Acute Taste Dysfunction in Oropharyngeal Cancer Patients after Transoral Robotic Surgery

OBJECTIVES

To compare taste changes after transoral robotic surgery (TORS) to taste changes in healthy controls.

METHODS

Oropharyngeal cancer patients receiving TORS and healthy controls were recruited. Participants underwent posterolateral and whole-mouth psychophysical taste testing (identification, intensity, and hedonics) at baseline and at 2 weeks postoperatively (patients) or follow-up (controls). Surgeons reported suspension time and glossopharyngeal nerve injury (GNI) based on the identification and sacrifice of the nerve. A Clinical Global Impression (CGI) of taste symptoms was completed at each session ("My sense of taste bothers me" on a 5-point scale from Never [1] to Always [5]). A taste disorder (TD) was a CGI of 3 (Sometimes) or worse. Within-subject changes in CGI and psychophysical scores were computed. "Worsened taste" was a CGI increase by ≥1 point at follow-up.

RESULTS

Of 69 participants, most (33/37 tumor, 31/32 controls) had normal baseline taste (CGI < 3). 14/33 (42%) TORS patients and no controls developed new TDs at follow-up. More smokers (7/9) had worsened taste than nonsmokers (19/60, difference = 46% [95% CI 16%-76%]). More patients without GNI (6/22) than with GNI (0/15) had postoperative phantogeusia (difference = 27% [95% CI 9-45%]). Tumor-ipsilateral taste identification (TI) decreased more in patients (-11.3%) than controls (0.8%, difference = 12.2% [95% CI 5.0-19.3%]). Suspension time was not associated with worsened taste symptoms or psychophysical changes.

CONCLUSIONS

Patient-reported taste changes after TORS are frequent. Compared to healthy controls, TORS patients have decreased tumor-ipsilateral TI. Suspension time and GNI are unlikely to cause symptomatic TDs. Further investigations of the etiology and long-term symptom burden of TORS-associated TDs will aid in the management of oropharyngeal cancer patients.

LEVEL OF EVIDENCE

3 (non-randomized controlled cohort study) Laryngoscope, 133:3520-3528, 2023.

Inkjet-based surface structuring: amplifying sweetness perception through additive manufacturing in foods

Additive manufacturing (AM) is creating new possibilities for innovative tailoring of food properties through multiscale structuring. This research investigated a high-speed inkjet-based technique aimed to modify sweetness perception by creating dot patterns on chocolate surfaces. The dots were formulated from cocoa butter with emulsified water droplets containing the sweetener thaumatin. The number and surface arrangement of dots, which ranged from uniformly distributed patterns to concentrated configurations at the sample's center and periphery, were varied while maintaining a constant total amount of thaumatin per sample. A sensory panel evaluated sweetness perception at three consumption time points, reporting a significant increase when thaumatin was concentrated on the surface. Specifically, an amplification of sweetness perception by up to 300% was observed, irrespective of dot pattern or consumption time, when compared to samples where thaumatin was uniformly distributed throughout the bulk. However, when thaumatin was concentrated solely at the sample center, maximum sweetness perception decreased by 24%. Conclusively, both the proximity of thaumatin to taste receptors and its spatial distribution, governed by different dot arrangements, significantly influenced taste responsiveness. These findings present a more effective technique to substantially enhance sweetness perception compared to traditional manufacturing techniques. This method concurrently allows for sensorial and visual customization of products. The implications of this study are far-reaching, opening avenues for industrially relevant AM applications, and innovative approaches to study taste formation and perception during oral processing of foods.

Gustatory stimulus interventions for older adults with dysphagia: a scoping review

BACKGROUND

Gustatory stimulus interventions have been shown to improve swallowing function in older adults with dysphagia. However, the optimal intervention strategies as well as their effects and safety remain unclear.

AIMS

To explore current evidence regarding gustatory stimulus interventions for dysphagia in older adults.

