Change of the human taste bud volume over time

Relative size of fungiform papillae in patients with neurofibromatosis Type 1

OBJECTIVE

To explore possible manifestations of neurofibromatosis on the tongue, especially, enlarged papillae fungiformes. According to the literature, enlarged fungiform papillae of the tongue are a very common oral finding in patients with Neurofibromatosis Type 1 (NF1).

MATERIALS AND METHODS

Firstly, photos of 18 NF1 patients' tongues, taken at different times were compared to rule of possible fluctuating papillae size. Secondly, 60 photos of 60 patients with NF1 were age/sex matched, blinded and compared to 60 photos of 60 healthy patients. Three independent medical doctors rated the photos in regard of the fungiform papillae as smaller/same/larger at two different times. The inter- and intraindividual results were compared. Thirdly, fungiform papillae of 11 NF1 patients were quantitatively measured using the Denver protocol.

RESULTS

The fungiform papillae showed a stable size. The comparison of the healthy individuals to the NF1 patients suggests that the larger papillae are significantly more frequent in NF1 patients than in age- and gender-matched non-NF1 individuals. The agreement between two ratings of each of the 3 raters at different time points was two moderate and one substantial, the agreement among raters was only fair, since the Fleiss' Kappa value of all 6 ratings was 0.38.

CONCLUSION

Although this study confirms that the evaluation of the size of the fungiform papillae by visual inspection only is very subjective, the fungiform papillae in NF1 patients do seem to be enlarged at a statistically significant level. Nonetheless the statistical difference is not distinctive enough to establish this as a diagnostic tool in diagnosing NF1.

CLINICAL RELEVANCE

Facilitating the diagnosis of NF1 is an important factor in finding the correct treatment for these patients. A clinical inspection of the tongue is a simple and non-invasive procedure. This paper addresses the question if an inspection of the tongue, especially the fungiform papillae is a reliable indicator for the diagnosis of NF1.

How to Manage Taste Disorders

Purpose of the Review

This study aims to summarize the current state of the art of how taste disorders are clinically best managed.

Recent Findings

Taste disorders are distressing for the concerned patients since eating and drinking become bothersome or impossible. Apart from nutritional problems, quality of life is impaired. Still, diagnosis and treatment of taste disorders are elusive, and general knowledge about taste and its affection is little within the population and the medical community. This review stresses the importance of accurate workup and diagnosis of taste disorders in order to offer an effective treatment. Yet unclear aspects of taste disorders are discussed, and interesting findings regarding the treatment of taste disorders are reviewed. A special focus is given to current pharmacological options on how to treat taste disorders.

Summary

Despite impressive insights into the gustatory function and molecular logic of taste receptor cells, there is currently poor clinical knowledge on the pathophysiology of taste disorders in humans. Diagnosing, measuring, and treating gustatory disorders remain restricted to a handful of specialized smell and taste centers worldwide. Despite interesting work on potential drugs treating taste disorders, many of the reported medications lack controlled and randomized trials confirming their efficacy in taste dysfunction. Future efforts need to be focused on the treatment of taste disorders.

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.

Development and validation of a contouring guideline for the taste bud bearing tongue mucosa

PURPOSE

To introduce a contouring guideline for the taste bud bearing tongue mucosa for head and neck cancer patients receiving radiotherapy.

METHODS AND MATERIALS

CT simulation images of oropharyngeal cancer patients were used to delineate both the whole tongue (extrinsic/intrinsic tongue muscles, floor of mouth) and the taste bud bearing tongue mucosa (method A: adaptation of the whole tongue structure; method B: axial adaptation of a mid-sagittal contour). Volumetric and dosimetric parameters of the whole tongue and the two methods of mucosal delineation, spatial overlap between methods A and B, and inter-observer variability for method B were calculated.

RESULTS

The study cohort was comprised of 70 patients with T1-4 N0-1 tonsillar (83%) and base of tongue (17%) cancers. Most of the comparative parameters between the whole tongue and mucosa (method A) significantly differed (mean, minimum, and maximum dose, V5-V70, D40-D90). The mean dose calculated for the whole tongue deviated on average 3.77 Gy compared to method A. No significant differences were found between methods A and B of the taste bud bearing tongue mucosa structure, and none of the dosimetric parameters differed more than 1.03 Gy on average. The mean Dice similarity coefficient for both mucosal structures was 0.79 ± 0.05, and 0.63 ± 0.12 for the inter-observer analysis of method B.

CONCLUSIONS

We defined two methods for delineating the taste bud bearing mucosa and both are equally satisfactory procedures. Either method is preferable over delineation of the whole tongue as organ at risk for taste impairment.

