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PubMed2007

Influence of chronic middle ear diseases on gustatory function: an electrogustometric study.

OBJECTIVE: We aimed to quantitatively determine whether middle ear inflammation associated with unilateral chronic otitis media (COM), cholesteatoma, or otosclerosis affects gustatory function. STUDY DESIGN: Prospective study. SETTING: University Hospital, Department of Otolaryngology. PATIENTS: Forty-two patients had unilateral COM (22 men, 20 women; mean age, 54.2 yr), 57 had unilateral cholesteatoma (35 men, 22 women; mean age, 42.1 yr), and 19 had unilateral otosclerosis (10 men, 9 women; mean age, 49.3 yr). MAIN OUTCOME MEASURES: Patients underwent taste testing using electrogustometry (EGM) and sensation thresholds were compared in the affected and unaffected ears among groups and between affected and unaffected ears in each group. RESULTS: Patients with COM and cholesteatoma exhibited an increase in taste threshold in the affected ears compared to the unaffected ears (p < 0.05), whereas otosclerosis patients did not. The extent of the increase of the sensation thresholds in the affected ears was very similar between patients with COM and those with cholesteatoma (p = 0.548). CONCLUSION: Our EGM study showed that cholesteatoma and chronic middle ear inflammation affected gustatory function to a similar degree.

Adult↗
PubMed2007

Chorda tympani nerve function after middle ear surgery.

OBJECTIVE: To assess chorda tympani nerve function before and after different types of middle ear surgery. The hypothesis was that in cases with cholesteatoma, iatrogenic injury to the nerve results in less postoperative taste disturbance than those undergoing myringoplasty or stapedectomy. STUDY DESIGN: Prospective questionnaire study. SETTING: ENT Department of a district general hospital in England. PATIENTS: Adult patients undergoing middle ear surgery in which there would be elevation of the anulus. MAIN OUTCOME MEASURE: Patients' change in taste sensation after surgery with follow-up to demonstrate subsequent recovery. RESULTS: A significantly higher incidence of taste disturbance follows myringoplasty and stapedectomy than for procedures in which the initial diagnosis was cholesteatoma, regardless of the extent of injury sustained by the nerve. The most common complaint after chorda tympani nerve injury is of a metallic taste sensation. CONCLUSION: Despite the small patient cohort, the results support the hypothesis that iatrogenic chorda tympani nerve injury in surgery for cholesteatoma results in less postoperative taste disturbance than that for otosclerosis. This may be because the disease process of cholesteatoma renders the nerve hypofunctional. The situation after myringoplasty is less clear. A larger study may help validate these findings.

Adolescent↗
PubMed1978

Taste dysfunction and changes in zinc and copper metabolism during penicillamine therapy for generalized scleroderma.

The taste function and the zinc and copper levels in serum and urine were followed for up tp 16 weeks in ten patients who were started on penicillamine therapy for generalized scleroderma (9 patients) and rheumatoid arthritis (one patient). During therapy the serum zinc concentration remained unchanged, whereas the serum copper concentration increased significantly during the first 4--5 weeks and then tended to decrease. Urinary copper rose significantly and remained considerably above the upper normal limit throughout the study. Six of the patients complained after about 4--5 weeks of a decreased taste function, which was gradually restored whether the medication was stopped or continued. The alterations in the taste acuity for sweet, salt, sour, and bitter significantly paralleled the variations in urinary copper before as well as during therapy. Thus, the patients who showed the most pronounced loss of taste, had a lower urinary copper output than those whose taste acuity was less disturbed.

Adult↗
PubMed2004

Subclinical alteration of taste sensitivity induced by candesartan in healthy subjects.

