Observation of tongue papillae by video microscopy and contact endoscopy to investigate their correlation with taste function

Photobiomodulation minimizes taste changes during hematopoietic cell transplantation: A randomized clinical trial

Prevention and treatment protocols for taste changes observed during hematopoietic cell transplantation (HCT) are not well-established. The purpose of this study was to assess the efficacy of photobiomodulation (PBM) in relieving taste changes and preventing lingual papillae atrophy. HCT patients received PBM (n = 42) on the tongue dorsum using an InGaAIP laser (660 nm, 100 mW, 1.1 W/cm2, 8.8 J/cm2). During the HCT conditioning (T0), severe neutropenia (T1), and after neutrophil engraftment (T2), taste acuity for sweet, bitter, sour, and salty solutions, and clinical appearance of lingual papillae were compared with those of a placebo group (n = 43). PBM significantly reduced hypogeusia, ageusia, and parageusia at T1 and T2, and also successfully prevented papillae atrophy during all the analyzed HCT periods. In conclusion, PBM enhanced taste acuity during HCT. The decrease in papillae atrophy indicated a potential regenerative effect of this therapy on tongue mucosa.

Endocrinology of Taste with Aging

Taste is one of our five primary senses, and taste impairment has been shown to increase with aging. The ability to taste allows us to enjoy the food we eat and to avoid foods that are potentially spoiled or poisonous. Recent advances in our understanding of the molecular mechanisms of taste receptor cells located within taste buds help us decipher how taste works. The discoveries of "classic" endocrine hormones in taste receptor cells point toward taste buds being actual endocrine organs. A better understanding of how taste works may help in reversing taste impairment associated with aging.

Taste Changes after Atresioplasty in Patients with Congenital Aural Atresia

OBJECTIVE

We evaluated chorda tympani nerve (CTN) and postoperative taste dysfunction according to anomaly severity and intraoperative CTN status.

STUDY DESIGN

Prospective observational study.

SETTING

Tertiary referral center, Samsung medical center hospital.

PATIENTS

Thirty-one patients who underwent atresioplasty by a single surgeon in a tertiary referral center were enrolled.

INTERVENTIONS

Therapeutic surgery.

MAIN OUTCOME MEASURES

Preoperative Schuknecht type and Jahrsdoerfer score and intraoperative CTN status were recorded, and a postoperative questionnaire was administered to evaluate taste function.

RESULTS

A significant difference was found among intact, cut, and unidentified groups in terms of Schuknecht type ( p = 0.000) and Jahrsdoerfer score (9.28 ± 1.11, 8.80 ± 0.83, 8.10 ± 0.93, p = 0.028). CTN was observed in Schuknecht type B, and not in type C ( p = 0.000), and was more likely to be observed as Jahrsdoerfer score increased ( p = 0.012). Taste disturbance tended to last longer in adult patients than in children. A significant difference was observed in the incidence of taste change between cut and intact CTN groups ( p = 0.018).

CONCLUSION

CTN was not identified during surgery in patients with Schuknecht type C anomalies, and there was no change in taste after surgery. Meanwhile, CTN was observed in all patients with Schuknecht type B anomalies, and CTN injury occurred in 41.67%. Therefore, CTN presence can be predicted by severity of anomaly, and patients with type B anomalies should be informed of the risk of CTN injury before surgery.

