Taste Complaints Research Articles

Riser's Reflux: An Eye-Opening Experience

Background: Patients with GERD commonly report waking up in the morning with a sour or bitter taste in their mouth. Presently, it is assumed that these complaints are related to acid reflux that has occurred during sleep. Aim: To compare the prevalence and frequency of acid reflux events prior to and immediately after awakening from sleep using a novel technique that objectively determines sleep period during pH testing without confining patients to a sleep lab. Method: 17 patients (M/F - 8/9, mean age 57.06 ± 16.93yrs, age range 27-81) with heartburn at least 3 times weekly and abnormal pH test were included in this study. All patients were evaluated by demographic and symptom checklist questionnaires. Patients were not receiving antireflux treatment. Patients underwent pH testing concomitantly with actigraphy. The actigraph is a watch-like device worn on the nondominant wrist that records motions with accelerometers that are stored digitally within the device. Actigraphy is a validated technique that determines sleep and awake periods. Novel software (FRIM©) that simultaneously integrates actigraphy and pH raw data matched by time was utilized to determine patients' sleep and awake periods and arousal time. The computer pH data output integrates the old supine and upright analysis and the new sleep and awake analysis for all pH parameters. The presence, frequency, and characteristics of acid reflux events were calculated prior to (up to 1 hour) and immediately after (10 and 20 minutes). None of the subjects had any food consumption during this time period. Results: 47.1% (8/17) of the patients had an acid reflux event within the first 20 minutes of awakening from sleep in the morning. Around awakening (5 minutes prior) and within the first 10 as well as 20 minutes after awakening, patients had a total of 12 and 29 acid reflux events, respectively. The mean number of acid reflux events per patient was 1.2 and 2.9, respectively. The mean duration of these reflux events was 0.8 and 0.79 minutes, respectively. The mean time to first reflux after awakening was 6.55 minutes, with a range of 0.48 minutes to 14.92 minutes. Only 2 (11.8%) of all patients had acid reflux within an hour prior to awakening with a mean duration of 2.37 minutes per event (both P<0.05). Conclusion: Riser's reflux is very common among GERD patients and may explain their complaints of sour or bitter taste in the mouth when rising up in the morning.

Mirtazapine Therapy for Dysgeusia in an Elderly Patient

Mirtazapine Therapy for Dysgeusia in an Elderly Patient

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.

A pilot plant evaluation of the Magnetic Ion EXchange® process for the removal of dissolved organic carbon at Draycote water treatment works

AbstractNatural organic matter (NOM) in water sources is undesirable for customers because it reacts with chlorine to form trihalomethanes (THMs), which can be harmful to health, and other organochlorine compounds that can cause taste complaints. A new Magnetic Ion EXchange process (MIEX® DOC) has been reported as being successful in removing NOM from raw water. The aim of this research was (a) to evaluate the performance of the MIEX® process in removing NOM from hard, lowland water on a pilot plant scale and (b) to compare the performance of the MIEX® process with low pH coagulation DAF, in particular, with respect to reducing THM levels. A 45 and 40% reduction in the amount of NOM and in the levels of THMs, respectively, in chlorine‐dosed water was achieved when the MIEX® process was used with dissolved air flotation (DAF).

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 ≥10 g d −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.

An assessment of the water quality of drinking water in rural districts in Zimbabwe. The case of Gokwe South, Nkayi, Lupane, and Mwenezi districts

Zimbabwe generally receives an average rainfall of 675 mm per annum of which only a maximum of 10% finds its way to rivers as runoff. Gokwe, Nkayi, Lupane and Mwenezi are some of the driest districts in Zimbabwe having mean annual runoffs (MAR) in the range 17–70 mm. River flows especially in Nkayi and Lupane are seasonal and often dry in the period June to November every year. The Kalahari sands predominantly found in such areas as Gokwe, Nkayi, and Lupane promote rapid percolation of rainwater leaving little runoff. The main source of water for domestic purposes in these areas is groundwater with very little reliance on surface water. This study analyzed the water quality of water points in Gokwe South, Nkayi, Lupane, and Mwenezi districts. Parameters analyzed were pH, temperature, dissolved oxygen (DO), turbidity and electrical conductivity (EC). Water quality perceptions from the villagers and the research team were investigated and possible correlations studied. Water quality perceptions included, taste and soap consumption and colour. The uses of the water at domestic level as well as available alternatives to borehole water were investigated. The pH generally ranged from 6.5 to 8.0, which is within the Canadian guidelines. DO was 0.3–5.9 mg/l while turbidity ranged from 0 to 259 NTU with Mwenezi having the highest turbidity value. Conductivity ranged from 70 to 9800 μS/cm with the lowest and highest values recorded in Gokwe and Mwenezi. It was found out that the water quality in terms of taste and odour was 97% satisfactory for Gokwe South, 85% Nkayi, 64% Lupane, and 62% for Mwenezi. High soap consumption which is related to hardness was perceived to be least in Lupane (14%) and highest in Mwenezi with 81%. In general taste complaints also corresponded to high soap consumption but the opposite was not true. It was observed that there was no clear correlation between the quality parameters studied and perceived quality as for example satisfactory taste responses were obtained at EC values higher than the threshold minimum value for objection.

