Taste disturbance

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Classification according to ICD-10
R43 Disorders of the sense of smell and taste
R43.2 Parageusia; Ageusia
R43.8 Other and unspecified disorders of the sense of smell and taste
ICD-10 online (WHO version 2019)

In medicine, taste disorders or taste disorders ( dysgeusia ) are disorders of the sense of taste ( gustatory ). They can be caused by various diseases, but also by medication.

Classification

The normal sense of taste is called normogeusia . Dysgeusia is divided into qualitative and quantitative taste disorders.

  • Qualitative taste disorders
    • Parageusia: altered perception of taste stimuli
      • Kakogeusie: Sub-form of parageusia, in which all taste stimuli are perceived as unpleasant or bad-tasting.
    • Phantogeusia: taste impressions without a source of irritation
  • Quantitative taste disorders
    • Hypogeusia: decreased taste perception
    • Ageusia: loss of taste perception
      • Complete Ageusia: People with this type of dysgeusia no longer perceive any taste stimuli.
      • functional ageusia: the affected person's sense of taste is severely restricted.
      • partial ageusia: people with this taste disorder cannot perceive a certain taste substance. On the other hand, they react normally to other taste stimuli.
    • Hypergeusia: Increased taste perception

Basics

Taste qualities are only sweet, sour, salty, bitter and umami . They can be tested with sugar solution , citric acid , saline solution , quinine solution and glutamic acid . “ Hot ” is qualified as a taste sensation, but strictly speaking it is a pain signal from the nerves in dishes that are seasoned with chilli , for example , then caused by the alkaloid capsaicin . Other taste qualities are also discussed, such as fatty , alkaline , metallic and water-like. The "coloring" of the taste occurs through the nose. A failure of the olfactory cells ( anosmia ) therefore also affects the sense of taste.

The taste buds for the front two thirds of the tongue come from the chorda tympani , a branch of the facial nerve (VIIth cranial nerve ). They run together with the lingual nerve , a branch of the mandibular nerve of the trigeminal nerve (fifth cranial nerve). The back third of the tongue is innervated by the glossopharyngeal nerve (IX cranial nerve). (For motor and sensory innervation see tongue ).

causes

A taste disturbance can occur due to damage or functional impairment

  • the taste buds ,
  • the peripheral nerves, which conduct the taste stimuli from the taste buds into the central nervous system, or
  • the taste path ( taste path) with course in the brain.

Common causes of dysgeusia are chemotherapy , asthma treatment with salbutamol, and zinc deficiency. Liver disease , hypothyroidism, and (rarely) certain types of epilepsy can also lead to dysgeusia. Taste disorders can occur with psychoses , for example with schizophrenia , with chronic use of drugs and narcotics , with diabetes mellitus , with chronic kidney failure or liver disease . Avitaminosis , endocrine diseases, hypothyroidism and malabsorption syndrome can affect the sense of taste.

Disorder of the taste buds

The taste buds can be temporarily or permanently damaged by various causes and thus lead to ageusia. Causes of damage to the taste buds include:

Nerve conduction disorder from the taste buds to the brain

Nerve conduction disorders can occur

Damage to brain areas that are responsible for taste perception

chemotherapy

One of the main causes of dysgeusia is cancer chemotherapy. The exact mechanism of chemotherapy-induced dysgeusia is unknown. Chemotherapy often causes damage to the oral cavity, resulting in oral mucositis , oral infection, and malfunction of the salivary gland . Chemotherapy can cause the usually non-pathogenic oral flora to cause severe infections that can lead to a reduction in saliva. In addition, patients who undergo radiation therapy also lose salivary tissue. Saliva is an important part of the taste mechanism. It interacts with the taste receptors in the mouth and protects them. Saliva imparts a sour and sweet taste through bicarbonate ions or glutamates . The salty taste is induced when the sodium chloride content exceeds the concentration in saliva. Examples of chemotherapy treatments that can lead to dysgeusia are cyclophosphamide , cisplatin, and etoposide .

Other possible causes

Taste cells (10–50 per taste bud ) have an average lifespan of 10 days and are regenerated from basal cells in the taste bud. The estimated number of taste buds decreases with age. At birth there are around 10,000 taste buds, in adults the number continuously decreases to 5,000 to 3,000 taste buds. In old age the number drops to under 2,000. Thus, the sense of taste decreases with increasing age.

The radiotherapy of head and neck cancer therapy to a modified saliva production even be a direct destruction of the taste buds in addition to the impact. There is a loss of microvilli and the reduction of intracellular vesicles of type III.

A zinc deficiency is discussed as another possible cause of the dysgeusia . While the exact role of zinc in dysgeusia is not known, zinc is in part responsible for the repair and production of taste buds.

Xerostomia (dry mouth syndrome) can cause dysgeusia because it requires normal salivation and concentration for taste. A taste disturbance can also be caused by factors such as gastroesophageal reflux , lead poisoning, and diabetes mellitus . Certain pesticides can damage the taste buds and nerves in the mouth. Patients who suffer from Burning Mouth Syndrome also often complain of dysgeusia.

Frequent irritation leads to a decrease in sensitivity ( pepper , hot spices ). Learning and conditioning processes are probably responsible for the preference for hot spices ( endorphin production , saliva production).