Consequences of Stapes Surgery on Tongue Morphological Characteristics in Narrow Band Imaging, Gustatory Function and General Sensation: A Prospective Tertiary Center Study

(1) Background: Chorda tympani (CT) manipulation during stapes surgery affects its functions. We hypothesized that this alters tongue morphology and sensory functions. (2) Methods: Patients undergoing stapes surgery were tested 1 day preoperatively, 1 and 6 months postoperatively. Narrow band imaging contact endoscopy (NBI) was used to determine the number of fungiform papillae (Npapillae) and the total score of blood vessel morphology (NBItotal). The taste was tested with taste strips. General sensation was tested with a static two-point discrimination. Tests were performed on ipsilateral and contralateral side of the tongue. (3) Results: 52 otosclerosis patients were included in the study. There was a statistically significant decrease of NBItotal (p = 0.005), Npapillae (p = 0.009), sensation of sweet (p = 0.003), salty (p = 0.035), sour (p = 0.036), and bitter taste (p = 0.013) within the test side during the follow-up. A statistically significant impact on presence of dysgeusia for sweet was found 1 month postoperatively (p < 0.005). Postoperative decrease in two-point discrimination score did not reach a statistical significance (p = 0.056). (4) Conclusions: CT manipulation affects fungiform papillae density, vascular patterns and taste sensation. The general sensation of the tongue is not influenced by CT manipulation.

Longitudinal trajectories and determinants of human fungiform papillae density

Tongue fungiform papillae contain taste buds crucial for taste and hormone-producing taste receptor cells; therefore, they may be considered as endocrine organs and have important age-associated physiological implications. We examine the cross-sectional and longitudinal trajectories of fungiform papillae density in 1084 participants from the Baltimore Longitudinal Study of Aging using linear regression models and mixed effects models. At baseline, the mean age was 67.86 ± 14.20 years, with a mean follow-up time among those with repeat visits of 4.24 ± 1.70 years. Women (53%) were younger (66.85 ± 13.78 vs. 69.04 ± 14.61 years, p < 0.001) and had a higher fungiform papillae density than men (16.14 ± 9.54 vs. 13.77 ± 8.61 papillae/cm², p < 0.001). Whites (67%) had a lower fungiform papillae density than non-Whites after adjusting for age and sex. Factors cross-sectionally associated with a lower fungiform papillae density included a higher waist-hip ratio (β = −8.525, p = 0.029), current smoking status (β = −5.133, p = 0.014), and alcohol use within the past 12 months (β = −1.571, p = 0.025). Longitudinally, fungiform papillae density decreased linearly with follow-up time (β = −0.646, p < 0.001). The rate of decline was not affected by sex, race, BMI, waist-hip ratio, smoking, or alcohol use. The longitudinal decline of fungiform papillae density over time needs to be explored further in order to identify other possible age-associated physiological determinants.

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.

Impact of Fungiform Papillae Count on Taste Perception and Different Methods of Taste Assessment and their Clinical Applications: A comprehensive review

Fungiform papillae are raised lingual structures which contain taste buds and thus play an important role in taste perception. These structures vary in number due to their relative sensitivity to a range of systemic and local factors which affect the dorsum of the tongue. Taste sensation can be measured using both chemical and electrical methods; however, the number of fungiform papillae has a direct effect on chemogustometric and electrogustometric values during evaluation. This review provides a general overview of fungiform papillae, their quantification methods and the various factors which may affect these structures. In addition, numerous methods of recording taste sensation and their clinical applications are highlighted.

Impact of Oral Intake of Glucosylceramide Extracted from Pineapple on Xerostomia: A Double-Blind Randomized Cross-Over Trial

Background: The aim of this double-blind randomized cross-over trial was to evaluate the effect of oral intake of glucosylceramide extracted from pineapple on oral moisture and xerostomia symptoms. Methods: Sixteen participants who had xerostomia symptoms were randomly allocated into two groups. One group received, as test samples, tablets containing glucosylceramide extracted from pineapple (GCP) followed by placebo tablets. The other group received the test samples in the reverse order. Participants were instructed to take tablets of the first test sample once a day (after breakfast) for two consecutive weeks. Then, after a washout period of four weeks, participants were instructed to take the other test sample for two consecutive weeks. The oral moisture level of the lingual mucosa, xerostomia symptoms, and the number of fungiform papillae was evaluated. Results: The oral moisture significantly increased, and the visual analog scale (VAS) of "How is the dryness of your mouth?" significantly improved after GCP tablets intake and not after placebo tablets intake. The number of fungiform papillae was not significantly different following the intake of GCP tablets or placebo tablets. Conclusion: Results suggested that oral intake of GCP may improve the moisture level and xerostomia symptoms.

