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This article focuses on the change in olfaction and taste with aging. It discusses histopathology with an emphasis on age-related changes, causes of chemosensory dysfunction in the elderly, how to evaluate a patient with dysfunction, useful tests and imaging, clinical consequences of chemosensory impairments, and available treatment options.
Bilateral paramedian thalamic infarcts are characterized by disturbance of consciousness, followed by persisting dementia, decreased spontaneity, apathy, amnesia and paralysis of eye movement. We report a 15-year-old boy with this syndrome, who exhibited transient coma at the onset. In addition to the typical symptoms, he complained of sensory disturbance in the lower extremities and face and the loss of taste sense. MRI showed symmetric paramedian thalamic infarction. There was no lesion in the midbrain. The etiology of infarct in this boy remained unknown despite extensive laboratory and neuroradiological examination. His sensory disturbance in the extremities and face may be due to extensive involvement of the inferolateral area of the thalamus by infarction of the paramedian thalamic artery. This patient illustrates that bilateral paramedian thalamic infarction can occur in a previously healthy child.
Rehabilitation and function following three anatomically discrete forms of partial laryngectomy (hemilaryngectomy, subtotal supraglottic laryngectomy, and partial laryngopharyngectomy) were studied in 68 patients. Study parameters included posttreatment respiration, deglutition, taste, smell, and hearing function; articulation and voice analysis; and social, communicative, and vocational adjustment. The major portion of the study involved specific testing of posttreatment voice quality and articulation. Recorded word lists and sentences were evaluated by independent observers regarding breathiness, hoarseness, harshness, pitch, loudness, and intelligibility. These data were analyzed employing a Statistical Package for the Social Sciences (SPSS) through the Washington University computer facilities.
According to the Physicians' Desk Reference (PDR), 36% of modern antihypertensive and antihyperlipidemic drugs produce untoward alterations in chemosensory perception. Such disturbances can adversely affect the quality of life, produce non-compliance to medication schedules, and may result in decreased food intake, loss of appetite, weight decrement, and depression. This review lists the primary antihypertensive and antihyperlipidemic drugs that adversely alter chemosensory function, provides information on better defining the nature of the dysfunction, outlines testing strategies and available tests that could be used to better define the prevalence of the dysfunction, and summarizes means for mitigating such alterations.
OBJECTIVE: To investigate changes in gustatory function during pregnancy and postpartum. DESIGN: Prospective study. SETTING: Obstetric outpatient clinic, Zurich University Hospital. POPULATION: Forty-four pregnant women, 46 controls. METHODS: A threshold-like measure of gustatory function was obtained for different concentrations of the four basic tastes using 'taste tablets'; subjects were also asked to rate the intensity and pleasantness/unpleasantness of suprathreshold taste solutions. Tests were performed in early pregnancy up to 14 weeks of gestational age, 8-12 weeks after the first and second examination and at least 6 weeks after birth. In parallel, controls were tested four times at intervals of 8-12 weeks. MAIN OUTCOME MEASURES: Gustatory score (number of correctly identified tastes). Results Pregnant subjects exhibited a decreased gustatory function compared with non-pregnant controls, still being present after birth. These 'objective' changes were observed although pregnant women rated the intensity of suprathreshold taste stimuli not significantly different from controls. Pregnant women rated salty stimuli to be more pleasant during the second trimester while they rated the salty stimuli to be less pleasant during the first and third trimester, and after birth. CONCLUSIONS: Pregnancy is accompanied by changes in gustatory function. Decreased gustatory sensitivity may allow pregnant and breastfeeding women to vary their diet in order to consume adequate electrolytes. The discrepancy between 'objective' and 'subjective' findings in gustatory function may relate to changes in central processing of gustatory information during pregnancy.
Following therapeutic irradiation of the head and neck, patients with profound xerostomia have complaints associated with oral dryness, effects upon use of oral prosthesis, speech, and taste. In addition, xerostomia may lead to risk of oral infections and rampant demineralization of teeth. The use of topical Oral Balance gel and Biotene toothpaste (Laclede Professional Products, Gardena, CA) versus carboxymethylcellulose gel and commercial toothpaste applications was assessed in a 2-week double-blind, crossover design. The palliative effects of Oral Balance gel and Biotene toothpaste were superior to the effects of a placebo. No effect on oral colonization by Candida species and cariogenic oral microflora was seen with use of the topical agents.
Traumatic events such as motor vehicle accidents, falls, or assaults can lead to dysfunction in olfaction or gustation. Mechanisms of posttraumatic olfactory dysfunction include direct injury to the sinonasal tract or olfactory epithelium, shearing effect on olfactory fibers at the cribriform plate, or brain contusion or intraparenchymal hemorrhage. Posttraumatic gustatory dysfunction is rare, but may occur as a result of direct injury to the tongue, injury to cranial nerves VII or IX, or brain contusion or hemorrhage. Evaluation of head-injured patients presenting with olfactory or gustatory complaints should include a thorough history, including assessment for pre-and posttraumatic chemosensory dysfunction and potential mechanisms of injury, complete head and neck examination including nasal endoscopy and cranial nerve testing, and focused radiographic imaging, usually CT of the sinuses and skull base. Formal olfactory and gustatory testing may be performed using various techniques, although in cases potentially involving litigation, methodologies able to detect malingering should be used. Treatable causes of chemosensory disturbance, most notably conductive olfactory losses caused by chronic rhinosinusitis or nasal obstruction, should be ruled out. In the event of neurosensory deficits, recovery may occur up to 12 to 18 months after the traumatic event. All patients should be counseled regarding the risks of their chemosensory deficits, and given suggestions for appropriate compensatory strategies.
