Evoked taste thresholds in a normal population and the application of electrogustometry to trigeminal nerve disease

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.

The impact of injury of the chorda tympani nerve during primary stapes surgery or cochlear implantation on taste function, quality of life and food preferences: A study protocol for a double-blind prospective prognostic association study

BACKGROUND

The chorda tympani nerve (CTN) is a mixed nerve, which carries sensory and parasympathetic fibres. The sensory component supplies the taste sensation of the anterior two-thirds of the ipsilateral side of the tongue. During middle ear surgery the CTN is exposed and frequently stretched or sacrificed, because it lacks a bony covering as it passes through the middle ear. Injury may cause hypogeusia, ageusia or altered taste sensation of the ipsilateral side of the tongue. To date, there is no consensus regarding which type of CTN injury (sacrificing or stretching), during middle ear surgery, leads to the least burden for the patient.

METHODS

A double-blind prospective prognostic association study was designed in a single medical centre in the Netherlands to determine the effect of CTN injury on postoperative taste disturbance and quality of life. 154 patients, who will undergo primary stapes surgery or cochlear implantation will be included. The taste sensation, food preferences and quality of life of these patients will be evaluated preoperatively and at one week, six weeks and six months postoperatively using the Taste Strip Test, Electrogustometry, supplementary questionnaire on taste disturbance, Macronutrient and Taste Preference Ranking Task, Appetite, Hunger and Sensory Perception questionnaire and Questionnaire of Olfactory Disorders to assess the association of these outcomes with CTN injury. Evaluation of olfactory function will only take place preoperatively and at one week postoperatively using the Sniffin' Sticks. The patient and outcome assessor are blinded to the presence or absence of CTN injury.

DISCUSSION

This study is the first to validate and quantify the effect of chorda tympani nerve injury on taste function. The findings of this study may lead to evidence-based proof of the effect of chorda tympani injury on taste function with consequences for surgical strategies.

TRIAL REGISTRATION

Netherlands Trial Register NL9791. Registered on 10 October 2021.

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.

Psychophysical testing of smell and taste function

The senses of smell and taste are largely underappreciated by laypersons and medical professionals alike. Unlike vision, hearing, balance, and touch, they are rarely evaluated quantitatively in the clinic, even though hundreds of thousands of persons seek medical help annually for disorders of these senses. Chemosensory disorders impact quality of life, including the flavor of foods and beverages, and compromise the ability to detect such environmental hazards as fires, leaking natural gas, and spoiled foodstuffs. Moreover, olfactory dysfunction can be a harbinger for Alzheimer's and other neurodegenerative diseases, and is known to triple the likelihood of mortality in older persons over the course of 4 or 5 years. Without accurate testing, one cannot establish the veracity of a patient's complaint, the probability of malingering, the impact of treatments, and whether the degree of dysfunction is normal relative to a patient's age and sex. This chapter provides basic information as to how to measure both the senses of smell and taste, as well as normative data for several clinical smell and taste tests.

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.

Effect of cigarette smoke on gustatory sensitivity, evaluation of the deficit and of the recovery time-course after smoking cessation

BACKGROUND

Study results have shown that chronic exposure to cigarette smoke affects the taste function in humans. However, neither the quantitative impact on taste sensitivity nor the time-course of taste recovery on stopping smoking have been precisely examined.

METHODS

The experimental design included 2 phases, (i) a case-control phase comparing the taste sensitivity level measured by Electrogustometric (EGM) thresholds from various parts of the tongue (locus) between smokers (n = 83) and non-smokers (n = 48), (ii) a follow-up study looking at the taste sensitivity recovery in smokers after smoking cessation (n = 24) and compared with non-smokers.

RESULTS

Smokers exhibited significantly lower taste sensitivity than non-smokers - the higher the nicotine dependence (Fagerström scores), the lower the taste sensitivity. After smoking cessation, EGM thresholds decreased progressively, and reached the taste sensitivity range of non-smokers depending on locus and time. After 2 weeks a recovery could be observed on the 3 Tip and the 2 edge loci; the recovery in the posterior loci was complete after 9 weeks, and in the dorsal loci recovery was observed only after 2 months or more.

CONCLUSIONS

Smoking cessation does lead to a rapid recovery of taste sensitivity among smokers, with recovery time found to differ based on the sensitivity of loci of the tongue. The use of EGM could potentially be explored as a motivational tool for smoking cessation.

