Bell s Palsy When Will I Taste Again
J Audiol Otol. 2017 Apr; 21(1): sixteen–21.
Upshot of Age and Severity of Facial Palsy on Taste Thresholds in Bong'due south Palsy Patients
Jung Min Park
1Department of Otorhinolaryngology-Caput and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.
Myung Gu Kim
2Section of Otorhinolaryngology-Head and Neck Surgery, Samsung Changwon Hospital, Sungkyunkwan University Schoolhouse of Medicine, Changwon, Korea.
Junyang Jung
threeDepartment of Beefcake, School of Medicine, Kyung Hee University, Seoul, Korea.
Sung Su Kim
4Department of Biochemistry and Molecular Biology, Medical Science and Engineering Research Center for Bioreaction to Reactive Oxygen Species, BK-21, School of Medicine, Kyung Hee University, Seoul, Korea.
A Ra Jung
oneSection of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.
Sang Hoon Kim
1Section of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee University, Seoul, Korea.
Seung Geun Yeo
1Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyung Hee Academy, Seoul, Korea.
Received 2016 Aug 17; Revised 2016 Nov fifteen; Accustomed 2016 Dec ix.
Abstract
Groundwork and Objectives
To investigate whether taste thresholds, as determined by electrogustometry (EGM) and chemical taste tests, differ by age and the severity of facial palsy in patients with Bell'south palsy.
Subjects and Methods
This written report included 29 patients diagnosed with Bell's palsy between January 2014 and May 2015 in our hospital. Patients were assorted into age groups and by severity of facial palsy, as determined past House-Brackmann Calibration, and their gustatory modality thresholds were assessed by EGM and chemical sense of taste tests.
Results
EGM showed that taste thresholds at four locations on the natural language and ane location on the cardinal soft palate, ane cm from the palatine uvula, were significantly higher in Bell's palsy patients than in controls (p<0.05). In contrast, chemical gustation tests showed no meaning differences in taste thresholds between the two groups (p>0.05). The severity of facial palsy did not bear on taste thresholds, every bit determined by both EGM and chemical taste tests (p>0.05). The overall mean electrical taste thresholds on EGM were higher in younger Bell's palsy patients than in healthy subjects, with the difference at the back-right area of the tongue differing significantly (p<0.05). In older individuals, withal, no significant differences in taste thresholds were observed betwixt Bell's palsy patients and good for you subjects (p>0.05).
Conclusions
Electric sense of taste thresholds were higher in Bell'south palsy patients than in controls. These differences were observed in younger, but not in older, individuals.
Keywords: Bell'south palsy, Gustation, Electrogustometry, Chemical taste test
Introduction
The most common symptoms in patients with Bong'south palsy include facial palsy and facial asymmetry. This condition, nevertheless, is sometimes accompanied past other symptoms, including otalgia, taste loss, dry eyes/eye discomfort, tinnitus, hearing loss, and dizziness. Bong's palsy patients who recover incompletely from their main symptoms after handling are frequently dissatisfied with their outcomes, but fiddling is known about the link between treatment and accompanying residual symptoms and patient satisfaction [1].
The facial nerves have multiple functions, including: 1) the command of muscles responsible for facial expressions, via motor fibers, 2) the control of secretions by the lacrimal and salivary glands, via parasympathetic fibers, 3) the control of gustatory modality buds in the inductive two-thirds of the natural language, via special sensory nerve fibers, and four) the control of general sensory nervus fibers that affect the auricles, the posterior wall of the external auditory canals, the ear lobes, and deep sensations of facial soft tissue. The special sensory nerve fibers of the facial nerve convey taste sensations from the anterior two-thirds of the natural language via the chorda tympani nerve and geniculate ganglion to the nucleus tractus solitaries in the medulla oblongata. Thus, paralysis of the facial nerve may lead to dysgeusia in the anterior 2-thirds of the tongue [ii].
