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http://dx.doi.org/10.4172/2324-8785.1000127
Journal of
Otology & Rhinology
Research Article
Post-Tonsillectomy Taste
Disorders- Review of Literature
Hanna Temporale1*, Krzysztof Zub1, Tomasz Zatoski1 and
Tomasz Krcicki1
Abstract
On the basis of the available literature this review shows the
characteristics, possible causes, pathophysiology and treatment
of persistent taste disorders, occurring as a complication after
tonsillectomy. Attention was drawn to the underestimation of the
incidence of these complications and the need to inform patients
assigned to tonsillectomy about the possibility of a deficit or
distortion of taste after surgery.
Keywords
Tonsillectomy; Complications; Taste disorders; Dysgeusia
Introduction
As one of the most important senses, correct perception of taste
determines proper physical and mental functioning. Some claim that
both taste and smell are responsible, to a large extent, for the food
selection, affect human nutritional status, and their dysfunction can
lead to diseases such as depression [1,2].
a SciTechnol journal
Post-Tonsillectomy Dysgeusia
Tonsillectomy is one of the oldest and most frequently
performed surgical procedures in otolaryngology. Although
surgical techniques have improved over the years, complications
still happen. Patients mostly suffer from pain or dysphagia. Lifethreatening complications like haemorrhage occur in 2-4% of the
patients [5]. Before tonsillectomy each patient must be informed
about the risk of taste impairment. Transient post-tonsillectomy taste
dysgeusia (PTD) is a common complaint. Long-lasting PTD is less
frequent but has significant consequences on patients quality of life.
Transient taste perception changes seem to be relatively frequent
after tonsillectomy [6-8]. They are mostly manifested by a metallic
or bitter taste and generally maintain from 4 days to 2 weeks after
the procedure. Persistent dysgeusia may last for 2 years or longer and
retreat spontaneously [1,6,7]. The cause of this complication remains
unknown, although there are several theories, which try to explain its
occurrence.
Nerves Injury
Indirect and direct intrasurgical injury of the lingual or tonsillar
branch of the glossopharyngeal nerve as well as pressure on the
lingual nerve (along with chorda tympani nerve) caused by tongue
retractor during tonsillectomy may lead to taste disturbance [1,2].
The close anatomic relationship between the palatine tonsil and
the lingual branch of the glossopharyngeal nerve makes the nerve
vulnerable during tonsillectomy. Clamping tonsillar branches of the
lingual or facial arteries to control hemorrhage at the inferior tonsillar
pole as well as using electrocautery can injure the nerve [9].
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Citation: Temporale H, Zub K, Zatoski T, Krcicki T (2013) Post-Tonsillectomy Taste Disorders- Review of Literature. J Otol Rhinol 2:3.
doi:http://dx.doi.org/10.4172/2324-8785.1000127
In 2004 Goins and Pitovski reported a case study of a patient with
post-tonsillectomy taste disturbance. Using electrogustometry the
lingual branch of the glossopharyngeal nerve (LBGN) was recognised.
The patient suffered from ageusia of the posterior one-third of the
tongue, which was compensated contralaterally with phantogeusia
manifested by metallic or bitter taste. The report suggests that
phantogeusia (taste perception despite the absence of the stimulus)
might result from the release-of-inhibition in the contralateral
glossopharyngeal nerve [10].
Inadvertent extension of lingual nerve and its compression
during tonsillectomy may be prevented by ensuring that the tongue
retractor is not fasten too tightly in the mouth, especially in cases
where the mouth opening is naturally limited [1,9]. Collet et al. notes
that also LBGN may be damaged in the mechanism of stretching
and compression by depression of the tongue [11]. Patients, who are
suspected of taste disorders caused by compression of the tongue,
usually complain of hypogeusia and also of glossodynia of the tip of
the tongue. In such cases, the prognosis is considered to be successful
because there is no permanent damage of the nerve [12]. On the
other hand, the researchers did not find that the occurrence of taste
disorders after tonsillectomy was affected by the length of surgery,
including the length of the use of tongue retractor [6].
Neuritis or cicatrisation during postoperative infection is
considered to be another possible cause of the LBGN dysfunction
[12].
Scinska et al. take into consideration the injury of the soft palate
innervation: the tonsillar branch from the glossopharyngeal nerve,
the palatine nerve (a branch from the maxillary nerve) or the petrosal
nerve (a branch from the facial nerve) as a possible cause of dysgeusia
after tonsillectomy [2]. The above observations seem to be supported
by cases of taste disorders in patients with the obstructive sleep apnea
syndrome (OSAS) after Uvulopaltopharyngoplasty (UPPP) [13].
Citation: Temporale H, Zub K, Zatoski T, Krcicki T (2013) Post-Tonsillectomy Taste Disorders- Review of Literature. J Otol Rhinol 2:3.
doi:http://dx.doi.org/10.4172/2324-8785.1000127
of the glossopharyngeal nerve, and an absence or a diminution in the
perception of cold is noted in the case of a lesion [18]. This test is
relatively easy to carry out and is not expensive.
Dysgeusia diagnostics also involves serum zinc-level test as well
as an accurate medical interview, including drug usage.
Conclusion
Post-tonsillectomy dysgeusia is still underestimated and only
little attention is given to it in clinical practise. The available literature
mentions nerves injury- mainly LBGN as a possible cause of taste
disturbances. Other causes mentioned might be zinc deficiency and
drug interactions. Typically, short-term dysgeusia does not require
treatment. There are case reports with the usage of zinc sulfate as
an effective therapy of persistent taste disturbances, occurring as
a complication of tonsillectomy. The aim of this publication is to
emphasize the problem of dysgeusia after tonsillectomy and the
need of informing patients about the possible risk of dysgeusia. It is
essential to take any required steps in order to prevent taste disorder
and, in case it does occur, to perform the appropriate diagnostic
procedures and monitor the treatment.
References
1. Stathas T, Mallis A, Naxakis S, Mastronikolis NS, Gkiogkis G, et al. (2010)
Taste function evaluation after tonsillectomy: a prospective study of 60
patients. Eur Arch Otorhinolaryngol 267: 1403-1407.
Author Affiliation
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