Factors related to taste sensitivity in elderly: cross-sectional findings from SONIC study

The sense of taste is important, as it allows for assessment of nutritional value, as well as safety and quality of foods, with several factors suggested to be associated with taste sensitivity. However, comprehensive variables regarding taste and related factors have not been utilised in previous studies for assessments of sensitivity. In the present study, we performed cross-sectional analyses of taste sensitivity and related factors in geriatric individuals who participated in the SONIC Study. We analysed 2 groups divided by age, 69-71 years (young-old, n = 687) and 79-81 years (old-old, n = 621), and performed a general health assessment, an oral examination and determination of taste sensitivity. Contributing variables were selected by univariate analysis and then subjected to multivariate logistic regression analysis. In both groups, females showed significantly better sensitivity for bitter and sour tastes. Additionally, higher cognitive scores for subjects with a fine taste for salty were commonly seen in both groups, while smoking, drinking, hypertension, number of teeth, stimulated salivary flow salt intake and years of education were also shown to be associated with taste sensitivity. We found gender and cognitive status to be major factors affecting taste sensitivity in geriatric individuals.

Comparison of Taste Threshold in Smokers and Non-Smokers Using Electrogustometry and Fungiform Papillae Count: A Case Control Study

INTRODUCTION

Smoking in long term is not only responsible for cancerous changes but is also one of the reasons of altered taste sensation in smokers. These taste changes are hypothesized to be due to reduction in density of fungiform papillae on the dorsum of the tongue.

AIM

The aim of this study was to assess the relationship between fungiform papillae count, blood Red Cell Distribution Width (RDW) and electrogustometric thresholds in smokers and non-smokers.

MATERIALS AND METHODS

Fungiform papillae count was assessed using digital photography and imaging software while electrogustometric thresholds were assessed using modified Transcutaneous Electric Nerve Stimulation (TENS) machine in 30 smokers and 30 non-smokers. The subjects also underwent RDW evaluation. The data collected was analyzed using Pearson's correlation coefficient.

RESULTS

Fungiform papillae counts in smokers were less than those of non-smokers and an inverse relationship was detected between smoking and fungiform papillae count. Electrogustometric thresholds were more in smokers than non-smokers and showed direct relationship with smoking. RDW was significantly more in smokers compared to non-smokers. An inverse relationship was observed between fungiform papillae count and RDW.

CONCLUSION

Our results suggest that smokers have a high taste threshold because of decrease in the number of fungiform papillae on the tongue and RDW values do show an inverse relationship with fungiform papillae density which depicts subclinical nutritional deficiency bringing atrophic changes in tongue.

Influences of age, tongue region, and chorda tympani nerve sectioning on signal detection measures of lingual taste sensitivity

Although the ability to taste is critical for ingestion, nutrition, and quality of life, a clear understanding of the influences of age, sex, and chorda tympani (CT) resection on taste function in different regions of the anterior tongue is generally lacking. In this study we employed criterion-free signal detection analysis to assess electric and chemical taste function on multiple tongue regions in normal individuals varying in age and sex and in patients with unilateral CT resections. The subjects were 33 healthy volunteers, ranging from 18 to 87 years of age, and 9 persons, 27 to 77 years of age, with unilateral CT lesions. The influences of age, sex, tongue region, and chorda tympani resections on signal detection sensitivity (d') and response bias (β) measures was assessed in 16 tongue regions to weak electric currents and solutions of sucrose, sodium chloride, and caffeine. Significant age-related decrements in d' were found for sucrose (p=0.012), sodium chloride (p=0.002), caffeine (p=0.006), and electric current (EC) (p=0.0001). Significant posterior to anterior, and medial to lateral, gradients of increasing performance were present for most stimuli. β was larger on the anterior than the posterior tongue for the electrical stimulus in the youngest subjects, whereas the opposite was true for sucrose in the oldest subjects. No sex differences were apparent. d' was depressed ipsilateral to the CT lesion side to varying degrees in all tongue regions, with the weakest influences occurring on the medial and anterior tongue. CT did not meaningfully influence β. This study is the first to employ signal detection analysis to assess the regional sensitivity of the tongue to chemical and electrical stimuli. It clearly demonstrates that tongue regions differ from one another in terms of their age-related sensitivity and their susceptibility to CT lesions.

