Bilateral taste disorders in patients with Ramsay Hunt syndrome and Bell palsy

Contact Endoscopic Surface Vascular and Epithelial Morphology in Leukoplakia and Carcinoma of the Vocal Cords: Vascular and morphological changes of vocal folds in leukoplakia and cancer

Purpose Leukoplakia is a macroscopic morphological term for thick white or grey mucosal patches that can represent various histologic diagnostic entities ranging from hyperplasia to malignancy. Aim was the study morphology of the superficial mucosa and microvascular network of the vocal cords in patients with suspected glottic squamous cell carcinoma (SCC) using contact endoscopy (CE). Material and Methods Seventy-nine patients (21 female, 58 male), with a mean age of 57.5 years ± 7.12 (range, 32-73 years), were prospectively enrolled and evaluated. Of these patients, 58 had leukoplakia (Group A/41 males and 17 females, with a mean age of 53.7 years ± 6.65), and 21 (Group B/ 17males and 4 females/ with a mean age of 60.5 years ± 6.04) had malignant lesions (pT1, n = 6; p T2, n = 8; pT3, n = 8; Group B), as proven by the results of the histological examination. Further, 79 non-smokers (control group-group C) were studied. CE imaging findings were classified into five types (I to V) based on the features of the mucosal intra-epithelial capillary loops. CE findings were correlated to the histologic findings. A separate analysis involving smoking status was done. Results The CE-based intraepithelial papillary capillary loop classification score was strongly correlated with the histological findings. Age was strongly associated with both malignancy and bilateral involvement. Smoking habits didn't significantly differ between patients with unilateral and bilateral SCC. Conclusions CE imaging of the vocal cord mucosal capillaries may be useful for the early detection of glottic SCC and pre-cancerous lesions.

[Functional and morphological disorders of taste and olfaction in COVID-19 patients]

Ziele

Testen der Prävalenz und Entwicklung akuter olfaktorischer und gustatorischer Funktionsstörungen und ihrer morphologischen Korrelate bei COVID-19-Patienten, die aufgrund von COVID-19-bedingten Atemwegserkrankungen einen Krankenhausaufenthalt benötigen.

Methoden

Eingeschlossen wurden 53 Krankenhauspatienten (23 Männer, 30 Frauen, Alter 42,54 ± 10,95 Jahre) mit RT-PCR-bestätigter COVID-19-Diagnose. Die Patienten wurden zweimal untersucht: direkt nach der Entlassung aus dem Krankenhaus und 4–6 Wochen später. Elektrogustometrische (EGM-)Schwellen im von der Chorda tympani versorgten Zungenbereich, am weichen Gaumen und im Bereich der Papillae vallatae wurden beidseitig erfasst. Der Geruchssinn wurde mit Riechstäbchen untersucht (Sniffin’ Sticks, Burghart GmbH, Wedel, Deutschland). Mittels Kontaktendoskopie wurden die Nasen- und Mundschleimhäute (fungiforme Papillen, fPap) der Patienten untersucht. Die Ergebnisse wurden mit denen von 53 gesunden Personen verglichen (23 Männer, 30 Frauen, Alter 42,90 ± 10,64 Jahre).

Ergebnisse

Die EGM-Schwellenwerte der Patienten waren in beiden Fällen signifikant höher als die der gesunden Probanden. Die EGM-Schwellenwerte bei der 2. Messung waren signifikant niedriger als bei der 1. Messung. Dementsprechend waren die vom Patienten berichteten gustatorischen Ergebnisse bei der 2. Messung verbessert. Dasselbe Muster wurde bei der Verwendung von Sniffin’ Sticks gefunden. Signifikante Veränderungen in Form und Vaskularisierung von fPap wurden bei Patienten festgestellt, insbesondere beim 1. Mal. Bemerkenswert ist, dass keine signifikanten Unterschiede in der Vaskularisation der Nasenschleimhaut der Patienten beobachtet wurden.

