Studies on the relationship between electrogustometry and sour taste perception

Systematic review: Validity, reliability, and diagnostic accuracy of the electrogustometer

Objective

What are the electrogustometer's (EGM) validity, reliability, and diagnostic accuracy in assessing taste sensation in adults compared to other taste tests?

Data Sources

PubMed Medline, Elseviers's Embase, and the six databases of Cochrane Library.

Methods

We conducted a systematic search on December 20, 2022, consisting of synonyms for EGM. We considered randomized controlled trials and observational studies with original data for inclusion if they included adults who underwent electrogustometry. Articles were excluded if no analysis regarding validity, reliability, or diagnostic accuracy had been performed or if these analyses could not be performed with the published data.

Results

Nineteen articles discussing 18 studies were included for data extraction. The included studies carry a high risk of bias. Overall, the association between a variety of reference taste tests and EGM was moderate or weak with correlation coefficients ranging from -0.51 to 0.40 with one outlier of -0.74 found in one study correlating EGM and taste solutions. Test-retest reliability was good with reported correlation coefficients between 0.78 and 1.0. The sensitivity, specificity, PPV, and NPV of EGM in identifying abnormal taste function varied widely between the four studies on diagnostic accuracy.

Conclusion

The included studies in this review lack the required standards regarding study design to draw firm conclusions about the validity, reliability, and diagnostic accuracy of the EGM. Future research is needed to assess these measurement properties. Based on the reported results, we would not recommend using the EGM as a screening test for taste disturbance in clinical practice.

Level of Evidence

NA.

Visualization of the relationship between electrogustometry and whole mouth test using multidimensional scaling

Interpreting the relationship between different taste function tests of different stimuli, such as chemical and electrical stimulation, is still poorly understood. This study aims to analyze visually as well as quantitatively how to interpret the relationship of results between taste function tests using different stimuli. Patients who underwent the whole mouth test and Electrogustometry (EGM) at a tertiary medical center between August 2018 and December 2018 were reviewed retrospectively with electronic medical records. Of the 110 patients, a total of 86 adults who self-reported that their taste function was normal through a questionnaire were enrolled. EGM measured the thresholds of the chorda tympani (CT) and glossopharyngeal nerve (GL) area of the tongue. The whole mouth test measured detection and recognition thresholds for sweet, salty, bitter, sour, and umami taste. Statistical analyses of Pearson's, Spearman's rank and polyserial correlation and multidimensional scaling (MDS) was performed. The EGM threshold for the average value of both CT regions and the recognition threshold of the whole mouth test were significantly correlated in sweet, salty, bitter, and sour taste (r = 0.244-0.398, P < 0.05), and the detection threshold was correlated only significant in sweet (r = 0.360, P = 0.007). In the MDS analysis results, the three-dimensional (D) solution was chosen over the 2-D solution because of the lower stress. Detection-, recognition threshold of whole mouth test and EGM thresholds of CT and GL area, those were standardized by Z-score, formed well-distinguished sections in the MDS analyses. The EGM threshold of the CT area was closer to the detection and recognition thresholds than the EGM threshold of the GL area. In general, the EGM threshold was closer to the recognition threshold than the detection threshold for each taste. Overall, visualization of the relationship of whole mouth test and EGM by MDS was in good agreement with quantitative analysis. EGM and whole mouth test seem to reflect different aspects of taste. However, when interpreting the EGM results, the EGM threshold of the CT area will show more similarity to the recognition threshold than the detection threshold for the whole mouth test.

Clinical, virological and immunological evolution of the olfactory and gustatory dysfunction in COVID-19

PURPOSE

New-onset olfactory and gustatory dysfunction (OGD) represents a well-acknowledged COVID-19 red flag. Nevertheless, its clinical, virological and serological features are still a matter of debate.

MATERIALS AND METHODS

For this cohort study, 170 consecutive subjects with new-onset OGD were consecutively recruited. Otolaryngological examination, OGD subjective grading, nasopharyngeal swabs (NS) for SARS-CoV-2 RNA detection and serum samples (SS) collection for SARS-CoV-2 IgG quantification were conducted at baseline and after one (T1), two (T2) and four weeks (T3).