Intraoral electrostimulator for xerostomia relief: a long-term, multicenter, open-label, uncontrolled, clinical trial

OBJECTIVE

A previous sham-controlled multinational study demonstrated the short-term efficacy and safety for xerostomia treatment of an intraoral device that delivers electrostimulation to the lingual nerve. The objective of this study was to test the hypothesis that those beneficial effects would be sustained over an 11-month period.

STUDY DESIGN

The device was tested on a mixed sample of 94 patients with xerostomia in an open-label, uncontrolled, prospective multicenter trial. Statutory outcome assessments were done at 5th, 8th, and 11th months and analyzed by multiple comparisons.

RESULTS

Improvements achieved at month 5 from baseline were sustained throughout the follow-up period for the primary outcome, xerostomia severity, and the secondary outcomes resting whole salivary flow rate, xerostomia frequency, oral discomfort, and difficulties in speech, swallowing, and sleeping. No significant side effects were detected.

CONCLUSIONS

The beneficial effects of a removable intraoral electrostimulating device were sustained for an 11-month period.

Influence of an iron intervention on the zinc status of young adult New Zealand women with mild iron deficiency

Interventions to combat mild Fe deficiency in women of childbearing age may affect Zn nutriture. We used dietary and laboratory indices to assess change in Zn status during a 4-month partially blinded placebo-controlled Fe intervention in women with low Fe stores (serum ferritin < 20 μg/l and Hb ≥ 120 g/l) from Dunedin, New Zealand. Subjects aged 18–40 years were randomly assigned to three groups: dietary advice (diet group; DG;n29), daily Fe supplement with meals (supplement group; SG;n23; 50 mg Fe as amino acid chelate) and placebo (placebo group; PG,n26). A validated semi-quantitative FFQ (SFFQ) was administered at baseline, and at 4, 8 and 15 weeks; fasting morning blood samples were assayed for serum Zn, alkaline phosphatase (ALP) and C-reactive protein at baseline, and at 4, 8, 12 and 16 weeks; hair Zn and taste detection thresholds by electrogustometry were measured at baseline and at 16 weeks. Intakes of flesh foods and vitamin C but not Zn or Fe increased, whereas phytate and phytate:Zn molar ratios decreased (allP ≤ 0·01) in the DG compared with the PG and SG, based on three SFFQ. Serum Zn increased in both the DG and PG (adjusted,P ≤ 0·002), so the between-group difference was not significant; the lack of a parallel rise in the SG was significant when compared with the PG (P = 0·02). ALP activity (but not hair Zn or taste acuity) followed a similar trend. In conclusion, Zn status was not improved compared with placebo by an Fe-based dietary intervention. However, a daily moderate-dose Fe supplement with meals appeared to lower Zn status in these young adult women.

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.

Olfaction and taste processing in autism

BACKGROUND

Autism is often associated with sensory symptoms, but few studies have examined chemosensory functions in this population. We examined olfactory and taste functioning in individuals with autism to characterize chemosensory processing and test competing hypotheses about underlying brainstem versus cortical abnormalities.

METHODS

Twenty-one participants (10-18 years) with autism were compared with 27 well-matched control participants with typical development. Taste identification was tested via sucrose, NaCl, citric acid, and quinine solutions applied to standard locations on the anterior tongue. Taste detection thresholds were established in the same regions with electrogustometry, and olfactory identification was evaluated with "Sniffin' Sticks."

RESULTS

Participants with autism were significantly less accurate than control participants in identifying sour tastes and marginally less accurate for bitter tastes, but they were not different in identifying sweet and salty stimuli. Taste detection thresholds via electrogustometry were equivalent. Olfactory identification was significantly worse among participants with autism.

CONCLUSIONS

True differences exist in taste and olfactory identification in autism. Impairment in taste identification with normal detection thresholds suggests cortical, rather than brainstem dysfunction. Further research is needed to determine the neurologic bases of olfactory and taste impairments, as well as the relationship of chemosensory dysfunction to other characteristics of autism.

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.

Studies on the relationship between electrogustometry and sour taste perception

OBJECTIVE

Electrogustometry is used as a measurement of taste perception. The prevailing theory is that the anodal current delivered to the tongue mucosa stimulates the sour taste receptors, but this is not universally accepted. Our aim was to evaluate to what extent electrogustometry relates to an ability to detect sour taste--rather than sweet, salt, or bitter.