Schlussfolgerung

COVID-19 beeinträchtigt sowohl die Geschmacks- als auch die Geruchsfunktion. Es beeinflusst auch parallel die Struktur und Vaskularisierung der Mundschleimhaut, wenn auch die Nasenschleimhaut in einem viel geringeren, nicht signifikanten Ausmaß. Unsere Ergebnisse deuten darauf hin, dass COVID-19 eine leichte bis schwere Neuropathie mehrerer Hirnnerven verursachen kann.

Assessment of Smell and Taste Disturbances among COVID-19 Convalescent Patients: A Cross-Sectional Study in Armenia

BACKGROUND AND OBJECTIVES

Neurological manifestations of Coronavirus Disease 2019 (COVID-19) such as olfactory and gustatory disturbance have been reported among convalescent COVID-19 patients. However, scientific data on the prevalence of smell and taste disturbance are lacking. Therefore, we present findings on the degree of smell and taste disturbances among the Armenian population.

METHODS

Study participants were randomly recruited and then categorized into two groups based on their course of the disease. A cross-sectional study was performed to assess participants' sensitivity to smell triggered by the olfactory and the trigeminal nerves; their ability to differentiate between various odors; and to evaluate their gustatory perception.

RESULTS

The smell test revealed that the degree of olfactory nerve disturbance was different by 30.7% in those participants of the early group as compared to those of the late group, and the degree of trigeminal nerve disturbance was different by 71.3% in the early group as compared to the late group. A variation of the differentiating ability among the participants of the early and late groups was detected. Gustatory disturbances for all flavors were also found to be different in both the groups. A moderate positive correlation (0.51) was found between the overall sensitivity of smell and the ability to differentiate between various odors as cumulatively stimulated by both the olfactory and trigeminal nerves. Also, a moderate positive correlation (0.33) was found between headache and smell sensitivity through the olfactory nerve and a high negative correlation (-0.71) was found between headache and smell sensitivity through the trigeminal nerve.

CONCLUSION

Pathological changes in the olfactory and trigeminal perceptive abilities caused disturbances in smell sensation, with the trigeminal nerve being more affected. The capacity to differentiate fragrances did not improve with time and the disturbance severity of bitter taste perception was higher among the study participants.

Taste and acoustic reflex after recovery from facial muscle paralysis in patients with facial nerve palsy

BACKGROUND

There are few studies on taste or acoustic reflex (AR) in patients after recovery from facial muscle paralysis (FMP).

OBJECTIVES

To investigate the recovery of AR and taste in patients who have recovered from peripheral facial nerve palsy (FNP).

MATERIALS AND METHODS

The study included 25 patients whose FMP had resolved after treatment for FNP. A difference in taste threshold of ≤4 dB between the affected and unaffected sides in the electric taste test was defined as normal; an AR on the affected side was assessed to be ≥90% of the AR on the unaffected side was defined as normal.

RESULTS

Six months after treatment, 8% of patients with FNP who had recovered from FMP still showed taste disorders, and 60% of patients showed abnormal AR. The number of subjects whose electric taste threshold was normal after treatment was significantly higher than the number of subjects whose AR assessment was normal (p < .01).

CONCLUSION AND SIGNIFICANCE

This study demonstrates that even among subjects whose FMP is resolved after treatment for FNP, there are some whose taste and AR do not recover. Physicians should be aware of ear symptoms persisting after facial muscle recovery.

Electrogustometry: Normative data for stimulus duration, tongue site and age decline

OBJECTIVES

Our primary goal was to evaluate the effect of stimulus duration on electrogustometry (EGM) thresholds. Additionally, we sought to evaluate any sex-related influences and compare the above results to those of taste strips.

DESIGN

Electrogustometry thresholds of various stimulus durations (0.5, 1.0, 1.5 and 2.0 seconds) were measured in 212 non-smokers (age range: 10-80 years, divided into eight age-groups) without self-reported gustatory impairment. Furthermore, taste strips chemogustometry measurements in 132 participants were performed.

SETTING

Tertiary referral medical centre.

PARTICIPANTS

212 non-smokers, divided into eight age-groups participated in the study.

MAIN OUTCOME MEASURES

Electrogustometry thresholds and taste strips, duration of EGM stimuli.

