Decreased Taste Sensation Research Articles

Long-COVID in patients with a history of mild or asymptomatic SARS-CoV-2 infection: a Nationwide Cohort Study

Objective Evaluating the prevalence of long-COVID symptoms in patients with a history of mild or asymptomatic infection with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and the factors associated with developing long-COVID. Design A nationwide cohort study. Using a centralized database, we have identified patients with and without a history of SARS-CoV-2 infection 1–6 months before data collection. Patients were asked to fill out an online questionnaire through text messages. Setting Israeli general practice. Subjects 2755 persons participated in the study in September 2021 (a response rate of 7.5%): 819 with and ,936 without a history of SARS-CoV-2 infection. Main outcome measures We asked patients to provide details about their demographic status, medical history, COVID-related variables and the presence of long-COVID symptoms. Results Most prevalent long-COVID symptoms were decreased smell sensation (35.1% vs. 4.3%, p < 0.001), decreased taste sensation (25.2% vs. 3.2%, p < 0.001), memory disturbances (36.9% vs. 14.4%, p < 0.001), dyspnea (24.2% vs. 10.7%, p < 0.001) and arthralgia (33% vs. 16.3%, p < 0.001). Risk factors associated with long-COVID included female gender, symptomatic COVID-19, overweight or obesity and the presence of dyslipidemia. About 34.6% of participants reported not returning to their baseline health condition after the acute illness. Conclusion Long-COVID is frequently seen following a mild symptomatic COVID-19 infection and, to a lesser extent, following an asymptomatic SARS-CoV-2 infection. Primary care physicians should be aware of these symptoms and consider this option in their differential diagnosis. Health policymakers should expect a significant impact of this syndrome on public health. Key Points Long-COVID has emerged as a significant health problem with a serious impact on normal daily function • Long-COVID symptoms were evident in patients with mild symptomatic disease and in asymptomatic patients to a lesser extent. • Risk factors for having Long-COVID symptoms include female gender, symptomatic disease, increased BMI, and the presence of dyslipidemia. • Fatigue, dyspnea, weakness, decreased libido, weight changes, memory, and sleep disturbances were associated with not returning to the baseline health state.

A case of trazodone induced prolonged hypogeusia

IntroductionPlenty of antidepressants have been reported to induce unpleasant tastes and/or odors as well as altered chemosensations when administered alone or in combination with other medications. Trazodone induced hypogeusia (decreased taste sensation) is a rare side effect. In this report, we would like to present a male patient with with hypogeusia after trazodona use and persisting for 3 months after the drug was discontinued will be discussed.ObjectivesA 52-year-old male, Trazodone 50 mg/day was started 4 months ago due to difficulty in falling asleep. On the 25th day of her daily treatment, her sense of taste began to decrease and gradually became more severe. So he stopped his treatment and he applied to the internal medicine and neurology polyclinics. Routine blood tests were within normal limits. To rule out the possibility of covid 19, 2 pcr tests were done and it was found negative. No recommendations other than chewing gum. The patient applied to the psychiatry polyclinic with the complaint of decreased taste sensation that in the 3rd month of his complaints.MethodsCASE REPORTResultsCASE REPORTConclusionsChemosensory side effects due to drugs are frequently seen in the elderly and in polypharmacy. It is usually accompanied by a decrease in salivary secretion. It resolves shortly after the causative drug(s) are stopped. It is important that our patient is middle-aged, does not have additional medical diseases and does not use drugs, and his complaints continue for 3 months after the stopped of Trazodone.DisclosureNo significant relationships.