METHODS

Nine electronic databases (PubMed, Web of Science, Embase, CINAHL, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, China Science and Technology Journal Database, and Sinomed) were searched from their inception to August 2022.

RESULTS

This review identified 263 articles, and 15 met the inclusion criteria. The types of gustatory stimulus interventions included spicy (n = 10), sour (n = 3), and mixed (sour-sweet) stimuli (n = 2), with most studies focusing on spicy stimuli. The most frequently reported spicy stimulus was capsaicin. Further, the most commonly reported intervention frequency was thrice a day before meals for 1-4 weeks. The stimuli concentrations and dosages could not be standardized due to the among-study heterogeneity. These studies reported 16 assessment tools and 42 outcomes, which mainly included videofluoroscopy and swallowing response time respectively. More than half of the included studies reported no adverse effects of gustatory stimulus interventions.

CONCLUSION AND DISCUSSIONS

Gustatory stimulus interventions improved swallowing function in older adults with dysphagia. However, assessment tools and outcomes for dysphagia should be standardized in the future, and explore personalized interventions based on different diseases and their stages, to determine the most cost-effective interventions, and to prevent its complications.

Tongue papillae density and fat taster status- a cardinal role on sweet and bitter taste perception among Indian population

Obesity is a complex nutritional disorder that may be influenced by calorie intake and eating behaviours. Aside from many studies, the influence of papillae count on obesity is still debated. Despite the multiple variables connected to weight gain and altered taste perception, determining the association between papillae count and taste sensitivity to fat, sweet and bitter tastes, in particular, has recently become a focus of attention. This study aimed to rule out the relationship between the number of papillae on different areas of the tongue and taste sensitivity in people (n = 150) among the various groups depending on their body mass index (BMI) and fat taste sensitivity. The general labelled magnitude scale (gLMS) was used for the taste sensitivity analysis, and participants were asked to rate the intensity of each concentration of the different tastants. Using a digital camera to obtain a picture of the tongue, the density of the papillae on the tongue was counted manually by three different operators. The study reveals that the total papillae density and BMI had a direct negative correlation (r = -0.43), with papillae density (PD) decreasing as BMI increased. Concurrently, persons with higher BMIs had lower papillae distributions (32.38 ± 1.85 PD/cm²) and significantly lower perceptions of the intensity of fat taste. Further examining papillae density in the anterior front part of the tongue, the front-right section, showed significantly higher papillae distribution (74.04 ± 2.11 PD/cm²) than the front-left section. When considering the sensitivity in the tip of the tongue, middle tongue, and whole mouth, high-sensitivity individuals for fat are more sensitive to both sweet and bitter tastes. Overall, the results of this study demonstrated a strong relationship between taste sensitivity in the Indian population, BMI, and tongue papillae density in various regions of the tongue.

The tongue map and the spatial modulation of taste perception

There is undoubtedly a spatial component to our experience of gustatory stimulus qualities such as sweet, bitter, salty, sour, and umami, however its importance is currently unknown. Taste thresholds have been shown to differ at different locations within the oral cavity where gustatory receptors are found. However, the relationship between the stimulation of particular taste receptors and the subjective spatially-localized experience of taste qualities is uncertain. Although the existence of the so-called ‘tongue map’ has long been discredited, the psychophysical evidence clearly demonstrates significant (albeit small) differences in taste sensitivity across the tongue, soft palate, and pharynx (all sites where taste buds have been documented). Biases in the perceived localization of gustatory stimuli have also been reported, often resulting from tactile capture (i.e., a form of crossmodal, or multisensory, interaction). At the same time, varying responses to supratheshold tastants along the tongue's anterior-posterior axis have putatively been linked to the ingestion-ejection response. This narrative review highlights what is currently known concerning the spatial aspects of gustatory perception, considers how such findings might be explained, given the suggested balanced distribution of taste receptors for each basic taste quality where taste papillae are present, and suggests why knowing about such differences may be important.

•

The existence of the tongue map has long been discredited.

