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
• Strokes 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)

Diagnosis

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

Management

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

Disposition

Outpatient ENT referral and workup

References

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