THE SALTY TASTE THRESHOLD AND TONGUE CLEANING HABITS IN HEALTHY YOUNG ADULT MALE SMOKERS

Introduction: Smoking has adverse effects on the body such as various types of cancer, coronary heart diseases, stroke, peripheral vascular diseases, and oral changes including decreased taste sensation. There have been many studies on the effects of smoking on taste threshold, but specific studies in a group of young adult males and data on the frequency of tongue cleaning habits have not been reported. This study aims to determine the salty taste threshold and tongue cleaning habits in healthy young adult male smokers. Methods: This study was a descriptive cross-sectional study, and the subjects were taken by consecutive sampling. The criteria for the subjects were healthy males, aged 18-24 years old, who had a habit of smoking 10 cigarettes or more per day and had smoked for more than 1 year. A questionnaire was conducted including data on tongue cleaning habits before measuring the salt taste threshold using various concentrations of sodium chloride solution which are 0,012M, 0,014M, and 0,016M. Introduction: Smoking has adverse effects on the body such as various types of cancer, coronary heart diseases, stroke, peripheral vascular diseases, and oral changes including decreased taste sensation. There have been many studies on the effects of smoking on taste threshold, but specific studies in a group of young adult males and data on the frequency of tongue cleaning habits have not been reported. This study aims to determine the salty taste threshold and tongue cleaning habits in healthy young adult male smokers. Methods: This study was a descriptive cross-sectional study, and the subjects were taken by consecutive sampling. The criteria for the subjects were healthy males, aged 18-24 years old, who had a habit of smoking 10 cigarettes or more per day and had smoked for more than 1 year. A questionnaire was conducted including data on tongue cleaning habits before measuring the salt taste threshold using various concentrations of sodium chloride solution which are 0,012M, 0,014M, and 0,016M. Results: Subjects consisted of 76 healthy young adult male smokers for 3-8 years. There were 39%, 53%, and 8% of subjects with a salty taste threshold at concentration 0.012M, 0.014M and 0.016M respectively. Most subjects had a smoking habit for 4 years (36%), and the tongue cleaning habit was not found in the majority of subjects (46%).Conclusion: Most of the subjects had a salty taste threshold higher than normal and more subjects do not have the habit of cleaning the tongue.

Taste Dysfunction after Tonsillectomy: A Meta-analysis.

We aimed to provide information on the effects of tonsillectomy, in particular, its effects on taste dysfunction; also known as dysgeusia, and provide direction for future research in this area. We independently searched five databases (PubMed, SCOPUS, Embase, the Web of Science, and the Cochrane database) for related studies published as recently as December 2019. From the included studies, we reviewed the findings on tonsillectomy and taste disturbance through the use of a questionnaire, chemogustometry, and electrogustometry. We analyzed other conditions that were measured in these studies that included; postoperative pain intensity and other morbidities (eg, postoperative bleeding, hemostasis, tongue numbness and zinc, copper, and iron hemoglobin levels measured). Postoperative taste disturbance based on questionnaire (VAS) scores at 14 days (SMD = -0.31 [-0.50, -0.12], P value = .0012) tended to decrease significantly in the post-tonsillectomy group compared to the pre-tonsillectomy group. Patients showed significantly decreased taste sensation after tonsillectomy than in the preoperative test. Postoperative electrogusmetry at 7 days (SMD = 0.60 [0.27, 0.94], P = .0004) tended to increase significantly in the post-tonsillectomy group compared to the pre-tonsillectomy group. Tonsillectomy is a commonly performed surgery, and taste disturbance occurs frequently as a post operative effect. Taste dysfunction is important to patients with regard to their quality of life and the overall effects of taste on their day-to-day life. This study can be a useful meta-analysis of dysgeusia in tonsillectomy.

A case report describing a rare presentation of Acute Inflammatory Demyelinating Polyradiculopathy (AIDP)

Background: AIDP (Acute Inflammatory Demyelinating Polyradiculopathy) commonly presents as bilateral lower extremity weakness and areflexia with albuminocytologic dissociation on CSF findings. Sensory symptoms are not prominent presenting features in patients. However, Bulbar and Miller Fisher variants of AIDP are very rare. This case report highlights the unique presentation where unilateral facial nerve palsy along with perioral numbness and decreases taste sensation was the presenting symptom. Case presentation: A 33-year-old male with a past medical history of rhabdomyosarcoma s/p resection who presented with the chief complaint of numbness and dysphagia. He developed left-sided facial droop and decreased taste sensation following an episode of bronchitis six weeks ago. Pertinent positives include mild dysphagia, decreased appetite, congestion and rhinorrhea. Physical exam was not significant except for decreased sensation of the upper and lower left face, decreased sensation of the right lower face, decreased light touch of the right upper extremity, 3+ reflexes of both upper and lower extremities bilaterally. Conclusions: This case report highlights the unique presentation of Bulbar AIDP with some symptoms of Miller Fisher syndrome. Predominant sensory symptoms such as perioral numbness and decreased taste sensation might be the predominant symptoms that bring the patient to attention. Hence, it is imperative to perform a lumbar puncture to support the diagnosis of variant AIDP when prominent sensory symptoms are present.