RESULTS

Electrogustometry thresholds increased progressively with age and with stimulus duration from 0.5 to 2 seconds. This pattern was consistent in all six anatomic areas, irrespective of sex. In contrast, when using chemogustometry, no age- or sex-related differences were observed.

CONCLUSIONS

Electrogustometry-threshold values increase progressively with age and with stimulus duration. Therefore, we recommend documenting stimulus duration in the future EGM recordings as it may significantly affect EGM amplitude threshold values.

Mastoid effusion on temporal bone MRI in patients with Bell's palsy and Ramsay Hunt syndrome

This study aimed to investigate the incidence of mastoid effusion on temporal bone magnetic resonance imaging (MRI) in patients with Bell’s palsy (BP) and Ramsay Hunt syndrome (RHS), and evaluate the usefulness of mastoid effusion in early differential diagnosis between BP and RHS. The incidence of mastoid effusion on 3.0 T—temporal bone MRI, which was conducted within 10 days after the onset of acute facial nerve palsy, was compared between 131 patients with BP and 33 patients with RHS. Findings of mastoid cavity on temporal bone MRI were classified into three groups as normal mastoid, mastoid effusion, and sclerotic change, and the incidence of ipsilesional mastoid effusion was significantly higher in RHS than BP (P < 0.001). Tympanic membrane was normal in 7 of 14 RHS patients with mastoid effusion, and injected without middle ear effusion in 7 patients. This study highlights significantly higher incidence of ipsilesional mastoid effusion in RHS than BP, and suggests that the presence of mastoid effusion may provide additional information for differential diagnosis between RHS and BP.

Gustatory function in persons with cerebral palsy

Gustatory function is closely related to chewing and swallowing; however, there are currently no reports regarding gustatory function in persons with cerebral palsy (CP). The aim of this study was to compare the gustatory function between persons with CP and healthy controls. We investigated sweet, salty, sour and bitter tastes using the whole-mouth method and measured the electrogustometric thresholds in the chorda tympani nerve area. Twelve participants with CP (6 women and 6 men) for whom gustatory testing was possible at our facilities, and 17 age-matched controls (9 women and 8 men) were included. The mean age ± standard deviation was 58.6 ± 8.1 years and 58.5 ± 8.7 years in subjects with CP and controls, respectively. Taste detection and identification were significantly worse in persons with CP compared with the controls. Taste identification was more impaired than taste detection. At the highest concentration, taste identification was impossible 11 times out of 48 (12 persons × 4 kinds of tastes) in persons with CP but such a deficit was not observed in 68 attempts (17 persons × 4 kinds of tastes) involving controls. The electrogustometric thresholds were not significantly different between the groups. Gustatory function associated with chewing and swallowing is worse in persons with CP compared to the controls.

A case of varicella zoster encephalitis with glossopharyngeal and vagus nerve injury as primary manifestation combined with medulla lesion

Varicella zoster virus (VZV) can invade the brainstem or brain via the glossopharyngeal, vagus , or facial nerve, resulting in brainstem inflammation or encephalitis. We report the case of a 66-year-old male patient with a primary manifestation of medulla injury of the glossopharyngeal and vagus nerves, combined with a medulla lesion, who was misdiagnosed with lateral medullary syndrome. Facial nerve injury and earache subsequently occurred and human herpes virus 3 (VZV) was detected by second-generation sequencing of the cerebrospinal fluid. The final diagnosis was varicella zoster encephalitis, which improved after antiviral therapy.

Systemic diseases and disorders

Alterations in the ability to smell or taste are of considerable consequence, impacting quality of life, safety, nutrition, and dietary activities. These primary senses are influenced by a wide range of systemic diseases and disorders that commonly involve the entire body. These include viral, bacterial, fungal, protozoal, cestode, and nematode infections that can spread throughout the gastric, lymphatic, neural, or circulatory systems as well as classic autoimmune disorders, collagen diseases, diabetes, and hypertension, and others. Although a considerable literature has evolved in which the function of both taste and smell has been assessed in a number of such disorders, quantitative chemosensory testing is still relatively rare with many disorders not receiving empirical assessment. Incongruent findings are not uncommon. This chapter reviews what is known about the influences of a wide spectrum of systemic diseases and disorders on the abilities to taste and smell.