METHODS

We compared automated electrogustometric thresholds with visual analogue scale (VAS) ratings of various tastant solutions in 114 subjects. The whole mouth, and each side of the tongue were tested separately. VAS scores from the strongest set of solutions, and the lowest electrogustometry thresholds for each location were used for statistics.

RESULTS

There was a significant correlation between electrogustometry threshold and the whole mouth perception of the salt taste solution. Electrogustometry correlated significantly but weakly for all taste qualities when testing was confined to left and right oral tongue. The positive predictive values of electrogustometry were no better in relation to sour taste perception than to the other taste qualities.

CONCLUSIONS

Our results do not support the theory that electrogustometry is mediated by sour taste receptors or even that it reflects the sour taste quality. We postulate that electrogustometry measures a function of taste perception, which is different from that induced by chemical stimuli.

Taste deficits related to dental deafferentation: an electrogustometric study in humans

Dental treatments, the prevalence of which increases with age, can cause orofacial somatosensory deficits. In order to examine whether they may also affect taste sensitivity, electrogustometric thresholds were measured at 9 loci on the tongue surface in 391 healthy non-smoking, non-medicated subjects. Results showed that the greater the number of deafferented teeth, the higher the thresholds. Irrespective of age, subjects with more than 7 deafferented teeth exhibited significantly higher thresholds than subjects with fewer than 7 deafferented teeth. Conversely, across age groups, no statistical difference was observed among subjects with no, or few, deafferented teeth. Hence, a taste deficit, which was not correlated to aging, was observed. An association was noticed between the location of taste deficits and the location of deafferented teeth. Higher thresholds at anterior sites, with no possible traumatic injury relationship, suggested that neurophysiological convergence between dental somatosensory and taste pathways - possibly in the nucleus tractus solitarius - could be responsible for these relative decreases of taste sensitivity when dental afferences were lacking. Among trigeminal contributions, lingual nerve and inferior alveolar nerve may synergize taste.

Olfactory threshold increase in trigeminal neuralgia after balloon compression

Idiopathic trigeminal neuralgia (ITN) is a well-known disease often treated with neurosurgical procedures, which may produce sensorial abnormalities, such as numbness, dysesthesia and taste complaints. We studied 12 patients that underwent this technique, in order to verify pain, gustative and olfactory thresholds abnormalities, with a follow-up of 120 days. We compared the patients with a matched control group of 12 patients. Our results found a significant difference in the olfactory threshold at the immediate post-operative period (p=0.048). We concluded that injured trigeminal fibers are probably associated with the increase in the olfactory threshold after the surgery, supporting the sensorial interaction theory.

Electrical Taste Thresholds Established on the Medial Tongue using Two Sizes of Electrodes

OBJECTIVES/HYPOTHESIS

The present study determined whether a 125 mm electrode would produce lower and more reliable electrical taste thresholds than a 25 mm electrode when measurement occurred in a medial tongue region relatively sparse in taste bud numbers. We hypothesized this would be the case and that the obtained threshold values would be higher than those previously reported for anterior and lateral tongue regions.

STUDY DESIGN AND METHODS

Sixteen college-age subjects were tested twice, once using the 25 mm electrode and once using the 125 mm electrode on each of two sessions separated by 2 to 16 days. The order of presentation of the sessions was counterbalanced across subjects. Measurement was confined to the medial tongue, 0.7 cm lateral to the median furrow.

RESULTS

As hypothesized, the larger electrode resulted in lower and more reliable threshold values than the smaller electrode (respective median threshold values = 20.06 microA & 33.59 microA, P = .001; respective test-retest rs = 0.78 [P < .001] and 0.46 [P < .05]). Also as hypothesized, the threshold values were higher (i.e., sensitivity lower) than previously reported for anterior and lateral tongue regions.

CONCLUSIONS

The magnitude and reliability of electrical taste thresholds depends on the tongue region examined and the size of the electrodes used. These results suggest that relatively large electrodes should be considered for electrogustometric threshold testing, particularly when lingual regions not highly populated with taste buds are evaluated.