Anatomical stability of human fungiform papillae and relationship with oral perception measured by salivary response and intensity rating

Fungiform papillae house taste buds on the anterior dorsal tongue. Literature is inconclusive as to whether taste perception correlates with fungiform papillae density (FPD). Gustatory reflexes modulate the amount and composition of saliva subsequently produced, and thus may be a more physiologically objective measure of tastant-receptor interactions. Taste perception fluctuates with time but the stability of individual fungiform papillae is unclear. This study followed ten healthy volunteers longitudinally at baseline, one and six months. FPD, diameter and position were measured and participants rated intensity perception of sucrose, caffeine, menthol and capsaicin solutions. Salivary flow rate, protein concentration and relative changes in protein composition were measured following each tastant. FPD, diameter and position were unchanged at six months. FPD did not correlate with intensity rating for any taste. FPD did correlate with changes in salivary protein output following sucrose (ρ = 0.72, p = 0.02) and changes in levels of proline-rich protein and mucin 7 following capsaicin (ρ = 0.71, p = 0.02, ρ = 0.68, p = 0.04, respectively). These results suggest that over six months fungiform papillae are anatomically stable, playing a greater role in mediating the physiological salivary response to stimuli rather than determining the perceived intensity of taste.

Individual Variation in PROP Status, Fungiform Papillae Density, and Responsiveness to Taste Stimuli in a Large Population Sample

Despite considerable research investigating the role of 6-n-propylthiouracil bitterness perception and variation of fungiform papillae density in food perception, this relationship remains controversial as well as the association between the 2 phenotypes. Data from 1119 subjects (38.6% male; 18-60 years) enrolled in the Italian Taste project were analyzed. Responsiveness to the bitterness of 6-n-propylthiouracil was assessed on the general Labeled Magnitude Scale. Fungiform papillae density was determined from manual counting on digital images of the tongue. Solutions of tastes, astringent, and pungent sensations were prepared to be moderate/strong on a general Labeled Magnitude Scale. Four foods had tastants added to produce 4 variations in target sensations from weak to strong (pear juice: citric acid, sourness; chocolate pudding: sucrose, sweetness; bean purée: sodium chloride, saltiness; and tomato juice: capsaicin, pungency). Women gave ratings to 6-n-propylthiouracil and showed fungiform papillae density that was significantly higher than men. Both phenotype markers significantly decreased with age. No significant correlations were found between 6-n-propylthiouracil ratings and fungiform papillae density. Fungiform papillae density variation does not affect perceived intensity of solutions. Responsiveness to 6-n-propylthiouracil positively correlated to perceived intensity of most stimuli in solution. A significant effect of fungiform papillae density on perceived intensity of target sensation in foods was found in a few cases. Responsiveness to 6-n-propylthiouracil positively affected all taste intensities in subjects with low fungiform papillae density whereas there were no significant effects of 6-n-propylthiouracil in those with high fungiform papillae density. These data highlight a complex interplay between 6-n-propylthiouracil status and fungiform papillae density and the need of a critical reconsideration of their role in food perception and acceptability.

Multisensory influence on eating behavior: Hedonic consumption

Research in obesity has traditionally focused on prevention strategies and treatments aimed at changing lifestyle habits. However, recent research suggests that eating behavior is a habit regulated not only by homeostatic mechanisms, but also by the hedonic pathway that controls appetite and satiety processes. Cognitive, emotional, social, economic, and cultural factors, as well as organoleptic properties of food, are basic aspects to consider in order to understand eating behavior and its impact on health. This review presents a multisensory integrative view of food at both the homeostatic and non-homeostatic levels. This information will be of scientific interest to determine behavior drivers leading to overeating and, thus, to propose effective measures, at both the individual and population levels, for the prevention of obesity and associated metabolic diseases.

How taste works: cells, receptors and gustatory perception

The sensitivity of taste in mammals varies due to quantitative and qualitative differences in the structure of the taste perception organs. Gustatory perception is made possible by the peripheral chemosensory organs, i.e., the taste buds, which are distributed in the epithelium of the taste papillae of the palate, tongue, epiglottis, throat and larynx. Each taste bud consists of a community of ~100 cells that process and integrate taste information with metabolic needs. Mammalian taste buds are contained in circumvallate, fungiform and foliate papillae and react to sweet, salty, sour, bitter and umami stimuli. The sensitivity of the taste buds for individual taste stimuli varies extensively and depends on the type of papillae and the part of the oral cavity in which they are located. There are at least three different cell types found in mammalian taste buds: type I cells, receptor (type II) cells and presynaptic (type III) cells. This review focuses on the biophysiological mechanisms of action of the various taste stimuli in humans. Currently, the best-characterized proteins are the receptors (GPCR). In addition, the activation of bitter, sweet and umami tastes are relatively well known, but the activation of salty and sour tastes has yet to be clearly explained.

Smell and taste disorders

Smell and taste disorders can markedly affect the quality of life. In recent years we have become much better in the assessment of the ability to smell and taste. In addition, information is now available to say something about the prognosis of individual patients. With regard to therapy there also seems to be low but steady progress. Of special importance for the treatment is the ability of the olfactory epithelium to regenerate.

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.