AIMS: There have been case reports of taste disturbance for the angiotensin II receptor blockers losartan and valsartan, but not for candesartan. This study was undertaken to examine whether candesartan causes taste disturbance. METHODS: Candesartan cilexetil (4 mg day(-1)) or vehicle was given to healthy volunteers (n = 8) for 7 days in a randomized, double-blind, placebo-controlled, cross-over design with a 2-week washout period. Clinical gustometry using the filter-paper disc test and electrogustometry were sequentially performed before and at the end of each trial. Serum and salivary zinc concentrations were also measured. RESULTS: Detection thresholds of four basic tastes (sweet, salty, sour and bitter) determined by the paper disc test were significantly (P < 0.05 in all tests) worsened (i.e. score of test increased) after repeated dosing of the drug, although the subjects did not notice such changes. The mean +/- SEM (and 95% CI) scores of the four tastes at just before the seventh dosing of candesartan or vehicle was 3.38 +/- 0.32 (3.02, 3.74) and 2.63 +/- 0.18 (2.18, 3.08) for sweetness, 3.63 +/- 0.38 (4.49, 2.77) and 2.63 +/- 0.26 (3.27, 1.98) for salt, 4.01 +/- 0.42 (3.04, 4.98) and 2.61 +/- 0.32 (3.35, 1.87) for sourness, 4.01 +/- 0.38 (3.22, 4.80) and 2.99 +/- 0.33 (2.24, 3.74) for bitterness, for candesartan and placebo, respectively. Electrogustometry confirmed the candesartan-related taste disturbance. Serum and salivary zinc concentrations were not influenced by candesartan. CONCLUSIONS: These data suggest that candesartan subclinically reduces taste sensitivity after repeated dosing in healthy subjects. Because similar events are reported for losartan and valsartan in case reports, this adverse effect might be a class effect of angiotensin-II receptor blockers (ARBs).

Adult↗
PubMed1979

Bell's palsy; prognostic accuracy of case history, sialometry and taste impairment.

A prognostic test in cases of Bell's palsy must be accurate and applicable early in the course of the disease. The case history is examined in 239 patients with Bell's palsy. The prognostic value of the case history, taste impairment and sialometry is investigated in a series of untreated patients who were followed up for 12 months. Sialometry is advocated as a reliable progostic indicator in the individual patient if a strong stimulant is used. None of the other examined parameters discrimates between good and poor outcome with reasonable accuracy. A follow-up time of 12 months is advocated in determining the ultimate outcome of a Bell's palsy.

Adolescent↗
PubMed1992

Long-term follow-up of patients with orofacial discomfort complaints.

To a group of 113 patients who exhibited wide variation in orofacial and general complaints, which they related to the effects of dental material, a new questionnaire was sent 8-10 years after the first examination. Eight patients had died, and 23 individuals could not be contacted. Of the remaining 82 patients, 62 (76%) individuals completed the questionnaire. Almost two-thirds (29%) of the responding patients reported that they were now free from the previous symptoms, or that these symptoms were alleviated (35%). Dryness of the mouth and smarting tongue were the most frequent symptoms at the follow-up. Half of the patients (52%) thought they still needed treatment for their complaints, and several of them had visited many other therapists after the end of the treatment period at the Department. The treatment outcome and symptom development may be regarded as acceptable with regard to the severity and long duration of the original complaints. However, the prognosis was poor in a substantial proportion of the patients, and this group continued to be a high consumer of health-care resources.

Burning Mouth Syndrome↗
PubMed2005

A decade-long sour-taste sensation successfully treated with a proton-pump inhibitor.

We report a case study of a 54-year-old Japanese woman who persistently suffered from a sour-taste sensation in her mouth for 10 years, and was treated with a proton-pump inhibitor (PPI). She found sour-tasting meals irritable, and after eating such meals the sour-taste sensation worsened. She also complained of eructation and regurgitation. Upper gastrointestinal (GI) endoscopy showed duodenal erosion, superficial gastritis, and erosive oesophagitis. After 2 weeks of PPI therapy (lansoprazole, 30 mg day(-1)) the sour taste subjectively decreased to 70%, and after 6 weeks the symptoms disappeared. In addition to increased sensitivity of the mouth, gastro-oesophageal reflux might have created her obstinate sour-taste sensations. It is suggested that in such cases PPI therapy should be attempted.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1988

Lack of cross sensitivity between captopril and enalapril.