SMELL AND TASTE COMPLAINTS

SMELL AND TASTE COMPLAINTS By Christopher H. Hawkes 2002. New York: Butterworth Heinemann Price $24.99. ISBN 0‐7506‐7287‐0 This is a very neat little book of just over 200 small pages. It is well‐illustrated, with six colour plates, and it is peppered with very helpful tables. Though it deals with a very small area of neurology, it is extremely well written and to the point. In my opinion, it would behove all students and practitioners of neurology, neurosurgery and ENT to spare a couple of hours to read the book from cover to cover. Though patients with specific smell or taste disorders are not that common in day‐to‐day practice, reading this book will undoubtedly assist in their management when they do appear, and it will also serve as a very useful reference book. Some time ago I read Patrick Susskind’s novel Perfume when it first came out. As with most of the people who read it, I …

Managing chloramination - success story for Sydney water

Sydney Water's Woronora Delivery System periodically trialed chloramination over the last three years, with initial trials resulting in nitrification and bacteriological counts. A more planned and structured approach was used in June 2000 to reintroduce chloramination. The aim of the study was to assess the feasibility of chloramination as the preferred method of disinfection for the Woronora system, considering the impact on issues such as trihalomethane (THM) formation, nitrification, compliance performance and residual chlorine management. The implementation of chloramination and the optimisation of system hydraulics have resulted in significant improvements in water quality performance in terms of chlorine residuals, heterotrophic plate counts (HPC20), total and faecal coliforms and disinfection by-products. Higher chlorine residuals were seen throughout the system, taste and odour complaints were reduced to negligible levels, THM levels declined by two-thirds and nitrification was not evident at any stage throughout the trial. A critical control matrix was developed as a vital management tool to address the issues that could impact on chloramination/nitrification in the system. Managing the nitrification balance in terms of the available ammonia and maintaining the chlorine to ammonia ratio close to 4:1 (as Cl2:NH3) within the total system and the maintenance of a higher residual chlorine level (&amp;gt;1.00 mg/L) were found to be the most critical factors in managing a chloraminated system.

Les troubles du goût

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.

Effects on menopausal symptoms and acceptability of isoflavone-containing soy powder dietary supplementation

To assess the acceptability of the delivery of an isoflavone supplementation in the form of a powdered drink, and whether the supplementation of dietary isoflavones in this manner decreased the incidence of menopausal flushes. The secondary aims included assessment of other symptoms or parameters of estrogen deficiency and responses to isoflavones. A randomized, double-blind, placebo-controlled, parallel-group trial comprising 24 postmenopausal women with symptoms of estrogen deficiency was performed over a 12-week period. The women were randomized to receive a dietary beverage containing isoflavones or an isoflavone-free, isocaloric placebo preparation. Although there was a high compliance rate among individual patients, there was a 25% withdrawal rate from the study in the active group. The incidence of complaints of bad taste tended to be higher in the active group (p = 0.07), and the total number of adverse events was significantly higher in this group (p < 0.001). There was no statistically significant difference in the incidence of flushes between the groups. There was no difference between the groups in Greene Menopause Symptom Scores, vaginal maturation value, levels of follicle stimulating hormone (FSH) or sex hormone-binding globulin (SHBG), or bone turnover markers. Powdered energy drinks are not commonly consumed in Australia and were poorly tolerated in this study. The high withdrawal rate and reporting of side-effects suggests that other methods of isoflavone delivery may be more appropriate in this culture, in future trials. At the dose used no benefit was seen in relief from menopausal symptoms, although for the sample size, the study could only have been expected to detect major differences between the groups.