Non-invasive intravital observation of lingual surface features using sliding oral mucoscopy techniques in clinically healthy subjects

To investigate intravital morphological features of the broader area of the lingual mucosa in clinically healthy subjects, and to attempt to evaluate subclinical conditions, we evaluated detailed intravital morphological features of the lingual mucosa using our newly developed oral contact mucoscopy techniques. Clinically healthy subjects (female: 19-22 years, average age: 20.27 years, and n = 28) were enrolled. A position indicator stain was placed on the lingual mucosal surface, and sliding images were captured and then reconstructed. In addition, the lingual mucosa was divided into six areas, and morphometry of the fungiform and filiform papillae was performed. The results were statistically analyzed. There were two morphological features among clinically healthy subjects involving the filiform papillae: the length of the papillae and the degree of biofilm (tongue coat) deposition. We defined a modified tongue coat index (mTCI) with scores ranging from 0 (tongue coating not visible) to 0.5, 1, 1.5, and 2 (thick tongue coating) for six sections of the tongue dorsum. No subjects received a score of 2. Significant differences were found in the mTCI between the six sections of the tongue dorsum, especially between the posterior areas and the lingual apex. The fungiform papillae of some subjects exhibited elongated morphological changes. Our findings suggest that magnified lingual dorsum examination of a broader area is especially important in accurate screening for subclinical or transient conditions of potential lingual mucosal diseases. For this purpose, our new oral mucoscopy and non-invasive intravital observational techniques were especially effective.

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

OBJECTIVE

Ramsay Hunt syndrome (RHS) and Bell palsy (BP) are typically known as facial nerve motor syndromes and are primarily unilateral. The aim of this study was to challenge this assertion, because both conditions are also known to be associated with viruses that typically affect several nerves.

METHODS

Ten participants with RHS, 12 with BP, all clinically unilateral, and 12 healthy controls were prospectively enrolled. Electrogustometric thresholds were measured bilaterally in the areas of the chorda tympani, the glossopharyngeal, and the major petrosal nerve. Also bilaterally, the taste function was tested using chemogustometry with different tastant concentrations. Again bilaterally, the morphology of the mucosa and the vessels of the anterior fungiform papillae were examined by contact endoscopy. Statistically, RHS and BP participants were compared with the healthy controls, and the paretic sides of RHS and BP were compared pairwise with their mobile sides.

RESULTS

Electrogustometrically, perception was reduced bilaterally in RHS (10-19dB, p < 0.001) and BP (3-5dB, p = 0.011-0.030) in all 3 innervation areas. Chemogustometrically, it was also reduced bilaterally in RHS (20-70%) and BP (8-50%). Papillary atrophies were increased 100% in RHS (p = 0.001) and BP (p < 0.001). They were more increased on the paretic side in RHS (30%, p = 0.078) and BP (83%, p < 0.001).

INTERPRETATION

In these 2 clinically unilateral conditions, the gustatory perception and morphology are bilaterally affected, more in RHS and more on the paretic side. BP, known as an isolated motor condition, appears to be a cranial polyneuritis. A bilateral examination and therapeutic gustatory monitoring might follow these observations in evidence-based practice. Ann Neurol 2018;83:807-815.

Association of tongue brushing with the number of fungiform taste buds and taste perception: A preliminary study using confocal laser scanning microscopy in combination with a filter-paper disc method

OBJECTIVE

The aim of this study was to investigate the association of tongue brushing with the number of fungiform taste buds and taste perception using a confocal laser scanning microscopy in combination with a filter-paper disc method (FPDM).