Oral inhibitors of angiotensin converting enzyme (ACE) now have an established place in the treatment of hypertension and heart failure. Captopril, the first of these agents, was initially used in high doses and was associated with adverse effects including proteinuria, skin rash and taste disturbance. We report 11 patients who developed side effects during captopril therapy (proteinuria two, rash four, taste disturbance four and taste disturbance with rash one) who were subsequently treated with enalapril, a second generation angiotensin converting enzyme inhibitor. Proteinuria did not recur in either patient, skin rash resolved in all five cases and taste disturbance resolved in four of five during enalapril therapy. We conclude that the side effects of proteinuria, skin rash and taste disturbance are consequences of captopril idiosyncrasy rather than inhibition of the angiotensin converting enzyme. The reported incidence of these side effects with the current recommended dosage of captopril is low.

Captopril↗
PubMed1996

Seven-day triple therapy with lansoprazole, clarithromycin, and metronidazole for the cure of Helicobacter pylori infection: a short report.

BACKGROUND: To refine our understanding of anti-Helicobacter pylori treatment regimens further, we evaluated the efficacy and safety of lansoprazole given in combination with clarithromycin and metronidazole for 7 days in an open-label, multicenter study. MATERIALS AND METHODS: H. pylori-positive patients self-administered lansoprazole, 30 mg; clarithromycin, 500 mg; and metronidazole, 500 mg bid for 7 days. Patients were assessed at pretreatment, at which time the presence of H. pylori was documented by rapid urease test or histology and culture, following study drug administration (week 1) for a brief evaluation only, and at least 4 weeks posttreatment (week 5), including endoscopy with collection of biopsy specimens for culture and histology testing. RESULTS: Of the 60 patients enrolled in the study, 59 had confirmed H. pylori infection, and 51 were included in an intent-to-treat analysis of efficacy. Primary metronidazole and clarithromycin resistance were observed in 84% and 8% of study patients, respectively. One month after the end of therapy, H. pylori infection was cured in 40 of 51 patients (78%); 95% confidence interval, (65%-89%). The triple-therapy regimen was well-tolerated, with only 2 patients (4%) requiring premature withdrawal from the study due to treatment-related adverse events. Taste perversion (15.0%) and diarrhea (11.7%) were the most frequently reported adverse events possibly or probably related to study medication during the treatment period. CONCLUSION: Despite a high prevalence of metronidazole resistance, a 1-week, triple-drug combination of lansoprazole, clarithromycin, and metronidazole is effective treatment for and well-tolerated by patients with H. pylori infection.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1997

Combination treatment with ranitidine is highly efficient against Helicobacter pylori despite negative impact of macrolide resistance.

BACKGROUND: This double-blind, randomized study evaluated the efficacy of dual and triple therapies including ranitidine for treatment of Helicobacter pylori infection. MATERIALS AND METHODS: Dyspeptic patients (n = 105) with a positive rapid urease test formed the intention-to-treat population (ITT). All patients were assigned to 14 days treatment with ranitidine 300 mg b.i.d and clarithromycin 750 mg b.i.d. Group A (n = 53) also received a placebo twice daily, while group B (n = 52) received lymecycline 300 mg b.i.d. Treatment with ranitidine, 150 mg b.i.d, was continued for an additional 30 days. H. pylori infection was verified by culture. Twelve weeks after antibiotic treatment, H. pylori status was investigated by culture and 14C-urea breath test (UBT). The per-protocol (PP) group consisted of 73 patients (A, n = 38; B, n = 35). RESULTS: Cure rates were 87% (95% C.I. = 72% to 94%) vs. 72% (95% C.I. = 58% to 83%) in the ITT-group and 89% (95% C.I. = 73% to 97%) vs. 87% (95% C.I. = 72% to 96%) in the PP-population (culture and UBT) when triple and dual therapies were compared. In all patients who were not cured, clarithromycin resistance of H. pylori was acquired. Side effects were experienced by 54% of patients. CONCLUSIONS: The difference in efficacy between the two treatment regimens was not significant. However, the cure rates in this study are comparable to combination treatments with omeprazole. Treatment failures were due to acquired clarithromycin resistance.

