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Taste and smell losses in HIV infected patients.

Human immunodeficiency virus (HIV-1) associated wasting is an increasingly common clinical manifestation of AIDS. The pathogenesis of wasting is multifactorial and includes reduced caloric intake as a major contributing mechanism. The perceptions of taste and smell play an important role in stimulating caloric intake and in optimizing nutrient absorption through cephalic phase reflexes. The purpose of this study was to evaluate the degree of losses in taste and smell function that occur in subjects infected with HIV. Taste and smell function was evaluated in 40 HIV infected individuals and 40 healthy control subjects matched for age, sex, race, smoking behavior, and number of years of education. Chemosensory tests administered to subjects included taste and smell detection thresholds, taste and smell memory tests, taste and smell discrimination tests, and taste and smell identification tasks. Significant differences were observed between experimental and control subjects in glutamic acid taste detection threshold (p < 0.001), quinine hydrochloride taste detection threshold (p < 0.001), menthol smell detection threshold (p < 0.001) and in the taste identification task (p = 0.006). Overall the results suggest abnormalities in the peripheral and central nervous systems, and subjective distortion of taste and smell. A significant correlation was not established between CDC classification of HIV infection and taste and smell function, although trends were observed suggesting worsening function with progression of HIV disease. These results document significant taste and smell losses in HIV infected subjects which may be of clinical significance in the development or progression of HIV associated wasting.

Acquired Immunodeficiency Syndrome↗

Gustatory disturbance due to cerebrovascular disorder.

OBJECTIVES: Review three cases of unilateral gustatory disturbance due to central lesions caused by cerebrovascular disorders, describe clinical findings and the results of taste examinations, and discuss the central gustatory pathways in humans. STUDY DESIGN: Retrospective review of three gustatory disturbance cases due to cerebrovascular disorders. Additional review of 12 cases with central gustatory disturbance that have been reported. METHODS: Central lesions of three cases were examined by magnetic resonance imaging or computed tomography scan. Electrogustometry and a filter paper disk assay using taste solutions were performed in these cases for each of the bilateral gustatory nerves. RESULTS: In one case of pontine infarct, gustatory disturbance ipsilateral to the lesion was found, and in one case of thalamic infarct and one case of internal capsular infarct, gustatory disturbance contralateral to the lesion was observed. CONCLUSIONS: Fifteen cases of unilateral gustatory disturbance due to central lesions, including the present cases, have been reported to our knowledge. Examination of these cases strongly suggested that the central gustatory pathways in humans ascend ipsilaterally from the solitary nucleus of medulla oblongata to the pons, and from the pons, cross to a higher position in midbrain and reach the thalamus contralaterally.

Adult↗

Sialochemical and gustatory analysis in patients with oral sensory complaints.

UNLABELLED: Our objective was to perform concomitant taste and salivary analyses in subjects with oral sensory complaints (OSC), including burning mouth syndrome (BMS), idiopathic taste aberrations, and xerostomia without established etiology, to attempt to find a possible explanation for the mechanism underlying those complaints. BMS is a disorder characterized by a painful burning or scalding sensation in clinically normal and healthy oral mucosa. Taste and salivary analyses were performed on 163 subjects with OSC who complained of BMS, taste aberration, or xerostomia, alone or in combination. These subjects were compared with 84 healthy, age- and sex-matched control subjects. The salivary and taste analyses were found to be helpful in distinguishing control subjects from complaining subjects. The most striking result found was the great similarity of both salivary and taste analyses in the BMS, taste aberration, and xerostomia groups, which were significantly different from the results obtained in the control group. An oral neuropathy or neurologic transduction interruption induced by salivary compositional alterations is suggested as the possible etiology for the complaints. This report might add an important objective diagnostic tool to the clinician treating such patients. PERSPECTIVE: The merit of the current study stems from the fact that it suggests for the first time a salivary-related local neuropathic mechanism for oral sensorial complaints. This may be of paramount importance, both with respect to the biological background of these complaints and to the possible therapeutic modalities that might be offered to suffering patients.

Adolescent↗

Oral health, taste, and olfaction.

Oral health, taste, and smell are critical components to an older person's overall sense of well-being and quality of life. Oral health problems can cause pain and discomfort and can hinder the maintenance of a satisfying and nutritious diet. Loss of taste and smell interferes with pleasure derived from food and food-related activities. Attention should be given to preserving teeth and optimizing oral function. Likewise, close evaluation of older adults' medications may identify the causes of taste and smell disorders. In instances in which nutrient intake is inadequate and chemosensory perception is considered a likely contributor, a trial of flavor enhancers or monosodium glutamate may improve both quality and quantity of intake. Much more information is needed to understand the interrelationship between chemosensory perception, food intake regulatory mechanisms, and nutritional status. Multidisciplinary studies will be required to understand how to improve nutrition through manipulation of oral characteristics, taste, and smell.

Aged↗

Changes in taste sensation and feeding behaviour in cancer patients: a review.