•

Taste receptors in the oral cavity respond to all tastes regardless of their location.

•

Human psychophysical data highlights a significant spatial modulation of taste perception in the oral cavity.

•

Highly-controlled studies of taste psychophysics rarely capture the full multisensory experience associated with eating and drinking.

Human Oral Sensitivity to and Taste Modulation by 3-Mercapto-2-Methylpentan-1-ol

Introduction

3-Mercapto-2-methylpentan-1-ol (3 M) is a key onion flavor (aroma), but past sensory work has focused primarily on ortho-nasal presentation. A series of experiments was conducted to characterize human sensitivity to oral 3 M solutions, then determine how 3 M impacts perception of basic tastes.

Methods

Detection thresholds were measured for a food grade, racemic mixture using a forced-choice staircase procedure (n = 19). Recognition was measured by presenting a single stimulus per trial (3 M, vanillin, or water), with "onion," "vanilla," or "water" as responses (n = 18). Supra-threshold intensity (n = 20) was measured for various concentrations using the general labeled magnitude scale (gLMS). Odor-taste interactions were studied using mixtures of 3 M and exemplars of basic tastes. Participants rated the intensity of basic tastes, or both taste and aroma, using the gLMS (n ranged from 10 to 15). All stimuli were in aqueous solution.

Results

Participants detected oral 3 M at about 0.90 ppb and recognized 3 M as "onion" at about 5 ppb. Supra-threshold intensity increased roughly as a cumulative logistic function of concentration. 3 M enhanced the rated savory intensity of monosodium glutamate, but did not enhance the dominant qualities of exemplars of the other four basic tastes. Under a response-context more favorable to an analytic approach, savory enhancement was reduced but not eliminated. Savory enhancement was eliminated with nose-clips.

Conclusions

Oral sensitivity was lower than previous retronasal studies would suggest, but roughly consistent with concentrations in cooked allium varieties. Oral 3 M selectively enhanced savory intensity, an effect likely due to retronasal aroma rather than taste or mouthfeel.

Implication

3 M is a promising candidate aroma to enhance or impart a savory flavor.

Alteration, Reduction and Taste Loss: Main Causes and Potential Implications on Dietary Habits

Our sense of taste arises from the sensory information generated after compounds in the oral cavity and oropharynx activate taste receptor cells situated on taste buds. This produces the perception of sweet, bitter, salty, sour, or umami stimuli, depending on the chemical nature of the tastant. Taste impairments (dysgeusia) are alterations of this normal gustatory functioning that may result in complete taste losses (ageusia), partial reductions (hypogeusia), or over-acuteness of the sense of taste (hypergeusia). Taste impairments are not life-threatening conditions, but they can cause sufficient discomfort and lead to appetite loss and changes in eating habits, with possible effects on health. Determinants of such alterations are multiple and consist of both genetic and environmental factors, including aging, exposure to chemicals, drugs, trauma, high alcohol consumption, cigarette smoking, poor oral health, malnutrition, and viral upper respiratory infections including influenza. Disturbances or loss of smell, taste, and chemesthesis have also emerged as predominant neurological symptoms of infection by the recent Coronavirus disease 2019 (COVID-19), caused by Severe Acute Respiratory Syndrome Coronavirus strain 2 (SARS-CoV-2), as well as by previous both endemic and pandemic coronaviruses such as Middle East Respiratory Syndrome Coronavirus (MERS-CoV) and SARS-CoV. This review is focused on the main causes of alteration, reduction, and loss of taste and their potential repercussion on dietary habits and health, with a special focus on the recently developed hypotheses regarding the mechanisms through which SARS-CoV-2 might alter taste perception.