25. Global Salivary Microbiome Activity In Female Adolescents With Anorexia Nervosa

Alterations in the gastrointestinal (GI) microbiome and gut-brain axis have been demonstrated in a range of neuropsychiatric disorders, likely through gene-environment interactions. Anorexia nervosa (AN) is a life-threatening mental illness with strong genetic underpinnings, and is characterized by dysregulated psychologic, metabolic and weight-regulation processes. The GI microbiome is implicated in many of these processes, affecting weight loss/gain, energy extraction from the diet, and communication with the brain via the gut-brain axis. The oropharynx represents the sole entry-point of the GI tract, lying in close proximity to the brain and cranial nerves. Evidence has shown that the microbial community residing in the oral cavity is a close representation of that in the upper GI tract, suggesting a role for the salivary microbiome as a diagnostic and prognostic tool for diseases affecting the GI tract. The oropharynx may represent a site of AN pathology, e.g. decreased taste sensation. Preliminary research suggests intestinal dysbiosis in AN, but the salivary microbiome has not been investigated. We characterized the salivary microbiome of females (age 11-21 years) with AN restrictive-type at the outset of treatment, in comparison to healthy controls (HC) and patients with anxiety (AX), a common comorbid diagnosis. Morning pre- and post-prandial salivary samples, and AN post-treatment samples, were collected (n=70). RNA sequencing was used to compare differences in taxa activity (at multiple taxonomic ranks), as well as alpha diversity (within sample) and beta diversity (between sample) among AN, AX, and HC groups. For global analysis, microbiome activity differences between groups were evaluated via permutational analysis of variance (PERMANOVA). The Wilcoxon rank sum test was used to identify differential activity of each individual taxon between groups and across pre/post-treatment AN samples. There was a significant difference in the global microbiome activity between AN and HC groups (p=0.004) as reflected by both alpha-diversity and beta-diversity comparisons, indicating salivary dysbiosis in AN. Six genera showed significantly different abundances between AN and HC samples, four of which were more abundant in AN and two of which were less abundant in AN. Rhodobacter, a genus more abundant in AN, includes species which possess an extensive range of metabolic capabilities. Leptospira, also more abundant in AN, is a spirochete bacteria that causes generalized symptoms such as vomiting, jaundice, abdominal pain, and diarrhea. Individual taxa comparisons between AN and AX/HC identified 13 taxa which uniquely characterized AN microbial samples, including enrichment in Proteobacteria and depletion in Firmicutes. Pre- and post-treatment comparison demonstrated a shift in activity of these 13 taxa towards a healthier state after treatment. This study presents evidence of upper GI microbiome dysbiosis in AN, consistent with previous gut microbiome findings. Several of the genera differentially expressed in AN are implicated in functional pathways that are characteristically dysregulated in the disease state of AN. Additionally, the salivary microbiome appears to improve to a healthier state following treatment. Future directions include uncovering the differential effects of nutrition/weight restoration and psychological improvement.

Association of tongue brushing with the number of fungiform taste buds and taste perception: A preliminary study using confocal laser scanning microscopy in combination with a filter-paper disc method

ObjectiveThe aim of this study was to investigate the association of tongue brushing with the number of fungiform taste buds and taste perception using a confocal laser scanning microscopy in combination with a filter-paper disc method (FPDM). MethodsTwenty-four subjects with or without a habit of tongue brushing (11 males and 13 females, 20–46 years old) participated in this study. Nine of the 24 subjects had no habit of tongue brushing (Group 1, n=9). Fifteen subjects had a habit of tongue brushing, and the brushing regions of the tongue were as follows: central region (Group 2, n=7), or entire region (Group 3, n=8) of the tongue dorsum. Using confocal laser scanning microscopy, the average number of taste buds per fungiform papilla (FP) was counted. Taste perception was evaluated using an FPDM. These observations were performed in the midlateral region of the tongue since the distribution of fungiform papillae is large in the midlateral region compared to that in the central region. ResultsThe subjects in Group 3 showed a significantly decreased number of fungiform taste buds compared to Group 1 and Group 2. Group 3 also showed significantly higher FPDM scores than the other two groups. ConclusionsExcessive tongue brushing of the entire tongue dorsum, including the midlateral region, may have an association with the decreased number of FP and taste buds and decreased taste sensation. To avoid these conditions, instituting proper tongue brushing methods, such as limiting it to the central region of the tongue and using a light touch, is suggested and is important for the subjects who are eager to participate in tongue brushing.