Factors affecting sensitivity to tastes include smell disorders, smoking, ingestion of booze, medications, degeneration with aging, endocrine changes in climacteric and pregnant women, mental and psychological factors, and xerostomia. Other factors include chronic diseases of the upper respiratory tract and laryngopharynx, chewing disorders, salivary gland disorders, poor dental hygiene and malocclusion of dental prostheses [3,4,5]. Many factors affecting taste vigil have been analyzed, including aging, foods, upper respiratory tract infections, olfactory sense, drinking alcohol, medications, trauma, head injury, chemical damage, blow, heavy metal poisoning, endocrine-metabolic disorders, neurodegenerative diseases, neurotransmitters, tumors, built abnormalities, and lifestyle patterns. To appointment, however, few studies have utilized electrogustometry (EGM) and chemic taste tests to assess the reduced sense of sense of taste in Bell'southward palsy patients [6,seven]. This report therefore compared taste thresholds in Bell's palsy patients and healthy subjects, as well as the effects on sense of taste of historic period and the severity of facial paralysis.
Subjects and Methods
The study included 29 subjects diagnosed with Bell's palsy in our infirmary between January 2014 and May 2015; their caste of Bell'southward palsy was determined using the House-Brackmann Scale. The command group consisted of 47 good for you volunteers without previous sense of taste disorder or ENT diseases (IRB No. KMC 2014-05-108). Subjects in both groups were classified by age into those <40 and ≥40 years. Subjects were evaluated by EGM (EG-IIB; Nagashima Medical Instrument Co., Tokyo, Nihon) and chemic sense of taste tests at within 14 days from the onset. Those who met any of the following criteria were excluded from the study: lack of a sense of hygiene; medical history of secretory, oral, degenerative neuronal, endocrine, cerebrovascular or psychological disease; innate abnormalities; or tumors. Patients suspected of neurological abnormalities and those with dysosmia or dysgeusia were also excluded. Participants were instructed not to swallow or potable anything besides water at least one hour before testing.
EGM was used to measure out electric threshold scores at four locations on the tongue, consisting of the left and right eye portions and the anterior and posterior borders of the circumvallate papillae; and at 1 location on the central soft palate, ane cm from the palatine uvula (Fig. 1). EGM commitment of electrical stimuli to these locations using a steel probe has been shown to produce a metallic, sour or bitter taste, with the lowest electric electric current divers as the threshold value. Before the outset of testing, a stimulus greater than the threshold value was administered to ensure that every subject could recognize EGM stimuli. Stimulation was initiated at the lowest current (3 µA) and was increased in 22 steps to a maximum of 400 µA until the subjects recognized the stimulus.
Areas assessed by electrogustometry. Five areas (blackness circles) were evaluated, 2 cm lateral to the midline tongue tip, the lateral borders of the circumvallate papilla, and ane cm above the uvula.
Chemical tastes were performed at two locations, the midline of the tongue and the primal soft palate, ane cm above from the uvula. Five reagents were tested; sucrose for sweet taste, sodium chloride for salty taste, quinine-hydrochloride for bitter sense of taste, tartaric acid for sour sense of taste, and monosodium glutamate for savory sense of taste (Fig. 2). Each reagent was tested at 10 concentrations. Several drops of each concentration of reagent were advisedly placed on the 2 locations using a pipette. Subjects were instructed to betoken the gustatory modality threshold and determine the type of taste. To wash out the previous gustation, the order of the chemical stimuli was randomized, the mouth was rinsed with tap water, and 1-2 minutes were allowed to expire until the next exam.
Areas evaluated by chemical gustation tests. These included the midline of the tongue and 1 cm in a higher place the uvula (black circles).
All statistical analyses were performed using the Statistical Package for the Social Sciences, version 18.0 (SPSS Inc., Chicago, IL, The states). The electric threshold values of the two groups were compared using Mann-Whitney U tests. The level of statistical significance was set at p<0.05.