Recent studies suggest the importance of alterations in taste sensation as a determinant of anorexia in cancer patients. These studies collectively support the conclusions that the likelihood of developing abnormalities in taste increases with increasing body burden of tumour, that taste abnormality is reversible on response of the underlying tumour to therapy, and that the abnormalities in taste can be correlated with decreased intake of energy. It is suggested that these studies, and studies currently in progress, may aid our understanding of food choices in cancer patients and may guide the use of food supplements to assist the cancer patient in maintaining adequate energy intake.

Anorexia↗

[Flexible rhinopharyngolaryngoscopy in the evaluation of patients with allergic and upper respiratory airway disorders].

Flexible rhinofaringolaryngoscopy is a valuable diagnostic tool in our daily practice, adding up to 60% of additional information in the diagnosis and clinical approach in neonates, children and adults with pathology of the upper respiratory tract and allergic diseases. We present a practical method for office use, and review our experience with 423 patients in whom the exam was performed. 49% had an abnormal nasal mucosa and middle meatus, site related to ethmoidal and maxillary sinus drainage. In 23 patients we found abnormal turbinates, either clefting, polypoidal changes, degeneration or concha bullosa; most of these findings were not appreciated after routine speculum examination. 7% of our patients had mucosal changes in the area related to the olfactory epithelium, edema and inflammation related to taste and smell disorders. 56 patients had inflammation and hypertrophy in adenoids, 50% of these with some degree of auditory canal obstruction (Eustaquian orifice). In the inferior pharynx and larynx, 58 patients had abnormalities, inflammation in glotic area (8%) due to speech dysfunction. They required speech therapy 4% (14 patients) with abnormal vocal cords, polyps (5), paralysis (4). 2 patients with carcinoma, were referred for biopsy and specific treatment. After gaining sufficient expertise rhinofaringolaryngoscopy is a useful and safe procedure which enhances the diagnostic ability of the practicing allergist/immunologist to evaluate complains referable to the upper airways.

Endoscopy↗

Techniques for human temporal bone removal: information for the scientific community.

Human temporal bones provide an irreplaceable resource for study of the pathology and pathophysiology of disorders of hearing, balance, taste, and facial nerve function. Additional specimens are needed to study disorders for which there are few human specimens; to increase the number of specimens for a given disorder to understand the natural variability and expression of the disease entity; to evaluate the accuracy of otologic diagnoses and the efficacy of otologic treatment modalities; to apply newly available scientific methods, including immunohistochemistry and molecular biologic or molecular genetic techniques; and to teach the anatomy of the human ear and modern otologic surgical techniques. This article provides information for the scientific community concerning techniques for temporal bone and auditory brain stem removal, including intracranial and extracranial approaches and methods to minimize postmortem autolysis and cosmetic defects. Close collaboration between physicians and funeral directors will maximize the yield and utility of these valuable specimens for scientific inquiry and training.

Brain Stem↗

Generalized argyrosis in man: neurotological, ultrastructural and X-ray microanalytical findings.

Generalized argyrosis can produce a number of abnormalities, including skin discoloration, liver and kidney dysfunction. We describe a patient with generalized argyrosis following long-term self-treatment with oral silver intake, in whom skin discoloration, progressive taste and smell disorders, vertigo and hypesthesia were observed. These findings were confirmed by chemosensory tests and electrophysiological investigations. The development of hypogeusia was assessed by subjective tests, while the progression of hyposmia was followed by recording olfactory evoked cortical potentials. Light and electron microscopy of tissue samplings demonstrated electron-dense mineral deposits in basal membranes, in macrophages, in the perineurium of peripheral nerves, along elastic and collagenous fibers, and in necrotic cells of the oral submucosa. Silver and sulfur deposits in affected tissues could be defined by X-ray microanalysis. The quantitative ratio between silver and sulfur in involved tissues was similar to that of an inorganic silver-sulfide (Ag2S) standard. The minute increase in the sulfur content when compared to the inorganic standard suggested a sulfur containing organic matrix of the tissue precipitates. Our findings indicate that the affinity of silver for membrane and neuronal structures and the deposition of silver as an insoluble compound (Ag2S) induce the progression of clinical disease.

Ageusia↗

[Semiologic study of chronic perennial and permanent paranasal sinus dysfunction. Prevalence of symptoms].

Rhino-sinus dysfunction is associated with several symptoms: nasal obstruction, anterior and posterior rhinorrhea, episodes of sneezing, painful or heavy feeling in the face, taste and smell disorders. Certain manifestations have an impact on the pharynx, the larynx or the tracheobronchial tree. This prospective study was conducted in 449 consecutive patients who consulted over an 18-months period from November 1995 to May 1997. The objective was to determine the symptom pattern, main disease of the nasal cavities and paranasal sinuses which were involved: chronic rhinitis, anterior sinusitis, bilateral and symmetric pansinusitis with or without nasosinus polyps. In the first part of the study, the frequency of different symptoms were determined for the main nasosinus diseases. Statistical analysis of the correlations between symptoms and diseases provided a specific approach to symptoms.

Adolescent↗