METHODS

Twenty-four subjects with or without a habit of tongue brushing (11 males and 13 females, 20-46 years old) participated in this study. Nine of the 24 subjects had no habit of tongue brushing (Group 1, n=9). Fifteen subjects had a habit of tongue brushing, and the brushing regions of the tongue were as follows: central region (Group 2, n=7), or entire region (Group 3, n=8) of the tongue dorsum. Using confocal laser scanning microscopy, the average number of taste buds per fungiform papilla (FP) was counted. Taste perception was evaluated using an FPDM. These observations were performed in the midlateral region of the tongue since the distribution of fungiform papillae is large in the midlateral region compared to that in the central region.

RESULTS

The subjects in Group 3 showed a significantly decreased number of fungiform taste buds compared to Group 1 and Group 2. Group 3 also showed significantly higher FPDM scores than the other two groups.

CONCLUSIONS

Excessive tongue brushing of the entire tongue dorsum, including the midlateral region, may have an association with the decreased number of FP and taste buds and decreased taste sensation. To avoid these conditions, instituting proper tongue brushing methods, such as limiting it to the central region of the tongue and using a light touch, is suggested and is important for the subjects who are eager to participate in tongue brushing.

Electrogustometry Thresholds, Tongue Tip Vascularization, Density, and Form of the Fungiform Papillae Following Smoking Cessation

The objective of this study was to evaluate differences in gustatory function and in shape, density, and vascularization of the fungiform papillae (fPap) of smokers' tongue before and after smoking cessation. In 24 smokers (19 males, 5 females; median age: 54.6 ± 2.9 years) electrogustometry (EGM) thresholds at the chorda tympani area, at the soft palate area and at the area of the vallate papillae were recorded bilaterally. Morphology and density of the fungiform papillae (fPap) and blood vessels' density and morphology at the tip of the tongue were examined using contact endoscopy (CE). Follow-up exams (EGM and CE) were performed on average 3.2 months after smoking cessation. Findings were compared between the 2 conditions as well as to those of a group of 24 non-smokers (median age: 55.2 ± 3.4 years; 19 males, 5 females). After smoking cessation, EGM thresholds decreased significantly (P = 0.02 or P = 0.03 depending on the tested area) but nonetheless still were quite different from those of non-smokers (P = 0.05 or 0.04 depending on the site of EGM measurement). Under CE the fPap density was higher after quitting smoking (P = 0.05) and the shape and vascularization of fPap also exhibited a trend to improvement (P = 0.05) after smoking cessation. Chronic exposure to cigarette smoke infers long lasting, although to a large extent reversible, alterations in morphology of taste buds in fungiform papillae, but rather irreversible EGM-related functional gustatory compromise, suggesting a profound physiologic effect on human peripheral taste organs.

TongueSim: Development of an Automated Method for Rapid Assessment of Fungiform Papillae Density for Taste Research

Taste buds are found on the tongue in 3 types of structures: the fungiform papillae, the foliate papillae, and the circumvallate papillae. Of these, the fungiform papillae (FP) are present in the greatest numbers on the tongue, and are thought to be correlated to the overall number of taste buds. For this reason, FP density on the tongue is often used to infer taste function, although this has been controversial. Historically, videomicroscopy techniques were used to assess FP. More recently, advances in digital still photography and in software have allowed the development of rapid methods for obtaining high quality images in situ. However, these can be subject to inter-researcher variation in FP identification, and are somewhat limited in the parameters that can be measured. Here, we describe the development of a novel, automated method to count the FP, using the TongueSim suite of software. Advantages include the reduction in time required for image analysis, elimination of researcher bias, and the added potential to measure characteristics such as the degree of roundness of each papilla. We envisage that such software has a wide variety of novel research applications.