RESULTS

SARS-CoV-2 infection was confirmed in 79% of patients. Specifically, 43% of positive patients were detected only by SS analysis. The OGD was the only clinical complaint in 10% of cases. Concurrent sinonasal symptoms were reported by 45% of patients. Subjective improvement at T3 was reported by 97% of patients, with 40% recovering completely. Hormonal disorders and RNA detectability in NS were the only variables associated with OGD severity. Recovery rate was higher in case of seasonal influenza vaccination, lower in patients with systemic involvement and severe OGD. Not RNA levels nor IgG titers were correlated with recovery.

CONCLUSION

Clinical, virological and serological features of COVID-19 related OGD were monitored longitudinally, offering valuable hints for future research on the relationship between host characteristics and chemosensory dysfunctions.

Assessment of Taste Function

Taste disorders, impacting well-being and physical health, can be caused by many etiologies including the use of medication. Recently, taste disturbance is also considered as one of the predominant symptoms of COVID-19 although its pathogenesis requires further research. Localized taste disorders may be overlooked considering that whole-mouth taste perception is insured through several mechanisms. Individuals often fail to discern taste from flavor, and interviews/surveys are insufficient to properly assess taste function. Hence, various taste assessment methods have been developed. Among them, psychophysical methods are most widely applied in a clinical context. Less-biased electrophysiological, imaging, or morphological methods are used to a much lesser degree. Overall, more research is needed in the field of taste.

Measurement of chemosensory function

Although hundreds of thousands of patients seek medical help annually for disorders of taste and smell, relatively few medical practitioners quantitatively test their patients' chemosensory function, taking their complaints at face value. This is clearly not the approach paid to patients complaining of visual, hearing, or balance problems. Accurate chemosensory testing is essential to establish the nature, degree, and veracity of a patient's complaint, as well as to aid in counseling and in monitoring the effectiveness of treatment strategies and decisions. In many cases, patients perseverate on chemosensory loss that objective assessment demonstrates has resolved. In other cases, patients are malingering. Olfactory testing is critical for not only establishing the validity and degree of the chemosensory dysfunction, but for helping patients place their dysfunction into perspective relative to the function of their peer group. It is well established, for example, that olfactory dysfunction is the rule, rather than the exception, in members of the older population. Moreover, it is now apparent that such dysfunction can be an early sign of neurodegenerative diseases such as Alzheimer's and Parkinson's. Importantly, older anosmics are three times more likely to die over the course of an ensuring five-year period than their normosmic peers, a situation that may be averted in some cases by appropriate nutritional and safety counseling. This review provides the clinician, as well as the academic and industrial researcher, with an overview of the available means for accurately assessing smell and taste function, including up-to-date information and normative data for advances in this field.

Role of obesity in otitis media in children

The ongoing childhood obesity epidemic has garnered significant attention among healthcare providers due to its short- and long-term sequelae. Multiple diseases have been associated with obesity, not limited to hypertension, diabetes, and attention deficit hyperactivity disorder. Over the past decade, the relationships between obesity and otologic conditions have been investigated. In this setting, otitis media has remained the focus of research, representing one of the most common pediatric illnesses. Initial studies suggesting a relationship between the two conditions have been supported with epidemiological studies controlling for socioeconomic factors. The purpose of this article is to review our current understanding of the relationship between otitis media and obesity and to discuss the healthcare implications of this association. In addition, several identifiable factors associated with each condition are discussed, as are potential pathophysiologic mechanisms that may help to elucidate the complex and multifactorial relationship between the two disease entities.

