Atsushi Negoro

Clinical study of flavor disturbance.

Objective We have observed that, in cases of smell loss, patients often complain of taste loss as well even though they actually have normal gustatory acuity according to gustatory tests; we have defined such symptoms as “flavor disturbance”. The clinical features of flavor disturbance are reported in this paper. Material and Methods A total of 297 patients (99 males, 198 females; mean age 55.5 years) were treated for olfactory disturbance at the hospital of Hyogo College of Medicine between July 1995 and August 2001. Sixty-six out of 297 patients (22.5%) also experienced taste disturbance, and 49 of these 66 cases were evaluated by means of smell and taste tests. These 49 patients who complained of taste and smell loss were classified into two groups according to the results of their smell and taste tests. Patients who only complained of olfactory disturbance were also reviewed. Results There was no relationship between the severity of olfactory disturbance and the degree of flavor disturbance. The incidence of flavor disturbance was high in patients with sudden olfactory disturbance after upper respiratory tract infection or head trauma and low in those with slowly progressive olfactory disturbance. The symptoms of flavor disturbance improved regardless of whether smell was improved or not. Conclusions The patients with flavor disturbance tended to misrecognize that they had taste loss because of sudden smell loss, and there were more of these cases than we expected. When patients with smell and taste loss are treated, flavor disturbance should also be considered.

Utility of real-time diagnosis using contact endoscopy for oral and lingual diseases.

OBJECTIVE In this study, we prospectively investigated the diagnostic accuracy of CE findings in oral and lingual diseases. METHODS Between January 2004 and December 2009, CE was used to examine 66 patients with oral and lingual diseases at Hyogo College of Medicine Hospital. Blood vessel networks and superficial cell layers in the mucosal epithelium of normal and lesion sites were observed after staining with 1% methylene blue. Endoscopic diagnoses (CE diagnosis) were compared with subsequent definitive diagnoses based on pathological findings. The sensitivity and specificity for CE diagnosis were calculated. RESULTS On CE findings, SCC showed the characteristics of absent and tortuous blood vessels, heterogeneous distribution, and increased nucleus/cytoplasm (N/C) ratio. Leukoplakia showed no atypical cells, abundant cornified layers, or cytoplasm without nuclei. Lesions were pathologically classified into three groups: 46 squamous cell carcinomas (SCC), 10 leukoplakias, and 10 other benign lesions (n=66). In 4 patients with SCC, malignancy was underestimated by CE findings. The overall diagnostic rate of the CE was 93.9% (62/66 patients). The sensitivity and specificity of SCC were 0.913 (42/46 patients) and 1.0 (20/20 patients), respectively. CONCLUSION The usefulness of contact endoscopy (CE) as an in vivo real-time diagnostic instrument that can deliver results prior to pathological confirmation was suggested.

S128 – Diagnosis and Treatment of 703 Patients with Taste Disorder

Objectives As life spans increase, the number of patients with taste disorder consulting in our taste clinic has increased. This study prospectively examined patients’ history, causes of taste disorder, and treatment outcomes. Methods Subjects consisted of 703 patients with taste disorder who consulted our taste clinic at the department of Otolaryngology, Hospital of Hyogo College of Medicine, between 1999 and 2007. There were 284 men and 419 women, and patient ages ranged from 12 years to 88 years with a mean age of 59.7 years. Electrogustometry (EGM) and filter paper disk method (FPD) were used to assess taste function. We also asked each patient to indicate the severity of symptoms using a visual analog scale (VAS). Patients were treated mainly with zinc sulfate (ZnSO4 300 mg/day, or polaprezinc 150 mg/day), and in some cases with iron supplement, herbal medicine, and minor tranquilizers. Results Idiopathic taste disorder was the most common cause (271 cases, 38.5%), followed by drug-induced (131 cases, 18.6%), post-common cold (83 cases, 11.8%), psychogenic (73 cases, 10.4%), iron-deficiency (37 cases, 5.3%) and others. Deficiency of serum zinc (less than 70 ?g/dl) was found in 50–70% of cases. The recovery rate was 130/183 (71.0%) in idiopathic, 41/61 (67.2%) in post-common cold, and 24/29 (82.8%) in iron deficiency. The recovery period in drug-induced (39.7 weeks) was longer than that in other cases (20.4 weeks). Results of EGM and FPD were not always associated with the severity of symptoms. Conclusions Treatment with zinc supplement may be useful for taste disorder.

Nizatidine Endances Salivary Secretion in Human Dry Mouth

There is no effective therapy for dry mouth although the number of patients with this condition have been increasing in recent years. Nizatidine, a histamine H2 receptor antagonist, has been reported to inhibit acetylcholine esterase, with a resulting increase in acetylcholine, in the cholinergic system. Therefore, this study was designed to evaluate whether nizatidine enhances salivary secretion in dry mouth patients.Both the basal and stimulated salivary secretions were measured before and after the administration of nizatidine (300mg/day) for 28 days in 18 healthy adult volunteers, 17 men and 1 woman (mean age: 39.7), and 19 patients with dry mouth, 3 men and 16 women (mean age: 66.4), who visited our clinic. The gustatory function was evaluated by the electric taste test and filter paper disk methods.Both the basal and stimulated salivary secretions significantly increased in both the control and dry mouth patient groups compared to the pretreatment baseline with significant differences in statistics, using the Wilcoxon test after administration of nizatidine for 28 days. In addition, 16/19 (84.2%) of dry mouth patients reported subjective improvements of oral dryness. But neither the electric taste test nor the filter paper disk test showed any evidence of significant improvement in the gustatory function. These findings suggest that nizatidine increased salivary secretion and is useful for the treatment of patients with dry mouth.