Evaluation of Gustatory Function in Patients with Chronic Rhinosinusitis

Chronic rhinosinusitis (CRS) is a chronic inflammatory disease of the mucosa of the nasal cavity and nasal sinuses. Many patients with CRS complain of gustatory dysfunction which affects their quality of life. To assess the gustatory function and acuity in patients with chronic rhinosinusitis using taste strips. This is a case control study carried out at our institute from May 2021 to June 2022 on 63 Patients with chronic rhinosinusitis with nasal polyposis and 63 normal controls. All patients of the study and control group will be subjected to full medical history taking including SNOT-22-Questionnaire, sinuscopic examination, computed tomography scan nose and paranasal sinuses using Lund-Mackay score. Taste strips representing five tastes (sweet, sour, salty, bitter and umami) were used to assess gustatory function in CRS patients and controls. 63 patients with CRS and 63 healthy controls were involved in our study, age 42.05 ± 14 years old for cases and 40.9 ± 13.6 years old for controls. There was a highly significant difference between cases and controls as regard SNOT-22-Questionnaire scores and Meltzer-scores with higher mean scores among cases. There was a highly significant difference between cases and controls as regard Sweet, Salt Sour, Bitter, Umami and Total Taste score, with lower mean scores among cases. This is most evident in bitter taste. There was a significant negative Correlation between each of SNOT-22-Questionnaire score, Meltzer-score and Lund-Mackay score and total taste score. Patients with chronic rhinosinusitis exhibited decreased gustatory function compared to healthy controls. The effect was most pronounced for bitter taste.

Effect of Functional Endoscopic Sinus Surgery on Gustatory Function in Patients With Chronic Rhinosinusitis

OBJECTIVES

In this study, we investigated the effect of functional endoscopic sinus surgery (FESS) on gustatory function in patients with chronic rhinosinusitis (CRS).

METHODS

Forty-three patients with CRS who underwent FESS were included in this study. Prior to FESS and 3 months after surgery, the severity of rhinosinusitis was assessed using the Taiwanese version of the 22-item SNOT (SNOT-22), endoscopic examination, and acoustic rhinometry. The olfactory function was evaluated using the phenylethyl alcohol odor detection threshold test and the traditional Chinese version of the University of Pennsylvania Smell Identification Test, and the gustatory function was evaluated using the whole mouth suprathreshold taste test (WMTT) and the taste quad test (TQT). Subgroup analyses were performed based on CRS phenotypes and endotypes.

RESULTS

The SNOT-22 significantly improved 3 months after FESS for all patients with CRS. The endoscopic score and olfactory function significantly improved in patients with eosinophilic CRS and in patients with nasal polyps (CRSwNP). The WMTT sweet and bitter scores were significantly lower after FESS in CRSwNP, but the TQT sweet score was significantly higher in patients without nasal polyps. In addition, patients with noneosinophilic CRS had significantly decreased WMTT and salty scores 3 months after FESS.

CONCLUSION

Our results showed that the effect of FESS on gustatory function of patients with CRS was different with the different testing procedures, the association with nasal polyps, and the underlying inflammatory patterns.

Chronic Rhinosinusitis: T2r38 Genotyping and Nasal Cytology in Primary Ciliary Dyskinesia

OBJECTIVES

Chronic rhinosinusitis (CRS) is a major hallmark of primary ciliary dyskinesia (PCD). We investigated the possible correlation between some severity markers of CRS and several clinical features of the disease. We further studied the bitter taste receptor TAS2R38 polymorphisms to identify the genotypes associated with more severe disease.

METHODS

We included 39 adult PCD patients with (CRSwNP) and without nasal polyposis (CRSsNP); a sample for nasal cytology was obtained and clinical cytological grading (CCG) was determined. The SNOT-22 and Lund-Mackay scores were recorded. A sample of DNA was extracted from peripheral blood to investigate TAS2R38 polymorphisms.

RESULTS

CRSwNP patients had features of more severe disease: indeed, they had statistically significantly higher frequency of previous sinus surgery, higher SNOT-22, LM scores, and CCG than CRSsNP patients. Upon genotyping of TAS2R38 polymorphisms, we observed that the AVI-AVI genotype, associated to homozygous nonfunctional bitter TAS2R38 receptor, was more prevalent among CRSwNP (100%) than in CRSsNP patients (0%); furthermore, AVI-AVI subjects showed statistically significantly worse SNOT-22 and CCG scores than PAV-PAV and PAV-AVI subjects. The group of AVI-AVI patients also had more frequent respiratory exacerbations, Gram-negative infections, and Pseudomonas aeruginosa colonization than PAV-PAV and PAV-AVI patients.