Anorexia and weight loss are frequently the first manifestations of cancer. Although psychological reasons are frequently included as a partial explanation for loss of appetite and weight in the cancer patient, there have been no systematic studies which establish the nature of this relationship. It is proposed that anorexia and cachexia are at times somatic consequences of the cancer patient's beliefs and attitudes about their disease and its treatments. The inability to overcome a sense of hopelessness leads to an adaptive biological reaction called conservation-withdrawal. The effects of the reaction of disengagement and inactivity in relation to the external world which includes external nutriment may be constructive or destructive depending on when it is experienced and the length of time the reaction continues. How this reaction is initiated and mediated biologically and how it may be related to and can be reversed by a shift in motivation are questions of great importance.
The current study documents the incidence of chemotherapy-related food aversions in defined patient populations and characterizes selected aspects of the problem. The association between the incidence of food aversions and patient outcome was also evaluated. Seventy-six primarily breast and lung cancer patients were interviewed before and at stipulated time points for 6 months after their initial course of chemotherapy. Learned food aversions (LFA) were documented via open-ended questionnaires and ratings for foods ingested during the 48-hour period surrounding the first day of treatment. Treatment-related aversions were observed in over 50% of the patients and involved all food groups. The aversions generally occurred shortly after the first course of chemotherapy, were food-specific and of short duration. No strong association was observed between the incidence of food aversions and treatment outcome measures, but quality of life issues warrant further consideration.
BACKGROUND: There is a perception that a total laryngectomy has a devastating effect on patients and their families, but only a few studies have addressed long-term quality of life (QOL) after laryngectomy. METHODS: A cross-sectional study of 49 patients more than 2 years since laryngectomy was performed with a general health status instrument (Short Form-12, version 2 [SF-12 v2.]) and a disease-specific QOL instrument (University of Washington Quality of Life questionnaire, version 4 [UW-QOL v4.]) in a national meeting of laryngectomy survivors. RESULTS: As measured by the UW-QOL, patients identified speech, appearance, and activity as the most important problems after total laryngectomy, but surprisingly, no correlation was seen between speech and overall QOL. Age was a predictor of appearance and anxiety, women were more likely to report difficulties swallowing, irradiated patients reported more difficulties with speech and anxiety, and patients who received chemotherapy were more likely to report difficulties with mood. The SF-12 captured no differences between normal subjects and laryngectomees in the physical summary domain (p = .21); however, laryngectomees scored better in the mental domain (p = .004). Laryngectomees had lower scores in physical function (p = .005) and role physical (p = .036). CONCLUSIONS: Long-term QOL is not decreased after total laryngectomy when it is measured with general health instruments and compared with the normal population, but impairment in physical scales is found when disease-specific questionnaires or subscale scores are included. Age, sex, radiation therapy, and chemotherapy are independent predictors of UW-QOL subscales. Voice handicap is identified as a problem but is not predictive of overall QOL. A strong relationship exists between UW-QOL and SF-12.
The issue of quality of life has largely been neglected within oral surgical practice. A questionnaire was designed to assess the effect of third molar surgery on a number of measures of health care outcome within the first postoperative week, that appeared not to have been previously addressed. These included level of physical discomfort, oral and vocal function, patients' perception of their appearance and social interaction. Patients were asked to complete the questionnaire one day following surgery and again 7 days after surgery. For each question they recorded the answer best describing how they felt, on a 4-point scale. Twenty-nine paired returns were received, for which the results for day 1 and day 7 were summated and compared. A two sample t-test revealed a small but significant improvement in the patients' perception of their quality of life over that time period. When a subset of 11 questions relating to physical wellbeing were analysed using the Wilcoxon Signed Rank Test, a significant improvement in only two of the 11 parameters (ability to masticate and perception of appearance) was found. These results show that within the first postoperative week some patients can experience a deterioration in their quality of life, that extends beyond the traditionally recognized side effects and which shows little improvement in the first postoperative week. It has been stated that patients have a right to know if their lifestyles are to be compromised by the effects of their treatment. We suggest that consideration be given to including reference at the preoperative assessment to some of these outcomes.
The treatment of carcinoma of the oral cavity (tongue, floor of mouth, lips and palate) can lead to different degrees of mutilation. A simple and effective method of evaluation is described, that permits to determine the functional results of different treatments in individual patients. In a special evaluation form, the actual weight of the patient, continuing pain, activities at home and at work, xerostomia, visible mutilation, disorders of tongue mobility and sensitivity, speech impairment, swallowing disorders and psychological problems are assessed. The documentations is completed by application of a score system, that allows a reliable determination of functional results after treatment of oral cavity carcinoma. About 30 minutes are required to complete the investigation. 31 own patients were examined following transoral laser surgery for the treatment of oral cavity carcinoma. The results are demonstrated and compared to those following conventional surgery.
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