Results
Subjects
The 29 patients in the Bell's palsy group comprised 8 males and 21 females, of mean age 41.iii years (range: 14-70 years); these included eleven patients <40 years (mean age, 23.ix years) and 18 patients ≥xl years (mean age, 52 years). In comparison, the 47 salubrious subjects comprised 21 males and 26 females, of mean historic period 37.3 years (range: 18-76 years); these included 28 subjects <twoscore years (mean age, 28.4 years) and 19 subjects ≥40 years (hateful age, fifty.iv years). There was no significant difference in historic period between control and facial palsy groups. (p>0.05). Of the 29 Bell's palsy patients, 17 had correct-sided and 12 had left-sided Bell'southward palsy. Grading by the Business firm-Brackmann Scale showed that 6 patients were diagnosed as Course Ii; 3 as Form Three; 14 as Course IV; and 6 equally Class 5.
Differences in taste thresholds between Bell'south palsy and command subjects
EGM showed that the electrical taste thresholds at all five locations, four on the tongue and one on the central soft palate, were significantly higher in the Bell's palsy than in the control grouping (p<0.05 each). Chemical tests for sweet, salty, bitter, sour, and savory tastes at the two locations on the tongue and primal soft palate showed no meaning differences in taste thresholds between the two groups (p>0.05 each) (Table 1).
Table ane
Taste threshold differences in the facial palsy and control groups
Gustation thresholds as a function of severity of facial paralysis
The Bell's palsy patients were divided into two subgroups based on the House-Brackmann Scale; a balmy-moderate group (Grades II, III, and IV; n=23) and a severe group (Grades V and Half dozen; n=6). No significant betwixt-grouping differences in electric gustatory modality thresholds or in chemical sense of taste tests at any locations on the tongue and soft palate were observed (p>0.05 each) (Tabular array 2).
Table 2
Gustation thresholds in Bell's palsy patients according to the House-Brackmann Scale
Differences between Bell's palsy and control subjects aged <40 years
Overall, the mean electric taste thresholds in Bell's palsy patients aged <40 years were higher than in similarly anile control subjects, with the deviation in the back-right area of the tongue differing significantly (p<0.05). No significant differences in chemical taste thresholds were observed between these two groups (p>0.05 each) (Tabular array iii).
Tabular array 3
Differences in taste thresholds in Bell'southward palsy patients and control subjects aged <40 years
Differences between Bong's palsy grouping and controls aged >40 years
Overall, the hateful electric taste thresholds in Bell's palsy patients aged >40 years were significantly higher than in similarly anile control subjects, but none of these differences was statistically significant (p>0.05). No significant differences in chemical taste thresholds were observed between these two groups of older subjects (p>0.05) (Table 4).
Table 4
Differences in taste threshold in Bong's palsy patients and control subjects anile ≥forty years
Discussion
The most mutual crusade of facial nervus paralysis is Bell'south palsy, besides known equally idiopathic facial nerve palsy. Additional causes include trauma, herpes zoster oticus, tumors, infections, birth defects including built diseases, hemifacial spasm, lesions of the fundamental nervous arrangement, and atypical Bell's palsy. Less frequent causes include toxicities and metabolic and iatrogenic factors [viii]. Bell's palsy can occur at any age, but its incidence is lowest in children nether 10 years of age and older people [nine] and highest in meaning women [ten], individuals with diabetes mellitus, and patients with a previous medical history of Bell's palsy [eleven]. Studies of symptoms accompanying Bell'south palsy take found that, of patients with this status, 67% have excessive tearing in the optics, 52% have postauricular pain, 34% have taste disorders, and xiv% accept phonophobia [ane,ix].