CONCLUSION

Our findings indicate for the first time that PCD patients with CRSwNP display a more severe disease than those with CRSsNP. Genotyping of TAS2R38 polymorphisms demonstrated that in PCD patients, the AVI-AVI genotype is strikingly more prevalent among CRSwNP than in CRSsNP, while the PAV-PAV genotype might be protective against Gram-negative infections and respiratory exacerbations.

LEVEL OF EVIDENCE

3 Laryngoscope, 133:248-254, 2023.

Gustatory dysfunction perceptions versus objective gustatory dysfunction among older adults

BACKGROUND

Research on gustatory dysfunction among older adults has been scarce relative to research on olfactory dysfunction, and the relationship between subjective and objective gustatory dysfunction has not been studied in detail. We aimed to evaluate whether subjective recognition of gustatory dysfunction correlates with objective diagnosis of gustatory dysfunction among older adults.

METHODS

In this retrospective, cross-sectional study, we reviewed the medical records of 138 patients of ages ≥ 60 years for whom data were available on self-reported and objectively measured gustatory and olfactory function from January 2018 through April 2021 at a specialized smell/taste center of a single institution. We reviewed self-reported and measured outcomes of gustatory and olfactory function using patient data including clinical characteristics, including age, sex, smoking history, and medical history.

RESULTS

We found that the subjective recognition of gustatory dysfunction does not correlate with the objective diagnosis of gustatory dysfunction based on the measured results of gustatory function tests. Subjective gustatory dysfunction, however, was correlated with subjective olfactory dysfunction. Among clinical and demographic characteristics, age and sex were significantly associated with measured gustatory function outcomes.

CONCLUSION

We suggest that subjective gustatory dysfunction underestimates objective dysfunction and recommend that older men with diminished olfactory function undergo gustatory function testing regardless of their self-reported gustatory function status.

Taste receptors in CRS, what is the evidence?: a systematic review

BACKGROUND

Bitter (T2Rs) and sweet (T1Rs) taste receptors are involved in the innate immune response of the sinonasal cavity and associated with chronic rhinosinusitis (CRS). Growing evidence suggests extraoral taste receptors as relevant biomarkers, but current understanding is incomplete. This systematic review synthesizes current evidence of extraoral taste receptors in CRS.

METHODS

PubMed, Embase, Cochrane, Web of Science, and Scopus were reviewed in accordance with Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines and included studies of genotypic and phenotypic T2R/T1R receptor status in CRS patients.

RESULTS

Twenty-two studies with 3,845 patients were included. Seventeen studies evaluated genotype and 10 evaluated taste phenotypes. Four of six studies examining the haplotype distribution of the T2R, TAS2R38, demonstrated increased AVI/AVI haplotype ("non-taster") frequency in CRS. Meanwhile, two studies demonstrated decreased bitter sensitivity in CRS with nasal polyposis (CRSwNP) while three other studies reported decreased bitter sensitivity only in CRS without nasal polyposis (CRSsNP). Findings regarding sweet sensitivity were mixed. Three studies with cystic fibrosis patients (n=1,393) were included. Studies investigating the association between clinical outcomes and TAS2R38 alleles were limited, but the nonfunctional combination of AVI/AVI was associated with increased utilization of sinus surgery and, in CRSsNP patients, with poorer improvement of symptoms postoperatively.

CONCLUSIONS

Both genotypic and phenotypic assessments of T2Rs suggest a potential association with CRS, particularly CRSsNP. However, limited evidence and mixed conclusions cloud the role of T2Rs in CRS. Future investigations should aim to increase diverse populations, broaden institutional diversity, examine T1Rs, and utilize uniform assessments. This article is protected by copyright. All rights reserved.

The Etiologies and Considerations of Dysgeusia: A Review of Literature

BACKGROUND

Dysgeusia is a prevalent qualitative gustatory impairment that may affect food intake and quality of life. The facial (VII), glossopharyngeal (IX), and vagus (X) nerves are the three cranial nerves responsible for sensing taste. Typically, dysgeusia is considered a general term for all taste disorders. In addition, dysgeusia may be a symptom of underlying systemic conditions such as diabetes mellitus, chronic kidney disease, respiratory infections, and nutritional deficiencies. Various subjective and objective diagnostic approaches are available to aid clinicians, each with its own set of benefits and drawbacks.