Adult↗
PubMed1997

One week triple therapy for Helicobacter pylori: does high-dose clarithromycin confer additional benefit?

BACKGROUND: Clarithromycin, a new acid stable macrolide antibiotic with proven efficacy against Helicobacter pylori, has been widely incorporated into eradication regimens but its optimal dosage schedule remains controversial. The standard dose of clarithromycin is 250 mg twice daily. METHODS: In a prospective study designed to evaluate the helicobactericidal efficacy, patient acceptability, and ulcer healing efficacy of a triple therapy regimen incorporating high dose clarithromycin, 100 consecutive patients with H. pylori-positive peptic ulcer received omeprazole 20 mg twice daily in combination with metronidazole 400 mg twice daily and clarithromycin 500 mg twice daily for seven days. H. pylori status was assessed before and at least 4 weeks after therapy by rapid urease test and histology. Adverse events and compliance were assessed by direct questioning. RESULTS: Only two patients failed to attend for repeat endoscopy, leaving 98 evaluable patients. Of these, 94 were H. pylori-negative after therapy, giving an intention-to-treat eradication rate of 94% (95% confidence interval, 89%-99%). The ulcer healing rate was 92% (86%-98%), and ulcer healing was significantly associated with H. pylori eradication (p < 0.01). Adverse events were reported by 33% of patients of which nausea was the commonest (14%). Noncompliance with therapy was significantly associated with H. pylori treatment failure (p < 0.001). CONCLUSIONS: Seven day triple therapy incorporating high dose clarithromycin effectively eradicates H. pylori and heals ulcers, but it is disadvantaged by a relatively high rate of adverse events. In view of these findings and the fact that no direct comparison to date has shown increased efficacy from high dose clarithromycin, we would recommend continued use of low dose clarithromycin when combined with omeprazole and a nitroimidazole.

Adult↗
PubMed1982

Efficacy and toxicity of D-penicillamine for rheumatoid disease in the elderly.

The efficacy and the toxicity pattern of D-penicillamine were studied in patients with rheumatoid disease followed up between April 1975 and March 1979. The population of patients was divided into an elderly group (greater than or equal to 60 years old, mean = 65 years) and a younger group (less than 60 years old, mean = 41 years). Patients with classic or definite rheumatoid disease not responsive to nonsteroidal drugs were eligible. The mean durations of disease prior to D-penicillamine therapy were five years in the elderly and seven years in the younger group. Overall, the mean follow-up time was 11 months. The average dosages of D-penicillamine were 461 mg/day in the elderly and 520 mg/day in the younger patients. Results indicated that D-penicillamine was efficacious in 75 per cent of the elderly during all time periods after three months, and in 75 per cent of the younger patients after three months until at least two years. Prior gold-salt therapy did not influence efficacy. Toxicity was significantly greater in the elderly for overall skin rash (P less than 0.01), severe skin rash (P less than 0.01), and marked abnormalities in the ability to taste (P less than 0.05). The incidence of hematologic toxicity was not increased in the elderly compared with the younger patients. Toxicity in either group was not influenced by prior gold-salt therapy. It is concluded that D-penicillamine was equally efficacious in both elderly and younger groups, and that the toxicity patterns were similar except for increased tendencies toward rashes and taste abnormalities in the elderly.

Adult↗
PubMed1998

6-month use of 0.2% delmopinol hydrochloride in comparison with 0.2% chlorhexidine digluconate and placebo. (I). Effect on plaque formation and gingivitis.