Oral complications of cancer and cancer therapy: from cancer treatment to survivorship

Answer questions and earn CME/CNE Oral complications resulting from cancer and cancer therapies cause acute and late toxicities that may be underreported, underrecognized, and undertreated. Recent advances in cancer treatment have led to changes in the incidence, nature, and severity of oral complications. As the number of survivors increases, it is becoming increasingly recognized that the aggressive management of oral toxicities is needed to ensure optimal long-term oral health and general well-being. Advances in care have had an impact on previously recognized oral complications and are leading to newly recognized adverse effects. Here, the authors briefly review advances in cancer therapy, including recent advances in surgery, oral care, radiation therapy, hematopoietic cell transplantation, and medical oncology; describe how these advances affect oral health; and discuss the frequent and/or severe oral health complications associated with cancer and cancer treatment and their effect upon long-term health. Although some of the acute oral toxicities of cancer therapies may be reduced, they remain essentially unavoidable. The significant impact of long-term complications requires increased awareness and recognition to promote prevention and appropriate intervention. It is therefore important for the primary oncologist to be aware of these complications so that appropriate measures can be implemented in a timely manner. Prevention and management is best provided via multidisciplinary health care teams, which must be integrated and communicate effectively in order to provide the best patient care in a coordinated manner at the appropriate time.

Revisão: metodologias para análise da sensibilidade gustativa ao sal

A avaliação da sensibilidade gustativa ao sal é utilizada na área da saúde, bem como em análise sensorial aplicada à Ciência e Tecnologia de Alimentos, para avaliar o paladar e identificar ageusia e hipoageusia de diversas origens; notavelmente, identifica os indivíduos que apresentam risco ou consumo excessivo de sal. A adoção de um método acurado e reprodutível para avaliação do limiar gustativo ao sal permite seu uso de forma ampliada. Esta revisão integrativa tem como objetivo descrever as metodologias empregadas para avaliar o limiar de detecção e reconhecimento do cloreto de sódio. Foram utilizadas as bases de dados CINAHAL, LILACS e MEDLINE, e as palavras-chave taste threshold, sodium chloride e salt. Foram localizados 27 artigos de 1985 a 2009 e, nestes, empregados 29 testes de análise do limiar. A maioria dos artigos utilizou o estímulo da boca toda (75,9%), seguida da aplicação tópica na língua (24,1%), aplicação da solução em partes da língua (10,3%), eletrogustometria (6,4%), disco impregnado (3,4%) e aplicação de vácuo (3,4%). Houve grande variação nos procedimentos metodológicos e, em alguns, ausência de informações importantes. Os artigos não apresentam cálculo do tamanho amostral e os critérios de seleção dos julgadores foram também variados. Assim, existe uma dificuldade para a reprodutibilidade e as comparações dos artigos. Avaliações comparativas entre os diferentes métodos de avaliação do limiar gustativo ao cloreto de sódio quanto à sua reprodutibilidade podem trazer subsídios importantes para a escolha do método mais adequado a ser empregado em pesquisa e na prática clínica.

Time for Taste-A Review of the Early Cerebral Processing of Gustatory Perception

The first successfully recorded event-related potential (ERP) for taste, one of our basic senses, was published nearly half a century ago. Despite this large time span, surprisingly little is known about the early neural processing of taste perception. Here, we are providing a comprehensive and critical overview of over four decades of research, with a focus on the temporal dimension of cerebral taste processing in healthy humans. For this purpose, we review studies using techniques that permit a high temporal resolution, namely, electroencephalography and magnetoencephalography, ERP, and event-related magnetic fields (ERF). Our current knowledge of taste ERP is interpreted in the context of our understanding of other, nonchemical senses. Gaps in the existing literature are identified and discussed. Finally, we suggest directions for future investigations using gustatory ERP/ERF.