Changes in electrogustometry thresholds, tongue tip vascularization, density and form of the fungiform papillae in smokers

The objective of this study was to evaluate differences in gustatory function in smokers of both sexes and identify any differences in the shape, density and vascularisation of the fungiform papillae (fPap) of smokers' tongue. Additional aim was to investigate any relation between the age, pack years and differences in shape, density, vascularization of fPap and sex. In 166 smokers (81 males, 85 females, age range 20-80 years), divided in age groups, electrogustometry (EGM) thresholds at the chorda tympani area, at the soft palate area and at the area of the vallate papillae were recorded bilaterally. Morphology and density of the fPap and blood vessels' density and morphology at the tip of the tongue were examined using contact endoscopy (CE). EGM thresholds of all smoking subjects tended to increase compared to the non-smoking participants. Morphology, vascularization and density of fPap were found to be worse in smokers than in non-smokers. Interestingly, some participants, despite having increased number of pack years, tended to have almost similar EGM thresholds with non-smoking subjects of the same age group. Smoking tends to affect density, morphology and vascularization of the fPap. There is a correlation between the duration of smoking (pack years) and the afore-mentioned parameters. The use of τ-Kendall criterion provided useful information about the different correlation between the EGM thresholds and vascularization, the EGM thresholds and morphology of fPap and EGM thresholds and density of fPap. The majority of smokers had elevated EGM thresholds compared to non-smokers. Smoking is an important factor which can lead to decreased taste acuity. The combination of methods, such as EGM and CE, can provide useful information about the morphology and function of taste buds. Of interest, women are less affected than men, irrespective of the age group.

Development of a new method using narrow band imaging for taste assessment

OBJECTIVES/HYPOTHESIS

The observation of fungiform papillae is a useful objective taste examination. The purpose of this study is to develop a new method using narrow band imaging for assessment of taste function.

STUDY DESIGN

Using a narrow band imaging endoscope, we assessed the number and blood vessel morphology of fungiform papillae and compared with the gustatory threshold by the filter paper disc test.

METHODS

The number of fungiform papillae was counted in 20 mm(2) , and blood vessels in fungiform papillae were evaluated morphologically by a five-point scoring system in 11 patients who had undergone middle ear surgery. The filter taste disc test was performed simultaneously to obtain the gustatory threshold and was compared with the number and blood vessel morphology of fungiform papillae.

RESULTS

Using a narrow band imaging endoscope, we could clearly detect not only fungiform papillae but also blood vessel morphology. There was a significant correlation between the values of the number of papillae and blood vessel morphology. Moreover, these two parameters revealed a significant inverse correlation with gustatory function. As expected, both parameters on the affected side were significant lower than those on the unaffected side in patients.

CONCLUSIONS

The assessment of fungiform papillae using narrow band imaging endoscopy is easy, highly sensitive, and reliable; therefore, it might be useful as an objective examination of taste function.

LEVEL OF EVIDENCE

N/A.

Review and update: advanced investigation methods for diagnosis of tongue lesions

Various specialized imaging modalities and guided microscopic methods developed in recent years, having proven value for the evaluation of tongue disorders. The list of which includes cineradiography, pulsed ultrasound, computer-assisted tomography, isotopic scanning, electromyography, magnetic resonance, video microscopy and stereo microscopy. The basic aim of the article is to review and throw light on the importance of complete examination of the tongue and application of advanced investigations for the proper diagnosis of the tongue lesions and its usefulness to the clinician.

Age-related changes in electrogustometry thresholds, tongue tip vascularization, density, and form of the fungiform papillae in humans