A Very Unusual Cause of Diarrhea in a 60-Year-Old Man

Purpose: A 60-year-old man presented with a nine-month history of diarrhea associated with 40-lb weight loss. He also complained of gradual loss of his nails and hair, burning of the tongue, decreased taste sensation and hyperpigmentation of his skin. He had a screening colonoscopy at the age of 50, which was normal. His laboratory tests were significant for low albumin and hemoglobin. Stool studies were all negative. A CT abdomen showed abnormal thickening of the distal gastric body and antrum. An upper endoscopy revealed diffuse mucosal abnormality characterized by erythema and nodularity in the gastric body and antrum, as well as in the duodenum. A colonoscopy revealed many small-to-medium sized polyps throughout the colon, along with patchy areas of moderately congested and nodular mucosa in the colon and the terminal ileum. Gastric biopsies revealed edema and foveolar hyperplasia suggestive of hyperplastic polyps, but no dysplasia. Random colonic biopsies revealed active focal colitis with multiple fragments of inflammatory polyps. The patient was diagnosed with Cronkhite-Canada syndrome (CCS). He was treated with prednisone and azathioprine with subsequent improvement in symptoms. CCS is an extremely rare non-hereditary disorder characterized by diffuse gastrointestinal polyps, diarrhea, weight loss, onychodystrophy, alopecia, hypoguesia and skin hyperpigmentation. Ever since being first described in 1955, a little over 400 cases have been reported worldwide with the majority of patients being from Japan. The GI tract polyps are of the hamartomas non-neoplastic type. Dysplastic changes can develop in these polyps, and the lifetime colorectal cancer risk is about 25%. Mortality rate, mostly related to the protein-losing enteropathy approaches 50% at 5 years from the time of diagnosis. No specifi c treatment has been standardized, but corticosteroids and azathioprine have been used with good results. Successfully treated patients should clear most of the inflammatory polyps, and any remaining polyps should be resected, as they are more likely to have an adenomatous component. Any dysplastic changes detected may warrant intestinal resection.Figure: Colon polyps.

Safety and treatment patterns of multikinase inhibitors in patients with metastatic renal cell carcinoma at a tertiary oncology center in Italy

BackgroundMultikinase inhibitors (MKIs) sunitinib and sorafenib have become a standard of care for metastatic renal cell carcinoma (mRCC). This study assessed safety and treatment patterns for these agents in a real-world clinical practice setting in Italy.MethodsA retrospective medical record review was performed at a tertiary oncology center in Italy. The study included MKI-naïve non-trial patients ≥18 years old, with a histological diagnosis of mRCC, and who received sunitinib or sorafenib as first MKI during 9/2005-7/2008. Data were collected on adverse events (AEs), treatment modifications (discontinuations, interruptions, dose changes), and reasons for these modifications.Results145 patients were included; 85 received sunitinib and 60 received sorafenib as first-line MKI. Median treatment duration was 6.6 (sunitinib) and 5.8 (sorafenib) months. 97.6% and 70.0% of patients receiving sunitinib and sorafenib, respectively, experienced ≥1 AE; 27.1% and 31.7% had ≥1 grade 3/4 AE. The most common any grade AE for sunitinib was fatigue/asthenia (81.2%), followed by mucositis/stomatitis (58.8%) and decreased taste sensation (42.4%), while for sorafenib this was fatigue/asthenia (43.3%) followed by hand-foot syndrome (38.3%) and diarrhea (31.7%). Treatment discontinuation, interruption, and dose reduction due to AEs occurred in 11.8%, 23.5%, and 30.6%, respectively, of patients receiving sunitinib, and 5.0%, 23.3%, and 36.7%, respectively, of patients receiving sorafenib.ConclusionsIn this retrospective study, most patients experienced ≥1 AE during first-line MKI treatment. AEs were reported frequently and resulted in treatment modifications in 40% of patients receiving sunitinib and 45% of patients receiving sorafenib. These results suggest a need for additional effective and more tolerable treatments for mRCC.

