Dysgeusia

Background

• Dysgeusia (also known as parageusia) refers to alteration in the sense of taste. This includes ageusia (lack of sense of taste) and hypogeusia (decrease in sense of taste).
• Can be primary or secondary in nature.

Clinical Features

• Any change in the subjective perception of taste including decreased, absence, or altered taste.

Differential Diagnosis

• Drugs, including chemotherapeutic agents
• Zinc deficiency
• Oral infections
• Upper respiratory infections (including COVID-19)
• Diabetes
• Stroke involving the pons, thalamus, and midbrain
• Xerostomia (possibly secondary to Sjogren's)
• Intrinsic taste bud dysfunction
• Hypothyroidism
• GERD
• Pregnancy

Evaluation

Evaluation of dysgeusia is difficult as it involves a complex interplay of the somatosensory system, the sense of smell, and the sense of pain.

• At a minimum, evaluation should include a complete and thorough physical exam of the tongue and oropharynx

Workup

Workup should focus on ruling out secondary causes. Questions should be asked regarding oral health, salivation, prior and/or current upper respiratory infections (including COVID-19)

• Consideration of ruling out potential secondary causes such as cancer, DM, hypothyroidism, or oropharyngeal causes

Diagnosis

• Typically a clinical diagnosis

Management

• Management should focus on treating the underlying cause, if one is identified.

Disposition

• Outpatient ENT referral and workup

References

• NEJM: Taste and Smell in Disease.
• JAMA: Smell and Taste Disorders, A Study of 750 Patients From the University of Pennsylvania Smell and Taste Center.