Otitis media exposure associates with dietary preference and adiposity: a community-based observational study of at-risk preschoolers

Chronic exposure to otitis media (OM) has been linked to risk of overweight/obesity. Here we tested if dietary behaviors explained some of the OM-adiposity relationship among 485 racially-diverse, low-income preschoolers (253 girls, mean age=45±7 months) enrolled in government-supported urban preschool programs. From measured weight/height, 4% were underweight, 17% were overweight and 13% were obese. OM exposure according to parent report varied across nearly equal quartiles-low (never, once) to high (3-5 times, 6+ times) exposure categories. Boys were more likely to be in the high exposure categories. Parents rated their child's liking/disliking of foods (high-fat/added sugar, fruits/juice, vegetables) and non-food activities. In analysis of covariance (ANCOVA), mean liking for vegetables and fruits/juice fell as OM exposure increased, with significant differences between lowest and highest exposure categories (p<.05). Food neophobic versus non-neophobic preschoolers also liked vegetables and fruits less (p<.001). In a two-way ANCOVA, main effects of OM and food neophobia independently predicted vegetable and fruit liking; preschoolers with more OM exposure and neophobia had the lowest liking. Although ANCOVA failed to reveal OM effects on mean liking for fat/sugar foods, the relative ranking of liking for these foods differed by OM category. Fat/sugar foods were ranked as most preferred for the high OM children, particularly the boys, surpassing the ranking of pleasurable non-food items. Conversely, low OM children ranked pleasurable non-food items and fruits/juice as more pleasurable than high OM children. BMI percentile varied with OM exposure, but not neophobia: preschoolers with the greatest exposure averaged the highest percentiles. In multiple regression analyses, liking for vegetables or fruits failed to associate significantly with BMI percentile. There was a small but significant association between greater fat/sugar liking and higher BMI percentile. Overall these findings confirm associations between high OM exposure and elevated adiposity in preschoolers. They also suggest this relationship is explained through lower affinity for vegetables and fruits and greater affinity for fat/sugar foods.

Evaluation of electrogustometry and the filter paper disc method for taste assessment

CONCLUSION

The results indicate that electrogustometry and the filter paper disc method are reliable methods to measure taste with a high degree of reproducibility.

OBJECTIVES

To thoroughly evaluate the reliability of electrogustometry and the filter paper disc method for taste assessments.

METHODS

Thirty-nine healthy test persons without any history of chronic middle ear disease, aged between 27 and 62 years, were recruited. In all, 772 electrogustometry and 30 filter paper disc assessments were made. A nerve decay test was performed, with measures taken before and after eating sweet, sour, bitter, salt, a mild or spicy meal, after smoking, and after taking Swedish tobacco snuff ('snus'), as well as before and after local anesthesia of the tongue. Measurements were performed on 5 consecutive days and repeatedly during 1 day. The correlation between electrogustometry and the filter paper disc method was also studied.

RESULTS

The results indicate that electrogustometry and the filter paper disc method are reliable methods to measure taste with a high degree of reproducibility. The only actions causing significant changes in the electrogustometry readings were eating a bitter substance and having local anesthesia of the tongue. The correlation between the methods was statistically significant except for the bitter flavor, where the correlation was just below the level of significance.

A basic smell test is as sensitive as a dopamine transporter scan: comparison of olfaction, taste and DaTSCAN in the diagnosis of Parkinson's disease

AIM

To evaluate relationship between odour identification, taste threshold, dopamine transporter scan (DaTSCAN) and motor function in early Parkinson's disease (PD) and their diagnostic accuracy.

METHODS

Seventy-three patients with early parkinsonism were evaluated by the Unified Parkinson's Disease Rating Scale (UPDRS), DaTSCAN, electrogustometry (EGM) threshold and University of Pennsylvania Smell Identification Test (UPSIT). Olfactory Event-Related potentials (OERP) were performed on 49 patients. At follow-up (mean 15.3 months), patients were diagnosed as 'PD' or 'non-PD'. DaTSCAN images were assessed visually and semi-quantitatively by QuantiSPECT.

RESULTS

The sensitivity of UPSIT (86%) was not significantly different from that of the DaTSCAN (92%). UPSIT correlated moderately with DaTSCAN uptake (r = 0.44; P < 0.005) and UPDRS score (r = 0.43; P < 0.05) and weakly with symptom duration (r = 0.25; P < 0.05). In the PD group, OERP showed increased latency but no change in amplitude and no correlation with DaTSCAN. EGM thresholds were impaired in 22% of the PD group but they did not correlate with any other test parameters. DaTSCAN-UPSIT discordance was found in nine patients with PD, but neither was diagnostically superior.