Burning Tongue and Lips

A 64-year-old woman visited one of us (M.T.B.) in the Oral Medicine Practice, Carolinas Medical Center, Charlotte, N.C., with a chief complaint of burning tongue and lips. She reported that she began to experience the sensation of a burning and coated tongue in June 2007. The burning sensation soon included her lips, and her tongue felt like sandpaper. The patient also reported having an abnormal taste but not a decreased taste sensation. Four weeks before she developed the burning sensation, the patient was treated with cephalexin and minocycline for a toe infection and staphylococcal blepharitis. In October 2007, she was treated with clindamycin for a recurrent staphylococcal blepharitis infection. The patient’s physician had treated her for an intraoral fungal infection with clotrimazole troches, fluconazole tablets and itraconazole tablets. She reported that her best response to treatment resulted from using clotrimazole troches, but that a coated tongue always returned when she discontinued use of her medications. She also reported having been treated with dexamethasone elixir, which worsened her condition. The patient’s medical history was significant for anxiety, osteoarthritis and peripheral neuropathy. She was being treated with several medications, including testosterone, progesterone, gabapentin, diclofenac sodium, nortriptyline, alprazolam, glucosamine and chondroitin. She had no known allergies, denied using tobacco or illicit drugs and drank wine occasionally in a social setting. A comprehensive review of systems revealed a woman who was moderately distressed as a result of her oral condition. She denied experiencing fatigue but complained of dry mouth of eight months’ duration and dry eyes of 12 to 15 months’ duration. The patient denied having any other systemic abnormalities. The clinician (M.T.B.) performed an extraoral examination, which revealed bilateral angular cheilitis. The intraoral examination revealed a well-restored dentition and no obvious signs of acute infection. The clinician expressed clear saliva from all four major salivary gland orifices except for the Stensen duct of the left parotid gland. The dorsal surface of the tongue had a generalized white coating with areas of erythema, and the tissues appeared dry (Figure 1). The clinician found no other soft-tissue abnormalities. Burning tongue and lips

A 52-year-old Female with Ramsay Hunt Syndrome

A 52 year-old female with a history of poorly controlled type IIdiabetes and a recent admission of right-sided pre-septal orbitalcellulitis presented with a facial rash and severe ear and eye painfor three days. The patient noted sudden right-sided vision lossand associated right-sided face, ear and eye pain three days prior toadmission. The pain was a 9/10 and was worsening since its onset.Upon questioning she also noted decreased taste sensation. Shedenied tinnitus, vertigo, hearing loss, nausea, vomiting, or fevers.

Taste Change after Middle Ear Surgery

Background and Objectives：During middle ear surgery, surgeons manipulate the chorda tympani nerve (CTN) at various degrees and warn the post-operative taste changes to patients preoperatively. The purpose of this study is to assess how many patients suffer from taste disturbance after surgery and the characteristics of their disease factors and surgical factors in patients complaining of it. In addition, it was designed to evaluate the clinical availability of electrogustometry (EGM)compared with subjective taste symptoms. Subjects and Method：One hundred thirty-one patients underwent middle ear surgery. Patients were divided to three groups, only tympanoplasty, tympano-ossiculoplasty without mastoidectomy and tympanoplasty with mastoidectomy. They were analysed by operative findings of CTN preserved, stretched, cut. The CTN function was measured at one day before surgery and one month after surgery by EGM. Taste questionnaires were given to all patients before and after surgery for one year. The results of EGM and questionnaires were compared with each other. Results：In pre-operative EGM results of unilateral surgery, the lesion side of tongue had more elevated threshold of EGM than the contralateral side. In the post-operative EGM, any statistical factor was not significant and EGM results was not correlated with subjective symptoms. The results of the test questionnaraires was that thirty-three patients (25%) reported taste change. In tympanoplasty-preserved CTN group, more patients suffered from taste change than mastoidedctomy-cut CTN group. Symptoms were decreased taste sensation, dysgeusia, and decreased general sensation of tongue. Subjective recovery time was on the average of 2.7 months (two weeks to one year) after surgery. Conclusion：EGM was not correlated with subjective symptoms after surgery. Iatrogenic CTN injury in advanced middle ear infection may not cause taste disturbance. Surgeons should have efforts to preserve CTN in even mild middle ear diseases. (Korean J Otorhinolaryngol-Head Neck Surg 2009;52:401-6)

