Elsevier

American Journal of Otolaryngology

Volume 34, Issue 5, September–October 2013, Pages 477-489
American Journal of Otolaryngology

Original contribution
Taste and smell function in chronic disease:: A review of clinical and biochemical evaluations of taste and smell dysfunction in over 5000 patients at The Taste and Smell Clinic in Washington, DC

https://doi.org/10.1016/j.amjoto.2013.04.006Get rights and content

Abstract

Purpose

To describe systematic methods developed over 40 years among over 5000 patients at The Taste and Smell Clinic in Washington, DC to evaluate taste and smell dysfunction.

Materials and Methods

A tripartite methodology was developed. First, methods to determine clinical pathology underlying the multiple disease processes responsible for taste and smell dysfunction were developed. Second, methods to determine biochemical parameters responsible for these pathologies were developed. Third, methods to implement these techniques were developed to form a unified basis upon which treatment strategies can be developed to treat these patients.

Results

Studies were performed in 5183 patients. Taste loss was present in 62% of patients, smell loss in 87%. Most patients with taste loss (52%) exhibited Type II hypogeusia; most patients with smell loss (56%) exhibited Type II hyposmia. Sensory distortions were present in 60%. Four common diagnostic entities were found: post influenza-type hyposmia and hypogeusia (27% of patients), idiopathic causes (16%), allergic rhinitis (15%) and post head injury (14%). Regardless of clinical diagnosis the major biochemical abnormality found in most patients (~ 70%) was diminished parotid salivary and nasal mucus secretion of cAMP and cGMP.

Conclusions

Taste and smell dysfunctions are common clinical problems associated with chronic disease processes. These symptoms require a systematic, integrated approach to understand their multiple and complex components. The approach presented here can and has led to effective treatment.

Introduction

There are many patients in the United States with taste and smell dysfunction related to chronic disease processes but a systematic, integrated approach to their evaluation has been lacking. To understand these processes an understanding of how these processes occur and how they can be evaluated is necessary prior to application of treatment to correct them.

Taste and smell are chemical senses. Chemosensory activity involving taste and smell function commonly reflects local and systemic changes in bodily function. Many pathologies of bodily function are manifested by these changes in taste and smell function. These changes fall into two classes – loss of sensory acuity and distortions of taste and smell function. These sensory changes usually reflect symptoms of chronic disease processes involving multiple organ systems including endocrine [1], [2], [3], [4], vitamin [5], [6], trace metal [7], [8], metabolic [9], neurological [10], [11], neurodegenerative [12], [13], hematological [14], immunological [15] and other organ systems [16], [17]. These two classes of dysfunction can also reflect local changes in oral or nasal cavities or in the brain although these changes are not the major pathologies which affect chronic taste or smell dysfunction (v.i.). Descriptions of patients with these sensory dysfunctions have been made by many prior investigators [9], [15], [18], [19], [20], [21], [22], [23], [24], [25], [26], [27] related to both local and systemic pathologies but a report of a systematic approach to evaluation of the multiple chronic pathological and biochemical processes responsible for these dysfunctions has been lacking.

In 1971 we published one of the first systematic studies describing one type of chronic human taste and smell dysfunction and its putative anatomical and biochemical pathology [28]. This publication, with its accompanying editorial [29], reported on patients at The Taste and Smell Clinic, established at the National Institutes of Health, Bethesda, MD, in 1970, the first clinical program in the United States devoted specifically to evaluate and treat patients with taste and smell dysfunction. Since that time, with the transfer of The Clinic, first to Georgetown University Medical Center in 1975, and then to the private sector in 1981, we evaluated and treated more than 5000 patients with these sensory abnormalities. During these studies we developed systematic methods to determine clinical characteristics of these patients, systematic techniques to describe, measure and classify their taste and smell dysfunction and systematic methods to determine some of the biochemical factors responsible for the pathology which initiated these chronic sensory abnormalities [30]. Based upon these clinical, sensory and biochemical techniques, treatment protocols were developed which were eventually successful in correcting many of the chronic sensory abnormalities responsible for these dysfunctions.

A tripartite methodology was developed to define these symptoms; this involves a detailed description of the clinical history and pathology with quantitative measurements of taste and smell function, biochemical techniques which define the clinical pathology in blood, erythrocytes, urine, saliva and nasal mucus and integration of these two methods to allow development of effective treatment of these patients.

We will not deal in this study in any systematic manner with treatment protocols to correct these chronic dysfunctions. These protocols have been previously published and are referred to primarily in association with the methodological studies described herein.

Section snippets

History

A comprehensive detailed and specific clinical history technique was developed. In addition to standard, commonly used clinical techniques [31], [32], [33] detailed questions were developed to characterize the complex changes which initiate and perpetuate these sensory dysfunctions.

Clinical history

Over a period of 40 years, 5183 patients were evaluated at The Taste and Smell Clinic in Washington, DC. Results of these studies offer a comprehensive understanding of the clinical pathology responsible for these changes in chronic loss and/or distortion of taste and smell and the biochemical changes responsible for these chronic changes.

Of the 5183 patients studied 2168 (42%) were men, 2997 (58%) were women. Men were aged 1.8–91 years (50.3 ± 0.4 years, Mean ± SEM); women were aged 1.8–96 years (51.2 ±

Discussion

Successful treatment of chronic taste and smell dysfunction depends upon utilization of the tripartite methodology developed in our program over the last 40 years to evaluate these patients. This includes:

  • 1)

    Clinical evaluations (recognition of clinical symptoms, neurological and physical examinations of the head and neck, quantitative measurements of sensory abnormalities and imaging studies).