Clinical and biological features associated with taste loss in internal medicine patients. A cross-sectional study of 100 cases

Which are the main features associated with taste loss in patients exposed to a wide range of drugs and diseases? In 100 consecutive patients admitted to a ward of internal medicine, we assessed taste complaints, performance status, alcohol and tobacco consumptions, diseases, drugs and laboratory data, measuring the electrical taste threshold as primary outcome. After adjusting for age, taste thresholds were not associated with sex, body mass index, tobacco, thrush, drugs, aliageusia and phantogeusia. Features associated with threshold increase included alcohol intake>or=10 gd-1, impaired performance status, complaint of taste loss, atrophic glossitis, cerebral disease, and an erythrocyte mean corpuscular volume. A multivariate analysis identified age, alcohol intake, complaint of loss or altered taste, mean corpuscular volume, and performance status as independent factors associated with taste loss. Inpatients may be screened for taste loss by a few features, to identify those for whom a nutritional intervention should be focused.

To divide or manipulate the chorda tympani in stapedotomy

The objective of this study is to determine the nature, duration and severity of chorda tympani symptoms in post-stapedotomy patients when the nerve has been known to have either sustained surgical manipulation or division. The study design was retrospective and blind, based at a tertiary Otology Referral Center (Gloucestershire Royal Hospital). All successive patients undergoing stapedotomy operated upon by the senior author (JMR) between November 1991 and October 1998 were included. The main outcome measures were postoperative graded dysgeusia (questionnaire) and post operative electrogustometry score, comparing the chorda tympani cut group and the chorda tympani preserved group. Sixty stapedotomies were performed in the study period. After a minimum interval of 8 months, questionnaire data were obtained in 55/60 (92%), and electrogustometry studies were carried out in 48/60 (80%). Symptoms of dysgeusia were experienced in the chorda tympani nerve cut (CC) group in 95% and in the chorda preserved (CP) group in 52%. For those with symptoms, duration was 6.7 months (+/-4.9 SD) and 3.4 months (+/-3.7 SD) for the CC and CP groups, respectively. From the electrogustometry data, after 8 months, the risk of total loss of response is significantly higher in CC patients (94%) than in CP patients (25%) (P = 0.0001). Also at 8 months, 54% of CP patients had normal ipsilateral electrogustometry responses compared with 6% in the CC group. In conclusion, cutting the chorda tympani results in significantly greater symptoms than when subjected to manipulation only, and these symptoms are likely to be more long lasting. Therefore, it is our recommendation that where possible the chorda be preserved. The risk of severe chorda symptoms when the chorda is cut is small (<5%). Preoperative consent to include dysgeusia is advised.

Electrogustometry: strengths, weaknesses, and clinical evidence of stimulus boundaries

Electrogustometry is well established as a clinical tool for the estimation of taste detection thresholds. Nevertheless, the user is sometimes unaware of the impact of superficially minor procedural and psychophysical factors upon the reliability and comparability of threshold estimates. The inherent strengths and limitations of the procedure are outlined, and aspects of the control and specification of the stimulus that moderate threshold measures are discussed. In addition, threshold estimates from two individuals with severe unilateral taste loss are used to illustrate the level at which anodal dc current may elicit common, rather than taste, sensation. Where chorda tympani section is complete and historical (older than 7-14 days), very high stimulus levels, conservatively over 5 micro A/mm2 (100 micro A linear current with a 5-mm diameter electrode), are required to activate trigeminal responses.

Trigeminal modulation of gustatory neurons in the nucleus of the solitary tract

Electrophysiological methods were used to investigate the effects of trigeminal nerve stimulation or transection on responses of single gustatory neurons in the nucleus of the solitary tract (NTS) to tastants (NaCl, sucrose, citric acid, monosodium glutamate) in pentobarbital-anesthetized rats. Unilateral transection of the lingual nerve, or the mandibular branch of the trigeminal nerve, resulted in significant reductions (by 21 and 29%, respectively; P<0.01) in tastant-evoked responses, with no further effect following bilateral transection. Electrical stimulation of the central cut end of the mandibular nerve directly excited nine of 14 gustatory NTS units. For these units, central mandibular stimulation facilitated the tastant-evoked responses in six, depressed responses in three, and had no effect in five. Facilitation of tastant-evoked responses peaked 4 min after mandibular stimulation and recovered within 8 min. Electrical stimulation of the peripheral cut end of the mandibular nerve significantly reduced tastant-evoked responses in nine other NTS units, with a maximal reduction at 4 min post-stimulation followed by recovery. Stimulation of the superior cervical sympathetic ganglion did not affect NTS tastant-evoked responses. These results suggest the presence of complex central modulation of NTS neurons by trigeminal afferents, as well as a peripheral depressant effect on gustatory processing possibly mediated via neuropeptide release from trigeminal nerve endings in the tongue.