The aim of the study was to investigate age-related changes in electrogustometry (EGM) thresholds, in morphology and density of the fungiform papillae (fPap) and in vessels' shape and density at the tip of the human tongue.In 156 nonsmokers (74 males, 82 females; age range: 10-80 years), divided in age groups, EGM thresholds at the chorda tympani area, at the soft palate area, and at the area of the vallate papillae were recorded bilaterally. Morphology and density of the fPap and blood vessels' density and morphology at the tip of the tongue were examined using contact endoscopy (CE). EGM thresholds at the chorda tympani area were significantly higher in both men and women ←60 years of age than in younger individuals. At the soft-palatine area, EGM thresholds were significantly higher in men aged 20-29 years and ←60 years compared with men of other age groups. In women older than 50 years, thresholds at all 3 areas were significantly higher than in the younger age groups. No significant differences in EGM thresholds between the two sexes at all locations tested were detected. The density of fPap decreased significantly in men aged >50 years and in women aged >60 years compared with younger individuals. Vascular density decreased significantly and vascular morphology worsened at the tip of the tongue in subjects older than 60 years of age compared with younger subjects. The study showed statistically significant differences in EGM thresholds between the right and the left side of the tongue and between the two sexes. Aging is associated with a progressive increase in EGM thresholds. Density of fPap plays an important role for taste acuity in females aged >60 years and males aged ←50 years. Morphology of fPap and vessels' density and morphology at the tip of the tongue, as tested by CE, emerge as factors influencing taste function in subjects of both sexes aged >60 years.

Breaking paradigms: a new definition for halitosis in the context of pseudo-halitosis and halitophobia

It is known that almost one-third of patients who seeks treatment for bad breath do not have genuine halitosis. Halitosis can occur even in cases when the malodor is not perceived by those around the patient and can neither be confirmed by organoleptic tests, nor by sulfur portable monitor readings. In such cases, these patients have been considered as halitophobic or have pseudo-halitosis. The complaint might signal the existence of a chemosensory dysfunction. Factors associated with taste and smell perception can be potentially connected to the occurrence of oral malodor. The threshold values of volatile sulfur compounds that have been used to establish the diagnosis of genuine halitosis do not take into account that the patient may perceive low levels of these and of other volatile compounds through retronasal olfaction. The current concept of halitosis requires the presence of a signal that has been based on equipment results, from the olfactory perception of the examiners and of those who interact with the patient. Nevertheless, the concept does not encompass the symptoms of halitosis. This paper addresses some of the possible causes of chemosensory dysfunction and proposes a new definition for halitosis.

Iatrogenic injury of the chorda tympani: a systematic review

Objective:

To review the currently available literature on iatrogenic injury of the adult chorda tympani.

Design:

Systematic literature review.

Method

Five electronic databases and one search engine were used to access available English language literature on the chorda tympani, focusing on iatrogenic injury.

Results:

The chorda tympani is most often injured during middle-ear surgery, after which at least 15–22 per cent of patients experience symptoms, mostly changes in taste and dryness of the mouth. Numerous factors influence whether injury to the chorda tympani causes symptoms, including the extent of injury, type of surgery, age of the patient, anatomical variables and subjective adaptation. Although most patients experience gradual symptomatic recovery, complaints can be persistent and troublesome.

Conclusion:

Care should be taken to preserve the chorda tympani during middle-ear surgery, and to warn patients pre-operatively about this potential complication. This is particularly important if surgery is bilateral.

Changes in taste bud volume during taste disturbance

On-line mapping and serial volume measurements of taste buds with confocal laser scanning microscopy provide information on the peripheral gustatory organ over time. We report the volumetric measurements of four selected fungiform papillae over 8 weeks in a 62-year-old man with taste disturbance, which was more apparent on the right than on the left side. In the two papillae on the right side, no taste buds were detected within the fungiform papillae in the sixth and eighth week. During sixth and eighth week, there was no response to the highest presented stimuli in electrogustometry (1 mA) on the right-sided tongue tip nor at the tongue edge. The morphology (shape, diameter) of the fungiform papillae on both sides remained unchanged. Comparison of the time course of the volume changes revealed differences corresponding to gustatory sensitivity. These findings suggest that the time course of volume changes indicated taste disturbance in our patient, rather than morphological changes in the fungiform papillae.