Taste dysfunction in vestibular schwannomas

Gustatory dysfunction associated with vestibular schwannomas (VS) is a poorly represented clinical presentation. One hundred and forty-nine cases operated from 1997 to 2005 where at least six-month follow-up was available were included. All patients were tested for taste sensations using four modalities of standard taste solutions. Apart from the taste sensations, any altered or abnormal taste perceptions were recorded both in the preoperative and postoperative period. After applying the exclusion criteria, the taste dysfunction was studied in 142 patients. The evidence of decreased taste sensation was found in 58 (40.8%) patients prior to surgery. Preoperatively, taste disturbance was found in 29 (37.2%) giant, 28 (45.9%) large and one (33.3%) medium-sized tumors, respectively. There were no significant age or sex-related differences. The postoperative taste disturbances were found in 65 (45.8%) patients. Among patients with anatomically preserved facial nerve, postoperative taste disturbances were found in 55 (42.3%) patients whereas nine (6.9%) patients reported improvement in taste sensations. Taste dysfunction is common following vestibular schwannoma surgery. Patient counseling prior to surgery is necessary to avoid any distress caused by taste dysfunction. Taste dysfunction should be included in the facial nerve functional grading system while assessing outcome.

Objective Assessment of Terbinafine‐Induced Taste Loss

Terbinafine (Lamisil), a widely prescribed oral antifungal agent, reportedly induces taste loss in 0.6% to 2.8% of those taking the drug. However, many so-called taste problems reflect olfactory problems, and the sole empirical study published on this topic, based on whole-mouth testing of a single subject, found no terbinafine-related deficit. In this study, we quantitatively assessed, using well-validated taste and smell tests, chemosensory function in six patients complaining of taste disturbance after terbinafine treatment and compared their test scores to those of six age-, race-, and sex-matched normal controls. Taste function was measured using a 96-trial regional test that assesses sweet, sour, bitter, and salty taste perception within the anterior (cranial nerve [CN] VII) and posterior (CN IX) lingual taste bud fields. Smell function was bilaterally evaluated using the 40-item University of Pennsylvania Smell Identification Test. Taste function for sweet-, sour-, and bitter-tasting stimuli was significantly depressed in both the anterior and posterior lingual regions. For sodium chloride, the decrements were confined to the posterior region. Olfactory function was within normal limits. These findings 1) support anecdotal case reports of taste loss after terbinafine use, 2) demonstrate that all four major taste qualities are affected, and 3) suggest that olfactory dysfunction is not involved. Because self-report markedly underestimates chemosensory deficits, more extensive quantitative testing of patients receiving terbinafine will likely reveal a much higher prevalence of terbinafine-induced taste loss than currently reported. Since being older than 65 years of age and having a low body mass index are reportedly risk factors for terbinafine-induced taste loss, physicians should be particularly on the alert for elderly persons taking this medication who may become depressed or alter their food intake in response to decreased taste sensation.

American Gastroenterological Association Future Trends Committee Report: Effects of Aging of the Population on Gastroenterology Practice, Education, and Research

American Gastroenterological Association Future Trends Committee Report: Effects of Aging of the Population on Gastroenterology Practice, Education, and Research

Long-term survival and functional quality of life assessments in patients with locally advanced unresectable squamous cell carcinomas of the head and neck treated with concurrent chemoradiation