Medicinal dysgeusia

There are a variety of drugs that can induce dysgeusia, including zopiclone, H1 antihistamines such as azelastine and emedastine . About 250 drugs affect taste. The sodium channels bound to taste receptors can be inhibited by amiloride , and the formation of new taste buds and saliva can be hindered by antiproliferative drugs. Saliva may contain traces of the drug and cause a metallic taste in the mouth; Examples are lithium carbonate and tetracyclines . Medicines containing sulfhydryl groups, including penicillamine and captopril , can react with zinc and cause a deficiency. Metronidazole and chlorhexidine interact with metal ions that are associated with the cell membrane. Drugs that block the renin-angiotensin-aldosterone system , for example by antagonizing the angiotensin II receptor (such as eprosartan ), have been linked to dysgeusia. There are few cases where it is claimed that calcium channel blockers like amlodipine also cause dysgeusia by blocking calcium-sensitive taste buds.

Medicines can cause specific and non-specific taste disorders. The symptoms are usually reversible after stopping the drug.

Trigger of unspecific disorders
Art drug
Hypogeusia Amphotericin B , Carbamazepine , Cisplatin , Diltiazem , Carboplatin , Levodopa , Nifedipine , Metronidazole
Ageusia Cisplatin , Diltiazem , Enalapril , Hydrochlorothiazide , Atorvastatin , Nifedipine , Ofloxacin , Spironolactone , Terbinafine , Triazolam
Dysgeusia Amiodarone , Captopril , Diltiazem , Enalapril , Losartan , Lisinopril , Morphine Sulphate , Nifedipine , Nitroglycerine , Selegiline
Trigger specific disorders
Art drug
Metallic phantogeusy Allopurinol , ethambutol , vitamin D.
Metallic dysgeusia Carbidopa , cisplatin , lidocaine , lithium , methotrexate , metronidazole , zinc salts , zopiclone , zaleplon , zolpidem
Bitter dysgeusia Amphetamines , flurazepam
Salty dysgeusia Amitriptyline , captopril , carboplatin
Sweet dysgeusia 5-fluorouracil
Acid dysgeusia Isotretinoin
Salty hypogeusia Amiloride

Complementary diagnostics

The Gustometrie is a diagnostic procedure for checking the sense of taste. While reactions to substances are tested in chemogustometry, the ability to react to electrical currents can be investigated in electrogustometry . The taste test is carried out on a site-specific basis with the help of dripping on dissolved substances ( sweetener , citric acid , table salt , quinine sulfate ).

A distinction is made between subjective gustometry , in which the patient's information is in the foreground, and objective gustometry , which makes this information verifiable.

  • Minimum concentrations that are required for the detection of taste molecules can be specified. In some cases, the classification of the taste molecules requires higher concentrations: a just perceptible salt concentration should taste sweet, a higher one salty.
  • Long-term stimulation with taste molecules causes an adaptation . After the stimulus has been removed, "negative" afterimages should occur, as in the visual system.
  • The perception of taste is influenced by olfactory (smell) and sensitive stimuli.
  • The sensitivity to taste decreases with age.

When testing tongue regions, 20 to 50 µl of liquid test solutions are applied to the front and back of the tongue using a pipette , soaked filter paper disks or cotton swabs . The whole mouth test involves giving small amounts (2-10 ml) of the solution and asking the patient to swirl the solution around in their mouth.

An objective check of taste disorders is only possible by measuring brain waves (so-called gustatory evoked potentials in the electroencephalogram ). In addition, vegetative parameters such as respiratory rate and skin resistance are measured.

The magnetic resonance imaging allows direct visualization of the cranial nerves. It also provides important information on the type and cause of a possible lesion.

Cell cultures can be used for diagnostics if fungal or bacterial infections are suspected .

In addition, a saliva analysis should be performed as it represents the environment for taste receptors, including the transport of flavors to the receptor and the protection of the taste receptor. Typical clinical examinations include sialometry (determination of saliva flow rate) and sialochemistry (determination of salivary composition ).

Studies have shown that electron microscopic images of taste receptors from saliva samples indicate pathological changes in the taste buds of patients with dysgeusia and other taste disorders.

therapy

The effects of drug-induced dysgeusia can often be offset by interrupting the patient's treatment with taste-altering drugs. It may be necessary to change medication.

In the case of chemotherapy-induced taste disorders, miraculin , a plant glycoprotein that acts locally on the taste buds , can provide relief.

Therapy of the underlying diseases or injuries is indicated.

Against dry mouth ( hyposalivation ), saliva substitutes are used as symptomatic therapy (wetting gel , aerosol , mouthwash , chewing agent ) and pilocarpine .

Many drugs are known to chelate or bind zinc , which affects the function of the element. There is a lack of evidence as to whether zinc supplementation is able to treat dysgeusia if no low zinc concentrations are detected in the blood.

Alpha-lipoic acid (ALA) is an antioxidant naturally produced by human cells and is essential in cancer. It's found in foods like red meat, offal, and yeast , but it can also be given in capsule form. ALA can be a potential treatment for patients, but it must be double-blind , randomized studies .

In particularly severe cases of taste disorders with high levels of distress, therapy with a local anesthetic such as lidocaine is carried out.

In addition to the above treatments, the patient can help alleviate the symptoms of dysgeusia on their own. This includes the use of non-metallic cutlery, avoiding foods with a metallic or bitter taste, increasing the consumption of protein-rich foods, possibly seasoning foods or avoiding spices . Good oral hygiene and the use of mouthwash can help .

Trivia

In the film Breast or Leg , an angry innkeeper at Louis de Funès , who plays an influential restaurant critic, causes a complete loss of taste (ageusia) by forcing him to eat huge amounts of inedible food.

Web links

Wiktionary: taste disorder  - explanations of meanings, word origins, synonyms, translations

swell

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