HIGHLIGHTS

Taste impairment can lead to a lack of enjoyment while eating, food aversion, and malnutrition, resulting in a decrease in the quality of life and loss of muscle mass. Therefore, the present review aims to address the probable etiologies, diagnostic aids, and management of dysgeusia. A broad search for studies was conducted using PubMed, Web of Science, Scopus, and Google Scholar. In addition, relevant studies found in the references of the selected articles were also studied.

CONCLUSION

Oral health care providers should be aware of the possible etiologies of dysgeusia, diagnostic tools, and treatment options. Accurate diagnosis of the cause of taste dysfunction has a significant impact on the management of taste impairment.

Smell and Taste Impairment in a Nationwide Sample of US Adults With Chronic Rhinosinusitis Symptoms

Objective

To estimate the prevalence of objectively confirmed olfactory and gustatory dysfunction in US adults reporting chronic rhinosinusitis (CRS) symptoms in a nationally representative database.

Study Design

Cross-sectional epidemiologic analysis.

Setting

Data were analyzed from the smell and taste component of the 2013-2014 NHANES data set (National Health and Nutrition Examination Survey).

Methods

Individuals reporting the presence of ≥2 cardinal CRS symptoms (nasal blockage, sinus pain, discolored mucus, and dysosmia) were identified as patients with a potential diagnosis of CRS. Associations were examined between the presence of CRS symptoms and both self-reported and objectively measured smell and taste.

Results

One-third (33%) of adults who have ≥2 CRS symptoms report subjective olfactory impairment, though only 18% of these adults have quantifiable olfactory dysfunction on objective testing. Of these adults, 27% report subjective taste impairment, but just 17% have quantifiable gustatory dysfunction on objective testing. The presence of ≥2 CRS symptoms was not significantly associated with objective olfactory or gustatory dysfunction, although the individual symptoms of subjective dysosmia and discolored mucus were associated with objectively confirmed olfactory dysfunction.

Conclusion

The prevalence of objective olfactory and gustatory dysfunction was higher among adults reporting the presence of ≥2 CRS symptoms, but the differences were not statistically significant. Specific sinonasal symptoms, including discolored mucus and subjective smell dysfunction, were significantly associated with objective smell impairment.

A Systematic Review and Meta-Analysis of Taste Dysfunction in Chronic Rhinosinusitis

OBJECTIVES

Patients with chronic rhinosinusitis (CRS) often describe alterations in sense of taste. These complaints have historically been attributed to olfactory dysfunction; however, there is evidence of direct, objective, gustatory disturbances in the setting of CRS that are not thoroughly characterized. This study sought to investigate and summarize gustatory dysfunction experienced by patients with CRS.

METHODS

PubMed, EMBASE, Cochrane Library, Web of Science, and Scopus databases were reviewed following PRISMA guidelines. English language, original studies investigating objective taste in adult patients with CRS were included. A meta-analysis with inverse variance, random-effects model was performed.

RESULTS

Of 2750 studies screened, 11 articles with 471 unique patients were included. Patients with CRS exhibit worse gustatory function compared to healthy controls (standardized mean difference 0.94 [95% CI, 0.44-1.45]). Hypogeusia was identified in 32/95 (33.7%) patients from three studies that used methods with a validated definition of hypogeusia. Older age, male gender, and smoking history were associated with taste dysfunction, while objective gustatory and olfactory dysfunction were not correlated. Subjective taste and quality of life measures were also not associated with objective taste. The impact of sinus surgery on objective taste is unclear.

CONCLUSION

Approximately 34% of patients with CRS experience hypogeusia. Neither olfactory function nor subjective taste were associated with objective gustatory function. Given the substantial prevalence of taste dysfunction patients with CRS, there is significant potential for growth in understanding of pathogenesis, impact on quality of life, and potential treatment strategies of taste impairment in the CRS patient population.

LEVEL OF EVIDENCE

1 Laryngoscope, 131:482-489, 2021.

Taste disorder's management: a systematic review

BACKGROUND

Taste disorder is a frequent drug-induced or disease-related oral trouble. Various pharmacological, surgical, or physical treatments have previously been proposed for taste function recovery.

OBJECTIVES

The aim of the present systematic review was to assess the effects of palliative and curative interventions on taste recovery in light of recent literature.