A double-blind, randomised, 6-month clinical trial with parallel group design in 149 patients with gingivitis was conducted to study the efficacy and safety of delmopinol hydrochloride 2 mg/ml (0.2% w/v, Decapinol Mouthwash) used for partly supervised mouthrinsing in comparison with chlorhexidine digluconate 2 mg/ml (0.2% w/v, Hibitane Dental, ICI Pharmaceuticals, UK) and placebo as an addition to normal oral hygiene. Assessments of efficacy were performed using the plaque index and bleeding on probing (BOP). Delmopinol showed 22% lower plaque index scores than placebo after 3 months (p<0.01) and 13% lower scores after 6 months. The corresponding figures for chlorhexidine were 38% (p<0.001) and 38% (p<0.001) after 3 and 6 months, respectively. Bleeding on probing was reduced for delmopinol in comparison with placebo by 11% after 3 months and by 18% (p<0.05) after 6 months. For chlorhexidine the corresponding figures were 18% (p<0.01) and 22% (p<0.01) after 3 and 6 months, respectively. While chlorhexidine showed greater plaque reduction than delmopinol (p<0.01 at 6 months), no statistically significant difference was reached between these two solutions regarding BOP. Both active solutions showed an increased amount of dental calculus in comparison with placebo. A transient anaesthetic sensation in the oral mucosa and taste affection were commonly reported adverse events in both the delmopinol and the chlorhexidine groups. The number of patients withdrawn from treatment due to adverse events or lack of cooperation was 7 in the chlorhexidine group, 4 in the placebo group and 1 in the delmopinol group. The results showed that rinsing with either 0.2% delmopinol hydrochloride or 0.2% chlorhexidine digluconate twice daily for 60 secs for 6 months results in less plaque formation and gingivitis than rinsing with placebo. Mouthrinsing with the 0.2% delmopinol hydrochloride solution was well accepted in this study.

Adult↗
PubMed1991

Oral conditions among German battery factory workers.

The purpose of the study was to evaluate the oral health situation of workers in a modern battery factory; in particular, to describe the prevalence and the severity of dental erosion and attrition in relation to exposure of airborne acids in the work environment. Measurements of the work environment at a German battery factory showed that the workers were exposed to sulfuric acids (0.4-4.1 mg/cm3). All workers at the factory were included in the survey and a total of 61 dentate individuals completed a questionnaire on their work environment, dental health, and symptoms from the mouth, nose, and throat. Information on oral health status, erosion, and attrition was collected by clinical examinations. Nearly all workers reported exposure to etching substances in their work environment: 56% complained of sharp and thin teeth and 29% of short teeth. Poor dental health conditions were observed (e.g. mean D-T = 3.8); the mean number of teeth with crown restoration was 5.3. The prevalence of erosion was 31% and 92% were affected by attrition. Erosion was found only in front teeth while attrition also occurred in posterior teeth. Due to the high level of crown restorations a rather moderate dose-effect relationship was observed. In conclusion, severe erosion and attrition due to sulfuric acid mists should be recognized as an occupational disease.

Acids↗
PubMed1993

Subjective reports of oral dryness in an older adult population.

In this study of an older adult population almost one-fifth reported oral dryness. It was the most common of 22 oral symptoms and complaints. In a logistic regression analysis of predictors of oral dryness three variables had significant independent effects: income, taking prescribed medications and experiencing a stressful life change within the previous 6 months. Subjects with oral dryness had more decayed crown surfaces than those without but there was no association with decayed root surfaces. Nor were there any significant associations between reports of oral dryness and a number of indicators of periodontal health. Those with dryness were more likely to report other oral symptoms such as unpleasant taste, a burning sensation in the tongue and other parts of the mouth and pain from dentures. They were also more likely to report problems chewing food, problems with eating and communication and were more likely to be dissatisfied with their oral health. Given its prevalence and effects, oral dryness constitutes an important health issue among older adults.

Aged↗