Influence of aging on electrogustometry thresholds

Taste thresholds were measured using electrogustometry by the same researcher at three pairs of sites in the mouth (soft palate, tongue tip and tongue base) in both smokers and non-smokers (n = 461; age range 15-94 years). Comparison of the results by decades showed that the threshold increased significantly with age, starting at age 60 for areas innervated by the chorda tympani and glossopharyngeal nerves and at age 70 for areas innervated by the greater petrosal nerve. For the older teenage subjects, females had significantly lower thresholds than males and thresholds for women tended to be lower than those for men at all sites examined. Thresholds for the two sides of the tongue were within approximately 6 dB of each other. Thresholds on the soft palate were consistently higher than those on the tongue tip and tongue base. Little difference was detected between thresholds on the tongue tip and those on the tongue base except in older teenage subjects, in whom thresholds on the tongue tip were significantly lower than those on the tongue base. Male smokers in their 30s and 40s had significantly lower thresholds on the soft palate than non-smokers in this age group.

[Taste disorders]

PURPOSE

This review focuses on the present state of the question about taste disorders with reference to their associated factors, diagnostic methods, and potential effects.

CURRENT KNOWLEDGE AND KEY POINTS

Taste disorders may be induced by many drugs and are associated to a number of acute or chronic diseases. Patients may be asked about their taste complaints, and taste thresholds may be determined by electrogustometry or chemical gustometry. Taste impairment may provide a good indicator to the course of some diseases such as diabetes mellitus in which hypogeusia predicts occurrence of degenerative complications. Dysgeusia may induce nutritional disorders and contribute to wasting in chronic liver disease, cancer, or human immunodeficiency virus infected patients. Mechanisms involved in dysgeusia are more than one in a patient. Taste disturbance may be secondary to a variety of causes that include zinc deficiency, lesions of the lingual epithelium, neurological impairment, and a pharmacological effect.

FUTURE PROSPECTS AND PROJECTS

A better understanding of the transduction mechanisms of the gustatory signal and the main pathogenic factors involved in dysgeusia may possibly improve the follow-up of the concerned patients notably in terms of nutritional status.

Reliability of electrogustometry for the estimation of taste thresholds

Electrogustometry has been used as a clinical tool for diagnosis and assessment of a variety of conditions. Several studies which have estimated electrogustometric taste threshold have reported good test-retest reliability but there is some evidence that thresholds measured this way may decrease with practice. In this study, repeated testing of the right and left sides of the tongue of two subjects over 80 sessions resulted in considerable session-to-session variability for both subjects, and three of the four sets of threshold estimates decreased systematically with continued testing. Two of the four data sets continued to show systematic decreases when the first 10 sessions were omitted from analysis to allow for any initial unfamiliarity with the testing procedure. This suggests that estimates based on few tests should be interpreted with caution, particularly when used for evaluation or monitoring of interventions.

Automated electrogustometry: a new paradigm for the estimation of taste detection thresholds

Electrogustometery, first introduced in the 1950s for the clinical assessment of taste function, has returned to favour in recent years. This is due, in part, to the credence given to the procedure by an increased understanding of the mechanisms of taste transduction. The reliability and validity of electrogustometric assessments of taste function should increase with the use of automated testing. An automated computer-controlled testing paradigm was used to obtain threshold estimates simultaneously from the left and right sides of the tongue in 97 volunteers aged between 17 and 63 years. A small but statistically significant advantage was found for thresholds from the right side of the tongue (P<0.01). The range of thresholds, and of interside differences obtained with this procedure, are reported, and practical issues related to testing are discussed.

The application of d.c. electrical stimulation in evoking and recording gustatory brain potentials

Evidence exists which supports the hypothesis that electrical stimulation of appropriate parameters can fulfil the fundamental requirements for an effective evoked potential taste stimulus. Nevertheless, it had previously been considered that electrical taste stimulation is inadequate for evoking gustatory brain potentials. Consequently, the majority of the earlier attempts to record gustatory evoked potentials (GEPs) reported in the literature have employed chemical stimulus techniques. The design of an electrical taste stimulator and its interface to an evoked potential recording unit is described. The first human brain potentials recorded with this system are presented, among which are those attributable to taste pathway activation. Following future work to unequivocally confirm that taste evoked brain potentials are achievable with this system, it has potential to become a clinically valuable tool.