MATERIALS AND METHODS

In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, a search of the literature published up to June 2019 was conducted using MEDLINE via PubMed, EMBASE, and The US National Institutes of Health Trials Register (PROSPERO registration reference: CRD 42019139315). The methodological quality of the included trials was rated with the "Delphi list For Quality Assessment of Randomized Clinical Trials" and the Newcastle-Ottawa scale.

RESULTS

From the 1842 titles first identified, 28 articles met the inclusion criteria. Interventions included zinc (aspartate, sulfate, gluconate, acetate, picolinate, and Polaprezinc®), esomeprazole, L-thyroxin, bethanechol, oral glutamine, delta-9-tetrahydrocannabinol, alpha-lipoic acid, Ginkgo biloba, artificial saliva, pilocarpine, local anesthesia, and improved oral hygiene. The quality of evidence ranged from poor to high.

CONCLUSION

Improving oral hygiene may promote taste ability. Zinc may prevent and alleviate taste disorder in patients undergoing head and neck radiotherapy.

CLINICAL RELEVANCE

The systematic review provided evidence about the clinical efficacy of oral procedures, zinc supplementation, and palliative cares in dysgeusic patients. Further research is needed to find effective treatments with low adverse effects.

Comparison of olfactory and taste functions between eosinophilic and non-eosinophilic chronic rhinosinusitis

OBJECTIVE

Most patients with chronic rhinosinusitis (CRS) complain of olfactory and/or taste dysfunctions. However, olfactory and taste dysfunctions depending on the subtype of CRS, classified as eosinophilic CRS (ECRS) and non-eosinophilic CRS (NCRS), have not been clearly reported. Therefore, the purpose of this study was to investigate the clinical features in olfactory and taste functions according to the subtype classified as ECRS and NCRS.

METHODS

We retrospectively analyzed the electronic medical records of patients who underwent endoscopic sinus surgery and were diagnosed with CRS. The patients were divided into ECRS and NCRS groups, according to their Japanese Epidemiological Survey of Refractory Eosinophilic Chronic Rhinosinusitis (JESREC) scores. We analyzed demographic characteristics, Sino-Nasal Outcome Test findings, Lund-Mackay score, and the results of previously-validated tests, including the Korean Version of Sniffin' Stick test and chemical gustatory function test.

RESULTS

Patients with ECRS and NCRS had decreased olfactory and taste functions compared to the control group. In particular, the olfactory score of ECRS patients was lower than that of NCRS patients (18.1 ± 9.5 vs 23.7 ± 8.5, respectively, p <0.001). On the other hand, taste scores of ECRS patients were not statistically different compared to NCRS patients (19.1 ± 4.7 vs. 18.3 ± 4.7, respectively, p = 0.166). Olfactory score decreased with increase in JESREC score (r=-0.203, p = 0.002), but it had no correlation with taste score (r = 0.072, p = 0.276).

CONCLUSION

We found a difference in olfactory function but no difference in taste function between patients in ECRS and NCRS groups. These results may provide valuable clinical features in terms of olfactory and taste functions according to the subtypes of CRS.

Bitter Taste Perception of the Human Tongue Mediated by Quinine and Caffeine Impregnated Taste Strips

Objectives:

Tests for gustatory function have become increasingly important in diagnosis and treatment of patients with taste disorders. While caffeine and quinine hydrochloride solutions have been used for global testing of bitter perception, only quinine has been used to test regional bitter perception by means of taste strips. The aim of the present study was to validate caffeine impregnated taste strips as an alternative to quinine taste strips for assessment of regional bitter perception.

Methods:

A total of 46 healthy volunteers (mean age/range, 23/19-27 years) were included in this study. Quinine and caffeine impregnated taste strips were pairwise presented at different parts of the tongue. Perceived intensity and hedonic dislike were evaluated using labeled magnitude scales. Additionally, gustatory function was assessed using the taste strips test and overall sense of taste was rated using visual analog scales.

Results:

Assessment of gustatory function demonstrated scores within the normogeusic range in most included subjects (mean/SD, 13.1/2.5). Notably, equally concentrated quinine and caffeine impregnated taste strips placed on different regions of the tongue did not lead to significant differences in perceived intensity or hedonic dislike, whereas quinine and caffeine impregnated taste strips of different concentrations placed on the same region on the tongue led to significant differences of perceived intensity and hedonic dislike. Furthermore, no correlation was found between self-assessment of gustatory function and taste strips scores.

Conclusion:

Caffeine seems to be a valid bitter compound for regional testing using taste strips and may be used alternatively to quinine.