Change of the human taste bud volume over time

OBJECTIVE

The specific aim of this study is to measure the taste volume in healthy human subjects over a 2.5-month period and to demonstrate morphological changes of the peripheral taste organs.

MATERIAL AND METHODS

Eighteen human taste buds in four fungiform papillae (fPap) were examined over a 10-week period. The fungiform papillae investigated were selected based on the form of the papillae or the arrangement of surface taste pores. Measurements were performed over 10 consecutive weeks, with five scans in a day once a week. The following parameters were measured: height and diameter of the taste bud, diameter of the fungiform papilla and diameter of the taste pore.

RESULTS

The findings of this exploratory study indicated that (1) taste bud volumes changed over a 10-week period, (2) the interval between two volume maxima within the 10-week period was 3-5 weeks, and (3) the diameter of the fPap did not correlate with the volume of a single taste bud or with the volume of all taste buds in the fPap within the 10-week period.

CONCLUSIONS

This exploratory in vivo study revealed changes in taste bud volumes in healthy humans with age-related gustatory sensitivity. These findings need to be considered when studying the effect of denervation of fungiform papillae in vivo using confocal microscopy.

Evaluation of young smokers and non-smokers with Electrogustometry and Contact Endoscopy

Background

Smoking is the cause of inducing changes in taste functionality under conditions of chronic exposure. The objective of this study was to evaluate taste sensitivity in young smokers and non-smokers and identify any differences in the shape, density and vascularisation of the fungiform papillae (fPap) of their tongue.

Methods

Sixty-two male subjects who served in the Greek military forces were randomly chosen for this study. Thirty-four were non-smokers and 28 smokers. Smokers were chosen on the basis of their habit to hold the cigarette at the centre of their lips. Taste thresholds were measured with Electrogustometry (EGM). The morphology and density of the fungiform papillae (fPap) at the tip of the tongue were examined with Contact Endoscopy (CE).

Results

There was found statistically important difference (p < 0.05) between the taste thresholds of the two groups although not all smokers presented with elevated taste thresholds: Six of them (21%) had taste thresholds similar to those of non-smokers. Differences concerning the shape and the vessels of the fungiform papillae between the groups were also detected. Fewer and flatter fPap were found in 22 smokers (79%).

Conclusion

The majority of smokers shown elevated taste thresholds in comparison to non-smokers. Smoking is an important factor which can lead to decreased taste sensitivity. The combination of methods, such as EGM and CE, can provide useful information about the vascularisation of taste buds and their functional ability.

Comparison of contact endoscopy and frozen section histopathology in the intra-operative diagnosis of laryngeal pathology

Andrea et al. were the first to use contact endoscopy in the diagnosis of laryngeal disease, in 1995. This method enables in vivo microscopy of laryngeal mucosa.

In the present study, comparison of contact endoscopy with frozen section histopathology was performed in 142 patients with various diseases of the larynx. Paraffin section histopathology diagnosed 70 benign lesions, 23 precancerous lesions and 49 malignant lesions. Frozen section histopathology showed a sensitivity of 89.8 per cent, a specificity of 98.9 per cent and an accuracy of 95.7 per cent (χ2 = 1.5; p = 0.18). Frozen histopathology diagnosed 45 malignant lesions, including one false positive and five false negative results. Contact endoscopy yielded a sensitivity of 79.59 per cent, a specificity of 100 per cent and an accuracy of 92.95 per cent (χ2 = 8.1; p = 0.002). All malignant lesions diagnosed by contact endoscopy were confirmed by histopathology; contact endoscopy failed to recognise malignant lesions in 10 patients.

Contact endoscopy is preferable to frozen section histopathology as it is noninvasive, provides information on microscopic diagnosis and laryngeal lesion margins, and enables visualisation of the laryngeal mucosa microvasculature. The use of contact endoscopy along with frozen section histopathology improves diagnostic accuracy and allows for operative (or other) therapy to continue according to the results obtained.

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.