An alternative pathway for sweet sensation: possible mechanisms and physiological relevance

Sweet substances are detected by taste-bud cells upon binding to the sweet-taste receptor, a T1R2/T1R3 heterodimeric G protein-coupled receptor. In addition, experiments with mouse models lacking the sweet-taste receptor or its downstream signaling components led to the proposal of a parallel "alternative pathway" that may serve as metabolic sensor and energy regulator. Indeed, these mice showed residual nerve responses and behavioral attraction to sugars and oligosaccharides but not to artificial sweeteners. In analogy to pancreatic β cells, such alternative mechanism, to sense glucose in sweet-sensitive taste cells, might involve glucose transporters and K_ATP channels. Their activation may induce depolarization-dependent Ca²⁺ signals and release of GLP-1, which binds to its receptors on intragemmal nerve fibers. Via unknown neuronal and/or endocrine mechanisms, this pathway may contribute to both, behavioral attraction and/or induction of cephalic-phase insulin release upon oral sweet stimulation. Here, we critically review the evidence for a parallel sweet-sensitive pathway, involved signaling mechanisms, neural processing, interactions with endocrine hormonal mechanisms, and its sensitivity to different stimuli. Finally, we propose its physiological role in detecting the energy content of food and preparing for digestion.

Regional Variation of Bitter Taste and Aftertaste in Humans

Despite widespread and persistent myths of a tongue map, all 5 prototypical taste qualities are sensed over the entire tongue. However, modern psychophysical data also suggest there may be more nuanced differences in suprathreshold intensity across oral loci, especially for bitterness. Here, we test whether bitter stimuli matched for whole-mouth intensity differ in perceived intensity across regions of the oral cavity in 2 experiments. Experiment 1 consisted of a whole-mouth sip and spit approach and Experiment 2 consisted of a spatial taste test using cotton swabs. In Experiment 1, participants (n = 63) rated overall intensity of 3 bitter solutions at 5 different loci (front, middle, back of tongue; roof of mouth; and lip). Temporal effects were explored using in-mouth and aftertaste ratings. In Experiment 2, participants (n = 48) rated the intensity of quinine and Tetralone solutions after solutions were painted on fungiform, circumvallate, and foliate papillae with a swab. After the spatial taste test, participants completed a questionnaire on self-reported beer intake. Analysis of variance results of both experiments show a significant locus by stimulus interaction, suggesting different bitterants were perceived differently across the various loci. This result was apparently driven by low-intensity ratings for Tetralone on the anterior tongue. Aftertaste ratings in Experiment 1 also revealed significant temporal effects: ratings on the anterior tongue decreased for all bitterants and ratings for quinine decreased at all loci. Reasons for these effects are not known but may suggest differential expression of bitter taste receptors or differences in bitter agonist-receptor binding affinity across tongue regions.

Development of a Regional Taste Test that uses Edible Circles for Stimulus Delivery

Introduction

Measurements of chemosensory function within specific regions of the tongue can yield important information about the sensitivity of lingual areas to chemosensory stimuli, and may identify possible nerve damage. A novel regional chemosensory test that uses thin edible circles was developed for human testing.

Methods

Edible circles placed at six different regions of the tongue were used to examine regional sensitivity to quinine for bitter taste, NaCl for salt taste, sucralose for sweet taste, and capsaicin for pungency. The six regions included the anterior tip of the tongue, the left and right lateral margins of the tongue (anterior and posterior), and the circumvallate region. Testing was completed with the mouth open, and the mouth closed.

Results

Intensity ratings at all sites were higher in the closed mouth condition for the three taste stimuli. Quinine intensity was highest at the circumvallate region with the mouth closed. NaCl and sucralose intensity were highest at the anterior tip and circumvallate regions. Capsaicin intensity was most highly perceived at the anterior tip of the tongue, but open and closed mouth intensity ratings showed no significant differences.

Conclusions

Regional differences in chemosensory perception were observed on the tongue, and these differences were dependent on the chemosensory stimulus, tongue region, and tasting mode.

Implications

Edible circles show minimal diffusion with saliva, can be used to examine both taste and irritation, and may be used to identify regional papillae counts on the tongue. Finally, edible circles should be invaluable for examining damage to the oral cavity.