Gustation buds, which are distributed throughout the anterior-two thirds of the tongue, are innervated by the chorda tympani and by special sensory nerve fibers of the facial nervus [12]. The posterior one-third of the tongue is innervated by the glossopharyngeal nerve, and gustation buds of the soft palate are innervated past the greater petrosal nerve of the facial nervus. In this study, iv locations on the natural language were tested, corresponding to the chorda tympani (2 cm from the midline of the tongue apex laterally); and the glossopharyngeal nerves, including the circumvallate and foliate papillae. The central soft palate 1 cm from the palatine uvula was also tested. Since Bell's palsy patients develop unilateral facial paralysis, tongues were tested bilaterally [6].
Gustatory role tests can exist classified equally qualitative or quantitative based on their characteristics. EGM and chemic sense of taste tests involve the assistants of stimuli, whereas whole-mouth/local mouth tests are based on the locations of the tongue [five]. In this study, both EGM and chemical taste tests were performed throughout the entire mouth, thus better reflecting the taste sensations perceived during actual nutrient ingestion. EGM showed that the electrical gustatory modality thresholds at 5 locations, four on the tongue and one on the central soft palate, were significantly higher in the Bell's palsy than in the control group. These results are consistent with previous reports showing that patients with Bell's palsy and herpes zoster oticus feel sense of taste disorders, which are triggered by paralysis of the facial nerve [7,13]. EGM testing showed greater differences in taste thresholds between the Bell's palsy and control groups than did chemical taste tests. This finding suggests that EGM makes it easier to control stimulus strength and to considerately determine whatever mild gustatory modality disorder with few subjective symptoms [six,14].
The results of both EGM and chemical taste tests did not differ between patients with mild-moderate and astringent Bong's palsy. These results suggest that normal or abnormal taste sensations at paralyzed sites are more important factors than the severity of taste disorders. Previous studies testing the effects of age on gustation thresholds revealed that subjects anile >40 years had a higher threshold than those anile <40 years, although the magnitude of these differences between the ii groups differed when assessing sour [xv], sour/bitter [16], sweet [17], and sour/salty [18] tastes [xix].
A written report of Korean subjects showed that EGM thresholds increased significantly with age in both males and females [20]. Although a second study using chemical function tests found that all thresholds for sweet, salty, bitter and sour tastes increased, only the increase in salty taste threshold was statistically significant [21]. Changes in sense of taste threshold with crumbling differed in men and women, with men showing gradual increases in gustation thresholds from their 10s to 60s, whereas women aged <40 years showed no differences and those anile ≥twoscore tears experiencing radical changes [20]. Similarly, in this study, therefore, subjects aged <40 years with Bell's palsy showed significantly greater increases in EGM-adamant gustatory modality thresholds than the control subjects. In patients aged ≥xl years, the EGM-determined sense of taste thresholds were higher in the Bong'south palsy than in the command group, but the taste test-determined thresholds were not. This result suggested that sense of taste sensitivity was similar in Bell'south palsy patients and controls aged >40 years. Similar to the other senses (i.eastward., sight, hearing, smell and impact), sense of taste loss may occur with age [19]. Many older patients take multiple medications because of chronic degenerative diseases [21], and taste function may be affected past factors such as gender [22], smoking [23], and medication [24]. At present, in that location are no widespread criteria for judging the presence of taste disorders at various ages [21].
The nowadays study had several limitations. Nosotros could not compare changes in sense of taste in Bell'due south palsy patients from before to later on treatment or after stratifying patients past historic period or by intensity of Bong'southward palsy (Firm-Brackmann grade) due to the pocket-sized sample size. In add-on, nosotros were unable to assess the relationship between EGM and chemic taste tests or the effects of previous medications, especially steroids, used to care for facial palsy.
In conclusion, the electrical taste thresholds were higher in patients with Bong'due south palsy than in healthy controls. In particular, the taste thresholds were higher among younger than older Bell'southward palsy patients.
Acknowledgments
This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (No. 2011-0030072).
Footnotes
Conflicts of interest: The authors have no financial conflicts of interest.
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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5392006/
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