Effects on menopausal symptoms and acceptability of isoflavone-containing soy powder dietary supplementation

Objectives: To assess the acceptability of the delivery of an isoflavone supplementation in the form of a powdered drink, and whether the supplementation of dietary isoflavones in this manner decreasedthe incidence of menopausal flushes. The secondary aims included assessment of other symptoms or parameters of estrogen deficiency and responses to isoflavones.Methods: A randomized, double-blind,placebo-controlled, parallel-group trial comprising 24 postmenopausal women with symptoms of estrogen deficiency was performed over a 12-week period. The women were randomized to receive a dietary beveragecontaining isoflavones or an isoflavone-free, isocaloric placebo preparation.Results: Although there was a high compliance rate among individual patients, there was a 25% withdrawal rate fromthe study in the active group. The incidence of complaints of bad taste tended to be higher in the active group (p = 0.07), and the total number of adverse events was significantly higher in thisgroup (p < 0.001). There was no statistically significant difference in the incidence of flushes between the groups. There was no difference between the groups in Greene Menopause Symptom Scores,vaginal maturation value, levels of follicle stimulating hormone (FSH) or sex hormone-binding globulin (SHBG), or bone turnover markers.Conclusions: Powdered energy drinks are not commonly consumedin Australia and were poorly tolerated in this study. The high withdrawal rate and reporting of side-effects suggests that other methods of isoflavone delivery may be more appropriate in this culture, infuture trials. At the dose used no benefit was seen in relief from menopausal symptoms, although for the sample size, the study could only have been expected to detect major differences between the groups.

Preliminary evidence of toxicity associated with the benthic cyanobacterium Phormidium in South Australia

In April 2000, the water supply for Yorke Peninsula in South Australia was deemed non-potable when extracts from a proliferation of the benthic cyanobacterium Phormidium aff. formosum in Upper Paskeville Reservoir were found to be lethally toxic by intraperitoneal injection into mice (400 mg kg−1). Routine water quality monitoring had failed to detect the development of the Phormidium until complaints of musty taste and odour, attributable to the production of 2-methyl-isoborneol (MIB), were received from the consumers. The 185 ML open-balancing storage, receiving filtered and chloraminated water from the River Murray, was isolated from the drinking water supply and a health alert was issued to approximately 15,000 consumers. The identity of the toxin(s) is thus far unknown, but clinical symptoms of toxicity in mice and chemical characteristics are distinct from the known major cyanotoxins. Preliminary characterisation of this toxin indicates that it has low solubility in water and organic solvents and is strongly associated with the particulate cellular material of the filaments. Toxicity of extracts was diminished by boiling and by treatment with chlorine, but not by chloramines. Further testing of floating cyanobacterial mats in the Torrens Lake in the city of Adelaide (Phormidium aff. formosum) and Myponga Reservoir (Phormidium aff. amoenum) in 2000/2001 was also found to be toxic by mouse bioassay. Toxicity is yet to be confirmed in monospecific cultured strains and further studies are required to identify the toxin and assess its health significance. Genetic characterisation of isolates has commenced in an attempt to classify their relatedness and to assist in the rapid identification of potentially toxic strains. © 2001 John Wiley & Sons, Inc. Environ Toxicol 16: 506–511, 2001

Preliminary evidence of toxicity associated with the benthic cyanobacterium Phormidium in South Australia.

In April 2000, the water supply for Yorke Peninsula in South Australia was deemed non-potable when extracts from a proliferation of the benthic cyanobacterium Phormidium aff. formosum in Upper Paskeville Reservoir were found to be lethally toxic by intraperitoneal injection into mice (400 mg kg-1). Routine water quality monitoring had failed to detect the development of the Phormidium until complaints of musty taste and odour, attributable to the production of 2-methyl-isoborneol (MIB), were received from the consumers. The 185 ML open-balancing storage, receiving filtered and chloraminated water from the River Murray, was isolated from the drinking water supply and a health alert was issued to approximately 15,000 consumers. The identity of the toxin(s) is thus far unknown, but clinical symptoms of toxicity in mice and chemical characteristics are distinct from the known major cyanotoxins. Preliminary characterisation of this toxin indicates that it has low solubility in water and organic solvents and is strongly associated with the particulate cellular material of the filaments. Toxicity of extracts was diminished by boiling and by treatment with chlorine, but not by chloramines. Further testing of floating cyanobacterial mats in the Torrens Lake in the city of Adelaide (Phormidium aff. formosum) and Myponga Reservoir (Phormidium aff. amoenum) in 2000/2001 was also found to be toxic by mouse bioassay. Toxicity is yet to be confirmed in monospecific cultured strains and further studies are required to identify the toxin and assess its health significance. Genetic characterisation of isolates has commenced in an attempt to classify their relatedness and to assist in the rapid identification of potentially toxic strains.

