Tomomi Nin

Preoperative assessment of taste function in patients with middle ear disease.

Objective To identify differences in taste function among patients with chronic otitis media, cholesteatoma, and noninflammatory disease before middle ear surgery. Study Design Retrospective analysis. Setting Tertiary referral hospital. Patients Two hundred thirty ears underwent primary middle ear surgery from January 2006 to December 2010. The subjects consisted of 84 men and 146 women with ages ranging from 20 to 60 years (mean, 43.9 yr). There were 95 ears with chronic otitis media, 61 ears with pars flaccida retraction-type cholesteatoma, 22 ears with pars tensa retraction-type cholesteatoma, and 52 ears with noninflammatory diseases such as otosclerosis and ossicular anomalies. Main Outcome Measure The patients underwent taste testing using electrogustometry and the filter paper disk method in the regions controlled by the chorda tympani nerve. Results None of the patients complained of taste dysfunction before middle ear surgery. Among the 4 groups, the patients with pars tensa retraction-type cholesteatoma displayed the highest electrogustometry threshold. The filter paper disk method did not detect any significant differences among the 4 groups. Conclusion Our findings suggest that the filter paper disk scores of all taste qualities (sweet, salty, sour, and bitter tastes) are not deteriorated preoperatively during chronic inflammation in the middle ear and that taste function is affected most in patients with pars tensa retraction-type cholesteatoma.

Trigeminal and taste sensations of the tongue after middle ear surgery.

Objective To establish clinical tests for measurement of trigeminal sensitivity on the human tongue and objectively assess changes in oral trigeminal sensitivity and taste ability after chorda tympani nerve (CTN) injury. Study Design Prospective study. Setting University hospital. Patients One-hundred and twenty-six patients with unilateral middle ear diseases who underwent primary middle ear surgery. Main Outcomes and Measures Trigeminal sensation was measured each operated side as well as nonoperated side both before and 14 days after surgery using 3 kinds of tests: Semmes-Weinstein sensory test (SW test), 2-point discrimination test, and the electrostimulator test. Taste function was assessed with electrogustometry (EGM) similarly. Results The patients which the CTN was not touched (n = 6) showed no differences between preoperative and postoperative thresholds in any tests. In the patients with sectioned CTN (n=30), postoperative thresholds on the operated side were significantly higher than preoperative thresholds on the electrostimulator test, 2-point discrimination test, and EGM. In the patients with manipulated but not sectioned CTN (n = 90), postoperative thresholds were significantly higher than preoperative thresholds on the electrostimulator test and EGM. The patients with manipulated but not sectioned CTN and abnormal EGM postoperative thresholds (n = 48) showed that postoperative thresholds were significantly higher than preoperative thresholds in all tests. Conclusion These findings suggest that the electrostimulator test was most useful to objectively assess small changes of trigeminal sensation among the 3 tests. The finding that trigeminal sensitivity of the tongue deteriorated on the operated side after CTN injury suggests that CTN function affected both taste sensation and trigeminal sensation of the tongue.

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.

Change of somatosensory function of the tongue caused by chorda tympani nerve disorder after stapes surgery

Patients after middle ear surgery often complain of taste disturbance and a lingual numbness. The purpose of this study was to objectively assess changes in the somatosensation of the tongue and taste function in patients undergoing stapes surgery.

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.