Earlier recovery of lingual dysfunction after middle ear surgery in pediatric versus adult patients.

OBJECTIVES: It is generally thought that the recovery of damaged chorda tympani nerve (CTN) function after middle ear surgery is different in pediatric patients from that in adult patients. The purpose of this study was to investigate the changes and the progress of taste and somatosensory functions of the tongue after middle ear surgery in pediatric patients compared with those of adult patients. STUDY DESIGN: Prospective study. METHODS: Fifty-nine pediatric patients and 106 adult patients underwent middle ear surgery. Taste and somatosensory functions of the anterior tongue, the so-called CTN functions, were assessed using electrogustometry (EGM), a 2-point discriminator, an electrostimulator, and a questionnaire before and 2 weeks and 6 months after surgery. RESULTS: Two weeks after surgery, there was no significant difference in the incidence of dysgeusia and abnormal EGM thresholds between the patient groups. The incidence of tongue numbness was significantly lower in pediatric patients than in adult patients regardless of CTN manipulation. Although the lingual somatosensory thresholds of adult patients were significantly increased, those of pediatric patients were not increased. Six months after surgery, the incidences of dysgeusia and an abnormal EGM threshold were lower in pediatric patients than in adult patients. Tongue numbness disappeared, and the thresholds of lingual somatosensory tests returned to normal in most pediatric patients. CONCLUSION: Not only taste function but also lingual somatosensory function was damaged after middle ear surgery even in pediatric patients. Pediatric patients complained of tongue numbness less frequently and showed earlier recovery than adult patients. LEVEL OF EVIDENCE: 2 Laryngoscope, 130:1016-1022, 2020.

Change of somatosensory function of the tongue caused by chorda tympani nerve disorder after stapes surgery.

OBJECTIVES: Patients after middle ear surgery often complain of taste disturbance and a lingual numbness. The purpose of this study was to objectively assess changes in the somatosensation of the tongue and taste function in patients undergoing stapes surgery. STUDY DESIGN: Prospective study. METHODS: Symptoms of taste disturbance and tongue numbness after surgery were investigated before and after surgery in 41 patients (13 males, 28 females; mean age 41.8 years) who underwent stapes surgery. Twenty-eight patients (9 males, 19 females; mean age 43.1 years) underwent sensory and taste function tests before and after surgery. Sensory function of the tongue was measured at the operated side and the nonoperated side using the 2-point discrimination test and an electrostimulator test. Taste function was assessed with electrogustometry (EGM). RESULTS: The chorda tympani nerve (CTN) was gently touched or stretched in all patients. Postoperative thresholds on the operated side were significantly higher than preoperative thresholds in all tests in the patients who underwent all three kinds of tests. Tongue somatosensory symptoms improved significantly earlier than the taste disturbance postoperatively, and the sensory thresholds returned to the baseline along with recovery of symptoms. CONCLUSION: These findings suggest that dysfunction of the CTN occurred following surgery even when the CTN was preserved, and that the sensory nerve threshold of the tongue correlated with the symptom of lingual numbness. The CTN may play a role not only in taste function but also in the somatosensory function of the tongue. LEVEL OF EVIDENCE: 4. Laryngoscope, 128:701-706, 2018.

Trigeminal and taste sensations of the tongue after middle ear surgery.

OBJECTIVE: To establish clinical tests for measurement of trigeminal sensitivity on the human tongue and objectively assess changes in oral trigeminal sensitivity and taste ability after chorda tympani nerve (CTN) injury. STUDY DESIGN: Prospective study. SETTING: University hospital. PATIENTS: One-hundred and twenty-six patients with unilateral middle ear diseases who underwent primary middle ear surgery. MAIN OUTCOMES AND MEASURES: Trigeminal sensation was measured each operated side as well as nonoperated side both before and 14 days after surgery using 3 kinds of tests: Semmes-Weinstein sensory test (SW test), 2-point discrimination test, and the electrostimulator test. Taste function was assessed with electrogustometry (EGM) similarly. RESULTS: The patients which the CTN was not touched (n = 6) showed no differences between preoperative and postoperative thresholds in any tests. In the patients with sectioned CTN (n=30), postoperative thresholds on the operated side were significantly higher than preoperative thresholds on the electrostimulator test, 2-point discrimination test, and EGM. In the patients with manipulated but not sectioned CTN (n = 90), postoperative thresholds were significantly higher than preoperative thresholds on the electrostimulator test and EGM. The patients with manipulated but not sectioned CTN and abnormal EGM postoperative thresholds (n = 48) showed that postoperative thresholds were significantly higher than preoperative thresholds in all tests. CONCLUSION: These findings suggest that the electrostimulator test was most useful to objectively assess small changes of trigeminal sensation among the 3 tests. The finding that trigeminal sensitivity of the tongue deteriorated on the operated side after CTN injury suggests that CTN function affected both taste sensation and trigeminal sensation of the tongue.

Preoperative assessment of taste function in patients with middle ear disease.