Taste function in patients with oral burning.

Burning mouth syndrome (BMS) is an oral pain disorder occurring primarily in post-menopausal women and is frequently accompanied by taste complaints. This association of symptoms suggests an interaction between the mechanisms of nociception and gustation, two senses with strong hedonic components. Seventy-three patients of the Taste and Smell Clinic at the University of Connecticut Health Center who reported experiencing 'unexplained oral burning' were evaluated for taste function. Both intensity ratings and quality identifications were measured for a concentration series of sucrose ('sweet'), NaCl ('salty'), citric acid ('sour') and quinine-HCl ('bitter'). The 57 women with BMS gave lower intensity ratings to NaCl and sucrose than comparably aged, same sex controls. Concentrations of NaCl and sucrose >0.10 M were most affected; concentrations of sucrose and NaCl <0.10 M were rated similarly by BMS and control women. No intensity differences were found for citric acid or quinine-HCl at any concentration and no differences were evident between the 16 BMS men and the 14 control men for any stimulus. The BMS women also misidentified the quality of 19% of the stimuli that were detected whereas control women misidentified 8%. Both groups detected a similar proportion of stimuli and found lower stimulus concentrations more difficult to identify than higher concentrations. Identification of NaCl as 'salty' and citric acid as 'sour' was particularly difficult for BMS women. The present findings are consistent with the hypothesis that pain pathway activation may affect neural and behavioral taste function.

Effect of antimicrobial and anti-inflammatory medications on the sense of taste

Elderly individuals and HIV-infected patients have a disproportionate number of taste complaints relative to the general population, and these taste alterations are correlated with the use of medications. Clinical reports of taste disorders have been associated with many drugs, including antimicrobial and anti-inflammatory medications. The purpose of this study was to quantify the taste effects of 6 nonsteroidal anti-inflammatory drugs (NSAIDS) and 13 antimicrobial drugs. The six NSAIDS were: diclofenac sodium salt, fenoprofen calcium salt, ibuprofen, ketoprofen, nabumetone, and sulindac. The 13 antimicrobials were: acyclovir, ampicillin, atovaquone, dapsone, enoxacin, ethambutol, lomefloxacin HCl, ofloxacin, pentamidine isethionate, pyrimethamine, sulfamethoxazole, tetracycline HCl, and trimethoprim. These 19 medications were applied topically to the tongues of unmedicated young and elderly volunteers as well as unmedicated HIV-infected patients to measure the direct effect of the drug on taste receptors. Topical application of drugs to the apical tongue surface was used to mimic the situation in which the drug is secreted into the saliva. The main finding was that the taste qualities of these drugs were perceived as predominantly bitter, metallic, and/or sour, although several did not have a taste. Elderly subjects had higher thresholds than young subjects for one-third of the drugs that were tested. Thresholds for HIV-infected patients were statistically equivalent to young controls; however, HIV-infected patients rated the drugs as more intense at four times above the detection threshold than young subjects. Most of these drugs when applied directly to the tongue also modified the taste intensity of other tastants (e.g., NaCl, citric acid).

Effect of Drawdown on Ammonium and Iron Concentrations in a Coastal Mountain Reservoir

Abstract Part way through a year-long water quality field survey, the Capilano Reservoir, located in the Greater Vancouver Water District, was drawn down to accommodate earthquake reinforcement work on the Cleveland Dam. This paper reports observations of the effect of drawdown on water quality in the reservoir, in the context of the original study. The drawdown exposed a large zone of deltaic material through which the Capilano River eroded a path up to 2.5 m deep. The deltaic material contained substantial amounts of nitrogen and iron (TKN, 4,470 mg kg-1; total iron, 21,800 mg kg-1). During drawdown, turbidity in the reservoir increased up to 25 times as compared to prior conditions. Ammonium (NH4+-N) and dissolved and particulate iron concentrations in the drawdown zone were up to two orders of magnitude higher than concentrations upstream. Both NH4+-N and dissolved iron were observed to travel the length of the reservoir. Persistence of NH4+-N in the highly oxygenated conditions may be explained by the presence of factors that inhibit nitrification. Persistence of NH4+-N and particularly dissolved iron may be due to adsorption and com-plexation reactions. Seasonally high concentrations of iron and ammonium at the water intake corresponded to the timing of complaints of taste, odour, turbid water, and staining in the distribution system. Observations made during this extreme drawdown suggest that transport of N and Fe from exposed deltaic sediments may play a role in the periodic increases in ammonium and iron observed in the Capilano Reservoir. Further understanding of the impacts associated with changing reservoir elevation should lead to the development of appropriate management strategies to maintain the high quality of GVWD water.