  • 2)

    Biochemical evaluations (determination of pathology found in blood, erythrocytes, urine, saliva and nasal

References (149)

  • D.A. Mattes-Kulig et al.

    Energy and nutrient consumption of patients with dysgeusia

    J Am Diet Assoc

    (1985)
  • B.B. Wrobel et al.

    Clinical assessment of patients with smell and taste disorders

    Otolaryngol Clin North Am

    (2004)
  • R.I. Henkin et al.

    An open label controlled trial of theophylline for treatment of patients with hyposmia

    Am J Med Sci

    (2009)
  • W. Forbes et al.

    Computed tomography in the diagnosis of diseases of the paranasal sinuses

    Clin Radiol

    (1978)
  • S.J. Zinreich

    Functional anatomy and computed tomography imaging of the paranasal sinuses

    Am J Med Sci

    (1998)
  • I.N. Lawes et al.

    Atlas-based segmentation of white matter tracts of the human brain using diffusion tensor tractography and comparison with classical dissection

    Neuroimage

    (2008)
  • B.J. Cowart et al.

    Hyposmia in allergic rhinitis

    J Allergy Clin Immunol

    (1993)
  • R.I. Henkin et al.

    Fractionation of human parotid saliva

    J Biol Chem

    (1978)
  • R.I. Henkin et al.

    Decreased parotid saliva gustin/carbonic anhydrase VI secretion: an enzyme disorder manifested by gustatory and olfactory dysfunction

    Am J Med Sci

    (1999)
  • B.J. Thatcher et al.

    Gustin from human parotid saliva is carbonic anhydrase VI

    Biochem Biophys Res Commun

    (1998)
  • R.I. Henkin et al.

    Decreased parotid salivary cyclic nucleotides related to smell loss severity in patients with taste and smell dysfunction

    Metabolism

    (2009)
  • R.I. Henkin et al.

    cAMP and cGMP in human parotid saliva: relationships to taste and smell dysfunction, gender and age

    Am J Med Sci

    (2007)
  • R.I. Henkin et al.

    Etiological relationships of parotid saliva cyclic nucleotides in patients with taste and smell dysfunction

    Arch Oral Biol

    (2012)
  • S.T. Wong et al.

    Disruption of the type III adenylyl cyclase gene leads to peripheral and behavioral anosmia in transgenic mice

    Neuron

    (2000)
  • R.I. Henkin et al.

    Improvement in smell and taste dysfunction after repetitive transcranial magnetic stimulation

    Am J Otolaryngol

    (2011)
  • M.B. Jorgensen et al.

    Studies on the sense of smell and taste in diabetics

    Acta Otolaryngol

    (1961)
  • S.N. Nickel et al.

    Neurologic manifestations of myxedema

    Neurology

    (1958)
  • R.I. Henkin

    The role of adrenal corticosteroids in sensory processes

  • R.I. Henkin

    Zinc in taste function: a critical review

    Biol Trace Elem Res

    (1984)
  • S.S. Schiffman

    Taste and smell in disease

    N Engl J Med

    (1983)
  • J.G. Heckmann et al.

    Neurological aspects to taste disorders

    Arch Neurol

    (2003)
  • R.I. Henkin et al.

    A syndrome of acute zinc loss

    Arch Neurol

    (1975)
  • R.L. Doty et al.

    Bilateral olfactory dysfunction in early stage treated and untreated idiopathic Parkinson's disease

    J Neurol Neurosurg Psychiatry

    (1992)
  • M.J. Serby

    Olfactory deficit in Alzheimer's disease?

    Am J Psychiatry

    (2001)
  • B. Mundt et al.

    Loss of smell and taste within the scope of vitamin B 12 deficiency

    Psychiatr Neurol Med Psychol (Leipz)

    (1987)
  • S. Nordin et al.

    Complaints of olfactory disorders: epidemiology, assessment and clinical implications

    Curr Opin Allergy Clin Immunol

    (2008)
  • R.B. Goodspeed et al.

    Chemosensory dysfunction. Clinical evaluation results from a taste and smell clinic

    Postgrad Med

    (1987)
  • K.B. Hüttenbrink

    Disorders of the sense of smell and taste

    Ther Umsch

    (1995)
  • R.L. Doty

    Studies of human olfaction from the University of Pennsylvania Smell and Taste Center

    Chem Senses

    (1997)
  • E. Pribitkin et al.

    Prevalence and causes of severe taste loss in a chemosensory clinic population

    Ann Otol Rhinol Laryngol

    (2003)
  • R. Harris et al.

    Clinical evaluation and symptoms of chemosensory impairment: one thousand consecutive cases from the Nasal Dysfunction Clinic in San Diego

    Am J Rhinol

    (2006)
  • R.M. Costanzo et al.

    Posttraumatic olfactory loss

    Adv Otorhinolaryngol

    (2006)
  • K.W. Delank et al.

    Olfactory function after functional endoscopic sinus surgery for chronic sinusitis

    Rhinology

    (1998)
  • H.R. Briner et al.

    Impaired sense of smell in patients with nasal surgery

    Clin Otolaryngol Allied Sci

    (2003)
  • R.I. Henkin et al.

    Idiopathic hypogeusia with dysgeusia, hyposmia and dysosmia: a new syndrome

    J Am Med Assoc

    (1971)
  • R.I. Henkin

    Medical importance of taste and smell

    J Am Med Assoc

    (1971)
  • R.I. Henkin

    Evaluation and treatment of human olfactory dysfunction

  • E.R. Pinckney

    Medical history-taking

    Arch Intern Med

    (1965)
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