OBJECTIVE: To identify differences in taste function among patients with chronic otitis media, cholesteatoma, and noninflammatory disease before middle ear surgery. STUDY DESIGN: Retrospective analysis. SETTING: Tertiary referral hospital. PATIENTS: Two hundred thirty ears underwent primary middle ear surgery from January 2006 to December 2010. The subjects consisted of 84 men and 146 women with ages ranging from 20 to 60 years (mean, 43.9 yr). There were 95 ears with chronic otitis media, 61 ears with pars flaccida retraction-type cholesteatoma, 22 ears with pars tensa retraction-type cholesteatoma, and 52 ears with noninflammatory diseases such as otosclerosis and ossicular anomalies. MAIN OUTCOME MEASURE: The patients underwent taste testing using electrogustometry and the filter paper disk method in the regions controlled by the chorda tympani nerve. RESULTS: None of the patients complained of taste dysfunction before middle ear surgery. Among the 4 groups, the patients with pars tensa retraction-type cholesteatoma displayed the highest electrogustometry threshold. The filter paper disk method did not detect any significant differences among the 4 groups. CONCLUSION: Our findings suggest that the filter paper disk scores of all taste qualities (sweet, salty, sour, and bitter tastes) are not deteriorated preoperatively during chronic inflammation in the middle ear and that taste function is affected most in patients with pars tensa retraction-type cholesteatoma.

Utility of real-time diagnosis using contact endoscopy for oral and lingual diseases.

OBJECTIVE: In this study, we prospectively investigated the diagnostic accuracy of CE findings in oral and lingual diseases. METHODS: Between January 2004 and December 2009, CE was used to examine 66 patients with oral and lingual diseases at Hyogo College of Medicine Hospital. Blood vessel networks and superficial cell layers in the mucosal epithelium of normal and lesion sites were observed after staining with 1% methylene blue. Endoscopic diagnoses (CE diagnosis) were compared with subsequent definitive diagnoses based on pathological findings. The sensitivity and specificity for CE diagnosis were calculated. RESULTS: On CE findings, SCC showed the characteristics of absent and tortuous blood vessels, heterogeneous distribution, and increased nucleus/cytoplasm (N/C) ratio. Leukoplakia showed no atypical cells, abundant cornified layers, or cytoplasm without nuclei. Lesions were pathologically classified into three groups: 46 squamous cell carcinomas (SCC), 10 leukoplakias, and 10 other benign lesions (n=66). In 4 patients with SCC, malignancy was underestimated by CE findings. The overall diagnostic rate of the CE was 93.9% (62/66 patients). The sensitivity and specificity of SCC were 0.913 (42/46 patients) and 1.0 (20/20 patients), respectively. CONCLUSION: The usefulness of contact endoscopy (CE) as an in vivo real-time diagnostic instrument that can deliver results prior to pathological confirmation was suggested.

Taste function after section of chorda tympani nerve in middle ear surgery.

OBJECTIVE: To investigate prospectively the clinical manifestations and the functional recovery of taste after section of chorda tympani nerve (CTN) during middle ear surgery, the subjective and objective study on the patients was performed. METHODS: Thirty-five patients underwent surgery with unilateral (n=32) or bilateral (n=3) section of CTN between January 2000 and April 2002. The patients were asked about taste symptoms before surgery and 2 weeks and 2 years after surgery. The CTN function was also measured with electrogustometry (EGM) at the same time points. RESULTS: In unilateral section of CTN, 19/32 (59.4%) complained of taste disorder and 11/32 (34.4%) tongue numbness. Most of these taste symptoms disappeared within 2 years although the EGM threshold did not recover. 16/17 patients (94.1%) who used to cook everyday had little difficulty in flavoring dishes. In bilateral section of CTN, the patients had no problem of taste at 2 years after surgery, either. CONCLUSION: These findings help explain the potential complications to the patients before surgery, although the number of cases was small in this series.

[Clinical experiences of the medication to taste disturbance by serum trace deficiency, especially serum iron deficiency].

Serum zinc deficiency is known to be a major cause of taste disturbances, but the effects of serum iron deficiency on taste disturbances are not widely known. In the present study, we clinically investigated the relationship between taste disturbances and serum iron deficiency as well as the results of pharmacological therapy. The clinical and serological test results of 25 patients with serum iron deficiency (3 men and 22 women; mean age +/- SD, 56.1 +/- 16.5 years) were reviewed at the Department of Otolaryngology, Hospital of Hyogo College of Medicine. All of the patients had been seen at the hospital between January 1999 and February 2003. Electrogustometry (EGM) and the filter paper disc method (FPD) were used to measure taste function. The patients were treated with iron and zinc supplements. The age distribution of the patients peaked at the ages of 40 and 70 years. The ratio of males to females was 1:7. Based on the EGM results, 70% of the patients exhibited taste disturbances. The FPD results showed that the recognition threshold of sour tastes was slightly higher than that of the other tastes. No significant difference in the results of treatment was seen, regardless of the duration of the deficiency. These results suggest that treatment with iron and zinc medicine is useful for correcting taste disturbances caused by serum deficiencies of trace elements.