the medication to taste disturbance by serum trace deficiency, especially serum iron deficiency]

Serum zinc deficiency is known to be a major cause of taste disturbances, but the effects of serum iron deficiency on taste disturbances are not widely known. In the present study, we clinically investigated the relationship between taste disturbances and serum iron deficiency as well as the results of pharmacological therapy. The clinical and serological test results of 25 patients with serum iron deficiency (3 men and 22 women; mean age +/- SD, 56.1 +/- 16.5 years) were reviewed at the Department of Otolaryngology, Hospital of Hyogo College of Medicine. All of the patients had been seen at the hospital between January 1999 and February 2003. Electrogustometry (EGM) and the filter paper disc method (FPD) were used to measure taste function. The patients were treated with iron and zinc supplements. The age distribution of the patients peaked at the ages of 40 and 70 years. The ratio of males to females was 1:7. Based on the EGM results, 70% of the patients exhibited taste disturbances. The FPD results showed that the recognition threshold of sour tastes was slightly higher than that of the other tastes. No significant difference in the results of treatment was seen, regardless of the duration of the deficiency. These results suggest that treatment with iron and zinc medicine is useful for correcting taste disturbances caused by serum deficiencies of trace elements.

[Therapeutic effects of imipenem/cilastatin sodium against severe infections in patients with hematopoietic disorders. Hanshin Infection Study Group]

One hundred ninety-eight patients with severe infections associated with hematopoietic disorders were treated with imipenem/cilastatin sodium (IPM/CS), and the efficacy and safety of the drug were evaluated. The results obtained are summarized below. 1. Out of 182 patients in whom efficacies are evaluable, responses were excellent in 50 patients, good in 52, fair in 21 and poor in 59, and the efficacy rating was 56.0%. 2. The efficacy rating in 87 patients who had failed to respond to prior treatment with other antibiotics was 58.6%. 3. There were significant differences in efficacy ratings when patients were grouped according to differences the number of neutrophils after treatment, less than 100, 101 approximately 500 and over 501/mm3. 4. The eradication rate in 38 patients from whom causative organisms were isolated was 75.8%. 5. Out of 197 patients in whom the safety was evaluable, side effects were observed in 19 patients (9.6%) and abnormal laboratory test values in 15 (7.6%).

[A case of plasmacytoma (IgD lambda) of the breast associated with multiple myeloma]

A case of secondary plasmacytoma (Ig. D. lambda) of the breast, associated with multiple myeloma, is reported, involving a 60-year-old woman in whom multiple tumors of the right breast appeared during the course of her treatment for multiple myeloma. These breast tumors were firm, non-tender, clear-margined, smooth-surfaced, and showed good mobility. An ultrasonogram revealed that the tumors had the shape of a clear-margined anechoic mass like a cyst. A histological diagnosis of a biopsied specimen determined plasmacytoma (Ig. D, lambda) and the patient was treated with chemotherapy which caused the tumors to greatly reduce.