Concurrent chemotherapy and radiation has been shown to be effective treatment for unresectable squamous cell carcinomas of the head and neck (SCCHN). While initial data has been encouraging, few studies have reported 5-year survival in conjunction with patient-assessed functional quality of life (QOL) outcomes. This report details the long-term survival and laryngeal/pharyngeal functional outcome of a phase II trial evaluating the combination of weekly carboplatin (CBDCA), paclitaxel, and daily radiation for patients with locally advanced unresectable disease. From 1993–1998, 62 patients with Stage III-IV SCCHN were prospectively treated with RT to 70.2 Gy at 1.8 Gy/fraction/day with weekly chemotherapy consisting of paclitaxel (45 mg/m(2)/wk) and carboplatin (100 mg/m(2)/wk). All patients presented with locally advanced disease (93% Stage IV); 77% had T4 disease and 21% had T3 disease. Fifty-eight percent had N2b-N3 disease. Sixty patients were evaluated for response and survival with a mean follow-up of 52 months (range 2–119). In March 2004, long-term functional and symptom-related quality of life analysis was performed in surviving patients using the Quality of Life-Radiation Therapy Instrument HeadsNeck Module (QOL-RTI/H&N). This questionnaire assesses pain, appearance, speech, chewing and swallowing, mucous and saliva, taste, and cough on a 0–10 Likert type scale, with a QOL score (QS) of 10 representing the highest perceived toxicity. Ninety-eight percent of patients completed the prescribed therapy. A clinical complete response (CR) at the primary site was obtained in 82%, with a total (primary site and neck) CR rate of 75%. Local-control for the entire cohort at 1 year, 3 years, and 5 years was 76.6%, 66.9% and 62.1% respectively. Overall survival (OS) at 1 year, 3 years, and 5 years was 77.1%, 50.7%, and 38.9% respectively, with a median OS of 37.3 months. Nineteen patients were eligible for QOL analysis, with a mean survival of 75.7 months. The most significant decrement in QOL for surviving patients included a decrease in chewing function, with all cases due to teeth extraction (mean QS 5.91), difficulty swallowing solid foods (mean QS 5.73), thickened saliva (mean QS 5.64), decreased amount of saliva (mean QS 4.82), and decreased taste sensation (mean QS 4.45). Factors that had an intermediate effect on long-term QOL included frequent or severe cough (mean QS 2.00), eating in public (mean QS 2.18), increased mucous production (mean QS 2.27), and difficulty speaking (mean QS 2.82). Long-term QOL factors which were least affected by concurrent chemoradiation include (in descending order): pain in the mouth (mean QS 0.73), cosmesis of face or neck (mean QS 1.27), pain in the throat (mean QS 1.73), swallowing liquids (mean QS 1.82), and eating regular foods (mean QS 1.91). The long term survival analysis of this phase II institutional study supports our contention that weekly carboplatin and paclitaxel with definitive daily external beam radiation therapy provides excellent local control (62%) and improved survival (39%), in patients presenting with locally advanced unresectable SCCHN. In addition, this QOL assessment reveals that surviving patients were most significantly impacted by the long-term effects of xerostomia, and had minimal chronic toxicities related to pain and cosmesis

Index of Suspicion

Index of Suspicion

Altered Food Preference after Cortical Infarction: Korean Style

Background: Altered food preference or preoccupation with certain food after stroke has been rarely described in the literature. Methods: We report four Korean patients who developed altered food preference secondary to unilateral cortical infarction. Results: Two patients showed preoccupation with meat such as Pulgogi or Kalbi (roast beef flavored with ingredients), which had not been their preference prior to the occurrence of stroke. All the patients became intolerant to the smell and taste of mackerel, and two disfavored hot Kimchi (cabbage salted with hot pepper). Quantitative taste assessment done in the patients revealed decreased taste perception in a variable pattern along with dysgeusia. Imaging studies showed that the region commonly involved was the frontal opercular area corresponding to the taste cortex. Conclusion: It is suggested that strokes involving the taste cortex may produce altered food preference associated with decreased taste sensation.

Clinical and physiological investigations in patients with taste abnormality.

The cause of taste abnormality was investigated in 25 patients with decreased taste sensation (hypogeusia group) and 14 patients with abnormal taste sensation (dysgeusia group) by examining taste threshold, salivary flow rate, Candida cell culture, and laboratory examination of peripheral blood. The cause of hypogeusia was identified as iron deficiency in 7 patients, oral candidiasis in 6, hyposalivation (xerostomia) in 6, and psychiatric distress in 3, and could not be determined in 3 (idiopathic). Dysgeusia was associated with psychiatric distress in 8 patients, oral candidiasis in 3, drug medication in 2, and hyposalivation in 1. In the hypogeusia group, the decreased taste sensation generally corresponded with elevated taste thresholds, which decreased along with improvement of the decreased taste sensation in all except the 3 patients with psychiatric etiology and 2 of the 3 patients with idiopathic etiology. In contrast, no elevation or depression of taste thresholds were observed in the dysgeusia group, and the abnormal taste sensation did not disappear in most cases; however, drug-induced dysgeusia improved completely within 2 months after cessation of the drug administration. The serum copper and zinc levels were not decreased in any patient, but a decreased serum iron level was observed in 7 patients. Based on these results, it is concluded that abnormal taste sensation may be induced by many oral and systemic disturbances and that hypogeusia, which may be induced by deficiency of iron but not of zinc or copper, is usually accompanied by elevation of taste thresholds, while dysgeusia is not.