Akihiro Ikui

Taste disorders: a survey of the examination methods and treatments used in Japan

Conclusions. In Japan, the number of patients seeking treatment for taste disorders from otolaryngologists is ≈240 000/year, and this number has almost doubled in the last 13 years. Taste examinations are routinely conducted in almost all university hospitals; testing is not as common in private clinics. Administration of zinc is the main treatment for taste disorders in Japan. Objectives. To investigate the number of patients who visited otolaryngologists for treatment of taste disorders between 2000 and 2002. In addition to determining changes in the number of patients that had occurred in the 13 years since the last study in 1990, the survey also sought to find out what types of taste examination were used to diagnose taste disorders in Japan and what therapies were used to treat them. Material and methods. A questionnaire was mailed to 1559 members of the Japan Society of Stomato-pharyngology. Results. The average number of patients with taste disorders who visited otolaryngological clinics between 2000 and 2002 was 244 858/year. This number is 1.77-fold greater than the number of patients reported by the last study in 1990 (138 575). Electrogustometry was used in 99% of university hospitals and in 20% of private clinics. The filter-paper disk method was also used in 57% of university hospitals and in 27% of private clinics. The main treatment was zinc administration. Most doctors (70%) prescribed polaprezinc, a zinc-containing drug that is used to treat peptic ulcers. Of these doctors, 78% stated that it effectively treated taste disorders and 11% that it did not.

Canal wall down tympanoplasty with canal reconstruction for middle-ear cholesteatoma: post-operative hearing, cholesteatoma recurrence, and status of re-aeration of reconstructed middle-ear cavity.

The post-operative outcome of hearing, the reconstructed external auditory canal, and the state of the reconstructed middle-ear cavity after canal wall down tympanoplasty with canal and attico-antrum reconstruction was studied in 103 ears with middle-ear cholesteatoma. The reconstructed mastoid cavity was re-aerated in 36.5 per cent of the cases, which was significantly lower than for the epitympanum (63.5 per cent) and tympanic cavity (82.4 per cent). Tympanoplasty was successful in terms of hearing results in 68.9 per cent of all subjects and in 75.4 per cent of the ears having a re-aerated tympanic cavity, which was significantly better than the 38.5 per cent for ears in which the tympanic cavity was not re-aerated. The findings of recurrent cholesteatoma, tympanic atelectasis, and tympanic effusion were observed with significantly (p<0.03) high incidence in ears with no re-aerated space in their reconstructed mastoid cavities. It was revealed that the post-operative outcome of this surgical technique was significantly related to the state of re-aeration of the reconstructed middle-ear cavity.

A zinc-containing compound, Polaprezinc, is effective for patients with taste disorders: randomized, double-blind, placebo-controlled, multi-center study.

Conclusions. The effect of a zinc-containing compound, Polaprezinc, was shown to clinically improve the disease conditions of idiopathic taste disorders with no serious side effects in a well controlled double-blinded clinical study. Objectives. The purpose of the present study was to evaluate the efficacy and safety of a zinc-containing compound in the treatment of patients with idiopathic taste disorders, including patients with low serum zinc, by a Good Clinical Practice (GCP)-compliant, randomized, placebo-controlled, double-blind, multi-center clinical study. Subjects and methods. A group of 109 patients suffering from taste disorders was assigned into placebo and three treatment groups. Each group of patients was given either placebo (n=28), or 17 mg (n=27), 34 mg (n=26) or 68 mg (n=28) of oral zinc, Polaprezinc preparations, daily for 12 weeks. Results. The group of patients given 68 mg zinc showed a significant improvement in their gustatory sensitivity compared with the placebo group. The most common side effects observed were increase in serum triglyceride and serum alkaline phosphatase, decrease in serum iron, and some gastrointestinal incidents, although they were not serious.

Immunohistopathological Investigation on Unspecific Chronic Sclerosing Sialadenitis of the Submandibular Gland (Küttner Tumor)

An immunohistochemical investigation was conducted on infiltrating lymphocytes in submandibular glands removed from three cases with unspecific chronic sclerosing sialadenitis of the submandibular gland (unspecific CSSS) which has been described for the first time by Küttner. A high degree of lymphocyte infiltration was recognized and formation of lymphatic follicles was observed. In particular, activated B cells were predominantly observed in that part of the lymphatic follicles which was equivalent to germinal centers. In the T cell subset, the helper/inducer T cells displayed significant dominance over suppressor/cytotoxic T cells, and were distributed in the dark peripheral zone of the follicles. The distribution pattern of these lymphocytes seemed to be similar to antigenically stimulated lymph nodes and it was recognized that the unspecific CSSS could be a site of exceedingly active local immune responses. The authors believe that these findings support the view that unspecific CSSS (Küttner tumor) is an immune disorder.

Causative factors of taste disorders in the elderly, and therapeutic effects of zinc

OBJECTIVES To determine the characteristics of causative factors of taste disorders amongst the elderly, and to examine the therapeutic effect of a zinc agent, taking into account age-related factors. SUBJECTS A total of 408 patients with taste disorders were divided into three groups by age: 49 years or younger, 50 to 64 years old, and 65 years or older. RESULTS The incidence of taste disorders caused by drug administration and systemic disease were significantly higher in the elderly group. A serum zinc concentration of 69 microg/dl or lower was found in 33 per cent of the elderly group, significantly more (p < 0.001) than the 19 per cent of the 49 years or younger group with such a concentration. Zinc administration was therapeutically effective in 70 per cent of the whole population studied, and in 74 per cent of the elderly population. CONCLUSIONS In the elderly, the incidence of taste disorders caused by drug administration or systemic disease was significantly greater compared with other age groups. The curative effects of zinc administration were not observed to be influenced by age.