Taste effects of lingual application of cardiovascular medications

Medications used to treat cardiovascular diseases such as congestive heart failure, high blood pressure, and arrhythmia, are prescribed extensively in Western countries. However, taste complaints are common side effects of many of these cardiovascular medications. Although clinical observations are helpful in determining potential taste problems from a medication, experimental studies are necessary to obtain quantitative data on taste. In the studies performed here, nine cardiovascular medications (labetalol HCl, captopril, diltiazem HCl, enalapril maleate, hydrochlorothiazide, propranolol HCl, mexiletine HCl, procainamide HCl, and propafenone HCl) were applied to the tongue in human volunteers to measure the direct effect of these drugs on taste receptors. The medications were applied topically to the tongue surface of both young and elderly subjects to mimic the situation in which the drug is secreted into the saliva. Detection thresholds ranged from 0.048 mM (propafenone) to 0.438 mM (procainamide). The detection thresholds of healthy elderly subjects did not significantly differ from young controls. The compounds tested had a predominantly bitter taste with other qualities as well. In addition, topical application of the medications to the tongue affected the taste of one or more taste stimuli, with medications differing in the pattern of taste effects exhibited. The mechanism of taste effects is not fully known, but the results of this study suggest one route may be due to medications' effect on peripheral taste receptors.

Effect of protease inhibitors on the sense of taste.

The purpose of this study was to investigate the taste properties of protease inhibitors which are essential components of drug regimes used to treat human immunodeficiency virus (HIV) infection. In this study, the taste properties of four protease inhibitors (indinavir, ritonavir, saquinavir, and nelfinavir) were investigated in unmedicated HIV-infected patients and healthy controls. Three of the four protease inhibitors (indinavir, ritonavir, and saquinavir) were found to be predominantly bitter (with additional qualities of medicinal, metallic, astringent, sour, and burning). Nelfinavir was found to be relatively tasteless. HIV-infected and uninfected control subjects detected protease inhibitors at similar concentrations, but HIV-infected subjects perceived suprathreshold concentrations as more bitter than controls. Detection thresholds ranged from 0.0061 mM for saquinavir in HIV-infected patients to 0.0702 mM for ritonavir in uninfected control subjects. Suprathreshold studies indicated that protease inhibitors modified the taste perception of a variety of other taste compounds. These results are consistent with clinical findings that protease inhibitors produce taste complaints that can impact patient compliance.

Taste and smell complaints in HIV-infected patients.

To define the scope of taste and smell (chemosensory) complaints amongst HIV-infected persons in the study population; to evaluate the clinical factors associated with chemosensory complaints; and to determine the impact of chemosensory complaints on quality of life. Cross-sectional survey. Tertiary care university medical center clinic. A total of 207 HIV-infected patients. Chemosensory complaint score from taste and smell questionnaire and quality of life scores from the Medical Outcomes Study HIV Health Survey (MOS-HIV). A total of 144 patients (70%) reported chemosensory complaints, 91 (44%) reported both taste and smell complaints, 47 (23%) reported only taste complaints, and six (3%) reported only smell complaints. Many patients complained that drugs interfered with their sense of taste, or that medications tasted bad. Higher chemosensory complaint scores were associated with a greater number of medications taken, tobacco use, and hay fever. Patients with chemosensory complaints had significantly lower scores in all domains of the MOS-HIV than those without complaints. Quality of life as measured by the MOS-HIV was lower in patients with chemosensory complaints even after controlling for number of AIDS diagnoses, number of medications, CD4 cell count, and HIV-1 viral load. Chemosensory complaints were common in the patient population and were associated with a poor quality of life. Medications played an important role in chemosensory complaints. Measures to optimize taste and smell function may improve quality of life and medication adherence, and prevent complications such as inadequate oral intake, malnutrition, weight loss, and ultimately wasting.

One‐Stop Shopping for Water Information

This question of the month was sent by the water quality manager at a Florida utility, who said that her utility had received numerous complaints from occupants of a high‐rise building regarding a coppery taste in the building's water. The utility staff speculated that the high‐rise building's copper plumbing needed frequent flushing, but the building manager was unconvinced. The water quality manager wanted to know if anyone on the AWWA staff could offer new suggestions regarding the cause of the taste complaints, or at least provide supporting information that might help convince the building manager of the need for flushing. AWWA staff members responded to the inquiry.