Chemosensory function and dysfunction

Taste and smell are fundamental sensory systems essential in nutrition and food selection, for the hedonic and sensory experience of food, for efficient metabolism, and, in general, for the maintenance of a good quality of life. The gustatory and olfactory systems demonstrate a diversity of transduction mechanisms, and during the last decade, considerable progress has been made toward our understanding of the basic mechanisms of taste and smell. Understanding normal chemosensory function helps clarify the molecular events that underlie taste and smell disorders. At least 2,000,000 Americans suffer from chemosensory disorders--a number that is likely to grow as the aging segment of the population increases. Smell disorders are more frequent than taste disturbances, due to the vulnerability and anatomical distinctiveness of the olfactory system, and because a decline in olfactory function is part of the normal aging process. Common gustatory and olfactory complaints are due to a number of medications, to upper respiratory infections, to nasal and paranasal sinus diseases, and to damage to peripheral nerves supplying taste and smell. Most chemosensory complaints have an identifiable cause. Although diagnosis of taste and smell disorders has improved considerably over the last two decades, treatment of these disorders is still limited to conditions with discernible and reversible causes. Future research is needed for a better understanding of chemosensory mechanisms, establishing improved diagnostic procedures, and disseminating knowledge on chemosensory disorders among practitioners and the general public.

Electrical taste detection thresholds and chemical smell detection thresholds in patients with cancer

Taste sensation in patients with cancer has previously been studied with the cumbersome method of chemical gustometry, which have produced inconsistent results. In this study taste thresholds were determined with the simple and reliable technique of electrogustometry in 51 patients with cancers of the lung (small cell), ovary or breast, and in 29 matched control patients with nonneoplastic disease. Chemical smell thresholds for phenyl-methyl-ethyl-carbinol were studied in the same group of patients. Electrical taste threshold was higher in patients with cancer compared with control patients (30 [12 to 80] microA versus 9.5 [6.1 to 24] microA; median [interquartile range], P less than 0.001). No differences were seen in smell thresholds. Patients who responded to chemotherapy obtained a decreased electrogustometric threshold at time of reevaluation (24 [8 to 64] microA versus 30 [15 to 90] microA; median [interquartile range], P less than 0.05). These results suggest an effect of the malignant disease itself on taste thresholds.

Paroxysmal kinesigenic choreoathetosis as presenting symptom of multiple sclerosis

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Hemiageusia: an unusual presentation of multiple sclerosis

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A case of childhood Kufs' disease

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The effect of chorda tympani section on ipsilateral and contralateral salivary secretion and taste in man

Bilateral chorda tympani section is an accepted treatment for troublesome sialorrhoea. Nevertheless the effects of this operation have been poorly studied. Twenty patients were studied with unilateral chorda tympani section and a healthy contralateral ear. The effects on ipsilateral and contralateral stimulated submandibular and parotid flow and taste recognition and detection thresholds were measured. Stimulated submandibular flow accounted for only 27% of the total salivary flow. Chorda tympani section had no effect on submandibular flow in seven patients and only reduced submandibular flow by approximately 54% in the remaining 13 patients. No significant effect was observed on ipsilateral parotid flow rate. Electrogustometric taste detection thresholds were more than twice the accepted upper limit of normal on the lesioned side and taste recognition thresholds were also markedly abnormal. Chorda tympani section alone is a poor method of reducing stimulated salivary flow.

The effect of chlorhexidine and benzydamine mouthwashes on mucositis induced by therapeutic irradiation

A variety of mouthwashes are frequently used in the management of irradiation-induced mucositis. Benzydamine has recently been introduced for alleviating this condition. Its efficacy as a mouthwash was compared with chlorhexidine in two groups of patients receiving radiotherapy for oral carcinoma. Mucositis and pain were recorded over a 6 week period and oral carriage of Candida species, coliforms and Staphylococcus aureus was assessed using an oral rinse technique. There was no significant difference in the mucositis scores, overall pain scores or the yeast and bacterial species isolated between the two treatment groups. However, 58% (7 out of 12) and 92% (12 out of 13) patients reported oral discomfort when rinsing the mouth with chlorhexidine and benzydamine, respectively. In both groups, the most common coliform isolated was Klebsiella pneumoniae and the carriage of yeasts was significantly greater than that of coliforms. These results indicate that, although the individual patient acceptance of chlorhexidine is better than benzydamine, there is little difference between the two mouthwashes both in controlling pain and mucositis or in the oral carriage of the micro-organisms studied.