Evaluating the Etiology of Metallic Taste During Head and Neck Cancer
Treatments: A Study of Facial and Glossopharyngeal Nerve Interactions
Abstract
Metallic Taste (MT) is frequently described during head and neck cancer
treatments but very little is known about its etiologies. One hypothesis
to explain the MT is the removal of facial nerve inhibition on the
glossopharyngeal nerve. Indeed, the decrease of taste afferents mediated
by the facial nerve (anterior two-thirds of the tongue) due to cancer or
its treatments, would reveal those mediated by the glossopharyngeal
nerve (posterior one-third of the tongue) and thus lead to MT
perception. The aim of this study was to evaluate the validity of this
hypothesis. Selective supraliminar taste tests on the tip and the base
of the tongue were regularly performed on 44 patients with head and neck
cancers before, during, and after their treatment. Sweet, salty, bitter,
sour, and MT were tested. Patients were grouped based on whether they
reported experiencing MT or not. 12 patients complained about MT
(27.2%), always during the treatment phase. Most of them (83.3%) were
treated by surgery and radiotherapy or radiochemotherapy. Supraliminar
tastes were altered in every patient, especially during the treatment
phase. Test results showed that perceived intensity was significantly
reduced in patients reporting MT for salt, sweet and sour. This was
observed more on the base of tongue than on the tip of the tongue. MT
was significantly linked with mucositis (p=0.027) but with neither
candidiasis (p=0.38) nor salivary flow (p=0.63). The hypothesis of
removal of facial nerve inhibition on the glossopharyngeal nerve cannot
explain MT in head and neck cancer.