CONCLUSION

Our patients with early PD have a frequent and severe olfactory deficit that correlates with disease severity, symptom duration and DaTSCAN but not EGM. The sensitivities of UPSIT and DaTSCAN are high at 86% and 92%, respectively. Although DaTSCAN is superior for 'localization', UPSIT is considerably 'cheaper', and neither is disease specific. EGM threshold impairment in PD is independent of the smell deficit, and probably signifies advanced disease.

Salt taste inhibition by cathodal current

Effects of cathodal current, which draws cations away from the tongue and drives anions toward the tongue, depend on the ionic content of electrolytes through which the current is passed. To address the role of cations and anions in human salt tastes, cathodal currents of -40 microA to -80 microA were applied to human subjects' tongues through supra-threshold salt solutions. The salts were sodium chloride, sodium bromide, potassium chloride, ammonium chloride, calcium chloride, sodium nitrate, sodium sulfate, sodium saccharin, sodium acetate and sodium benzoate, which taken together encompass salty, bitter, sour and sweet taste qualities. The taste of NaCl, the salty and bitter tastes of the other chloride salts and the taste of NaNO(3) was inhibited, suggesting the current displaced stimulatory cations from salty and bitter receptors. However, bitter tastes of non-halide sodium salts were not inhibited, likely because other bitter receptors respond to anions. A discharge current at cathode-off ubiquitously evoked a metallic taste reminiscent of anodal taste used in clinical electrogustometry. Analogous effects on ambient NaCl responses were recorded from the hamster chorda tympani nerve. Increases in tastes of the saccharin and benzoate anions were not evoked during current flow, suggesting that cathodal current does not carry stimulatory anions to sweet receptors. Cathodal current may selectively inhibit salty and bitter-salty tastes for which proximal stimuli are cations.

The cortical chronometry of electrogustatory event-related potentials

Electrogustometry (EGM) is the standard tool to assess gustatory functions in clinical environments. The stimulation elicits a percept often described as metallic, sour or salty, also referred to as electric taste. To date, the neuronal mechanisms that underlie electric taste perception are not yet fully understood. Electroencephalographic (EEG) approaches will certainly complement behavioral procedures and, furthermore, extend the understanding of gustatory processing in general and disturbances of gustatory functions in particular. We used anodal pulses applied to the tip of the participants' tongue while EEG was recorded. The major disadvantage of combining EEG and EGM, namely the electrical stimulation artifact, was overcome by means of Independent Component Analysis (ICA), which separated the EGM artifact from the neural portion of the EEG. After artifact correction, we found a largely uncontaminated electrogustatory event-related potential (eGERP) at both individual and group level. Furthermore, source analysis revealed an early involvement of bilateral insular cortices and the adjacent operculi, the areas comprising the primary taste cortex. The procedures, described in detail, pave the way for the eGERP to become an affordable and objective tool for the assessment of taste function, and thus to complement behavioral measures (i.e. EGM detection thresholds). Furthermore, they render the access to different levels of the electrogustatory processing pathway possible and by doing so they may aid the identification and localisation of lesions that cause taste disturbances.

Is electrogustometry useful for screening abnormalities of taste?

Background:

Electrogustometry is an accurate and increasingly popular method used to examine taste. However, its usefulness as a screening test is unknown.

Methods:

We asked 114 subjects, some healthy but most with medical conditions possibly affecting taste, to rate their overall taste ability, on a scale of zero to 10. Those who had current symptoms related to taste– and who rated their taste as five or worse – were defined as ‘aberrant tasters’. We recorded automated electrogustometry thresholds, and visual analogue scale intensity ratings, for solutions of the four basic tastes (sweet, sour, salty and bitter). A visual analogue scale score of 50 was used as a cut-off point to identify ‘poor tasters’.

Results:

The sensitivity and specificity of electrogustometry in identifying abnormal taste function were low.

Conclusions:

We conclude that automated electrogustometry is not a useful clinical screening method for taste disturbance in a population such as ours.