A Review of Objective Measures of Gustatory Function

Several studies of diagnostic tests of gustatory function have been reported. Results show that none of the subjective tests are satisfactory because they cannot detect psychogenic disease or malingering. Of the objective modalities that have been investigated, gustatory-evoked potential testing has been the most widely studied because it does not require expensive equipment and can be used in multicenter studies. The techniques developed to date for measuring gustatory-evoked potentials are not yet clinically useful for diagnosing taste disorders. Future directions for improving this method of evaluating gustatory function include improving stimulation methods and equipment, in order to obtain better stimulation-related potentials and better means of distinguishing between normal and abnormal gustatory-evoked potential patterns, and applying these new standards to the evaluation of data.

Use of digital subtraction fluoroscopy to diagnose radiolucent aspirated foreign bodies in infants and children

OBJECTIVES Most tracheobronchial foreign bodies in children are radiolucent, and accurate diagnosis of such foreign bodies is not always easy. This can result in delay of diagnosis or misdiagnosis of foreign body aspiration. We report the usefulness and pitfalls of use of digital subtraction fluoroscopy (DSF) to diagnose radiolucent aspirated foreign bodies in infants. METHODS From 1991 through 1999, DSF was conducted for a total of 19 patients (ranged from 11 months to 4 years and 7 months in age (mean 1.8+/-0.9 years)) who were suspected to have radiolucent aspirated foreign bodies. Since DSF revealed abnormal findings in a trachea or main bronchus in 18 cases, inspection was performed for foreign body bronchofiberscopically. In the one remaining case, no abnormality was recognized on DSF, but since the symptoms at the time of onset strongly suggested aspirated foreign body, bronchofiberscopy was also performed. RESULTS Foreign body was verified bronchoscopically in 13 of 19 cases, and all 13 (100%) had abnormal findings on DSF, including obstruction of the trachea in two, obstruction of the bronchial lumen in nine, and indistinct visualization of the bronchial lumen in two. Bronchial stenosis was verified bronchoscopically in five of the remaining six cases, including mucus plug in three, granuloma in one and mucosal edema in one case. All five patients (100%) had abnormal findings on DSF, including obstruction of the bronchial lumen in four and indistinct visualization of the bronchial lumen in one. In the one remaining patient with normal findings of DSF, no foreign body or pathological bronchial changes were noted. CONCLUSIONS DSF was very sensitive in the diagnosis of foreign body aspiration and stenotic changes in the bronchial lumen. However, its diagnostic specificity for aspirated foreign body itself was not high (17%). Therefore, when abnormalities are found on DSF, we recommend to perform flexible bronchofiberscopy initially under general anesthesia via a tracheal tube. When a foreign body is verified, rigid ventilation bronchoscopy is successively performed to retrieve the foreign body.

Gustatory Function of the Soft Palate

Several characteristics of the gustatory function of the soft palate principally elucidated by our own recent investigations, as well of those of others, are described. The soft palate has a gustatory function which is independent of the tongue and is innervated by the greater petrosal nerve. Taste papillae of the soft palate are morphologically similar to the fungiforme papillae which exist on the anterior part of the tongue. In individuals aged , 20 years, gustatory functions of the soft palate, examined by means of the electro-gustatory and filter paper disk tests are as good as those of the tongue innervated by the chorda tympani and glossopharyngeal nerve. In younger individuals, the gustatory function of the soft palate plays as important a role as that of the tongue. Gustatory thresholds of the soft palate, as well as those of other sites innervated by other taste nerves, tend to be elevated with aging, and the degree of elevation in the soft palate is much greater than that of other sites. The most sensitively perceived taste at the soft palate is a sweet taste in the majority of subjects. Taste papillae of the palate in rats become flattened and decrease in number with age. These changes are more prominent in zinc-deficient rats.

Two Cases of Acinic Cell Carcinoma of the Parotid Gland

Acinic cell carcinoma is a rare and low-grade malignant tumor of the parotid gland. We treated two acinic cell carcinomas of the parotid gland, each occurring in a young man (18 and 30 years old, respectively). Based on preoperative examination and MRI findings, we expected to find benign tumors, but they were revealed to be acinic cell carcinomas by the permanent pathological specimens. We performed partial parotidectomy in one case, and subtotal parotidectomy in the other, and preserved the facial nerve in both. There has been no metastasis or recurrence for two years after the operations, but we need to follow both patients for a long time.

Activation of intravascular coagulation in Bell's palsy.

Although the causes of Bell’s palsy are still unknown, it is more or less the unanimous view that ischemic hypothesis and viral hypothesis constitute the main factors. With regard to ischemia, it has been believed that such factors as embolism which occur in vasa nervorum distributing to the facial nerve, or as vasospasm which is induced by dysfunction of the autonomic nervous system, cause ischemia. When considering embolism, it is easily understood that the coagulation functions of individuals are involved in such an abnormality. However, very few studies have so far been made on the functional state of coagulation in patients with facial paralysis. We made a study on the condition of coagulation functions in the acute phase of Bell’s palsy based on the clinical examination centering on the thrombin-antithrombin III complex (TAT), and plasmin-α2 plasmin inhibitor complex (PIC), which have recently attracted much attention as indexes of hypercoagulability. Relationships between the coagulation and the fibrinolytic systems, TAT and PIC, are shown in Fig. 1.