Affiliation:
1. Department of Otolaryngology – Head and Neck Surgery Washington University School of Medicine St Louis Missouri USA
2. School of Medicine University of Missouri Kansas City Kansas City Missouri USA
3. Monell Chemical Senses Center Philadelphia Pennsylvania USA
4. Department of Genetics Washington University School of Medicine St Louis Missouri USA
Abstract
ObjectivesTo compare taste changes after transoral robotic surgery (TORS) to taste changes in healthy controls.MethodsOropharyngeal cancer patients receiving TORS and healthy controls were recruited. Participants underwent posterolateral and whole‐mouth psychophysical taste testing (identification, intensity, and hedonics) at baseline and at 2 weeks postoperatively (patients) or follow‐up (controls). Surgeons reported suspension time and glossopharyngeal nerve injury (GNI) based on the identification and sacrifice of the nerve. A Clinical Global Impression (CGI) of taste symptoms was completed at each session (“My sense of taste bothers me” on a 5‐point scale from Never [1] to Always [5]). A taste disorder (TD) was a CGI of 3 (Sometimes) or worse. Within‐subject changes in CGI and psychophysical scores were computed. “Worsened taste” was a CGI increase by ≥1 point at follow‐up.ResultsOf 69 participants, most (33/37 tumor, 31/32 controls) had normal baseline taste (CGI < 3). 14/33 (42%) TORS patients and no controls developed new TDs at follow‐up. More smokers (7/9) had worsened taste than nonsmokers (19/60, difference = 46% [95% CI 16%–76%]). More patients without GNI (6/22) than with GNI (0/15) had postoperative phantogeusia (difference = 27% [95% CI 9–45%]). Tumor‐ipsilateral taste identification (TI) decreased more in patients (−11.3%) than controls (0.8%, difference = 12.2% [95% CI 5.0–19.3%]). Suspension time was not associated with worsened taste symptoms or psychophysical changes.ConclusionsPatient‐reported taste changes after TORS are frequent. Compared to healthy controls, TORS patients have decreased tumor‐ipsilateral TI. Suspension time and GNI are unlikely to cause symptomatic TDs. Further investigations of the etiology and long‐term symptom burden of TORS‐associated TDs will aid in the management of oropharyngeal cancer patients.Level of Evidence3 (non‐randomized controlled cohort study) Laryngoscope, 133:3520–3528, 2023
Funder
National Institute on Deafness and Other Communication Disorders