Interventions for managing taste disturbances

What is the aim of this review?

The aim of this Cochrane Review was to find out what is the best method for the management of zinc-deficient/idiopathic (of unknown cause) taste disorders and taste disorders secondary to chronic renal failure in children and adults.

Key messages

Giving zinc supplements or acupuncture may have some benefit in treating taste disorders. However, we still need more high-quality studies to ascertain the role of zinc supplements and acupuncture in treating taste disorders.

What was studied in the review?

The sense of taste is essential to the health and psychological well-being of an individual. Taste disorders can range from lack of taste, to distortion of taste, to reduced ability to taste. Any disorder in taste perception can lead to conditions like malnutrition and consumption of poisonous food substances. The cause may be due to disease, drugs, radiation treatment, or ageing; or it may result from unknown causes.

Various treatment methods have been used to improve taste sensation. These include the use of zinc compounds, pilocarpine, alpha lipoic acid, transcranial magnetic stimulation, ginkgo biloba and acupuncture.

What are the main results of the review?

We collected and analysed all relevant studies to answer this question and found 10 trials in which a total of 581 subjects received different treatments. Nine trials assessed the benefits of zinc compounds and one trial assessed the effects of acupuncture. We only included studies on taste disorders in this review that were either idiopathic, or resulting from zinc deficiency or chronic renal failure.

Two trials were from Germany, three from Japan, two from the UK, and three from the US. These studies compared zinc with placebo or acupuncture with sham procedure for patients with taste disorders. Two were government funded, three were privately funded, two were funded by a pharmaceutical company and three trials did not mention funding details.

When patients with taste disorders are given zinc, compared to placebo:

- we found very low-quality evidence that was insufficient to conclude on the role of zinc supplements to improve taste acuity reported by patients and very low-quality evidence that zinc supplements improve taste acuity in patients with zinc deficiency/idiopathic taste disorders;
- zinc supplementation showed adverse events like eczema, nausea, abdominal pain, diarrhoea, constipation, decrease in blood iron, increase in blood alkaline phosphatase and minor increase in blood triglycerides;
- no studies were found that looked at improvement in taste discrimination or quality of life.

When patients with taste disorders are given acupuncture, compared to sham procedure:

- we found very low-quality evidence that is not sufficient to conclude on the role of acupuncture for improving taste discrimination in cases of idiopathic dysgeusia (distortion of taste) and hypogeusia (reduced ability to taste);
- acupuncture trial did not show adverse events;
- no studies were found that looked at improvement in taste acuity or quality of life.

We were unable to draw any conclusions regarding the superiority of zinc supplements or acupuncture as none of the trials compared these interventions.

How up-to-date is this review?

We searched for studies that had been published up to 4 July 2017.

Authors' conclusions: 

We found very low-quality evidence that was insufficient to conclude on the role of zinc supplements to improve taste acuity reported by patients and very low-quality evidence that zinc supplements improve taste acuity in patients with zinc deficiency/idiopathic taste disorders. We did not find any evidence to conclude the role of zinc supplements for improving taste discrimination, or any evidence addressing health-related quality of life due to taste disorders.

We found very low-quality evidence that is not sufficient to conclude on the role of acupuncture for improving taste discrimination in cases of idiopathic dysgeusia (distortion of taste) and hypogeusia (reduced ability to taste). We were unable to draw any conclusions regarding the superiority of zinc supplements or acupuncture as none of the trials compared these interventions.

Read the full abstract...
Background: 

The sense of taste is very much essential to the overall health of an individual. It is a necessary component to enjoy one's food, which in turn provides nutrition to an individual. Any disturbance in taste perception can hamper quality of life in such patients by influencing their appetite, body weight and psychological well-being. Taste disorders have been treated using different modalities of treatment and there is no consensus for the best intervention. Hence this Cochrane Review was undertaken. This is an update of the Cochrane Review first published in November 2014.

Objectives: 

To assess the effects of interventions for the management of patients with taste disturbances.

Search strategy: 

Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 4 July 2017); the Cochrane Central Register of Controlled Trials (CENTRAL; 2017 Issue 6) in the Cochrane Library (searched 4 July 2017); MEDLINE Ovid (1946 to 4 July 2017); Embase Ovid (1980 to 4 July 2017); CINAHL EBSCO (1937 to 4 July 2017); and AMED Ovid (1985 to 4 July 2017). The US National Institutes of Health Ongoing Trials Register ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for trials. Abstracts from scientific meetings and conferences were searched on 25 September 2017. No restrictions were placed on the language or date of publication when searching the electronic databases.

Selection criteria: 

We included all randomised controlled trials (RCTs) comparing any pharmacological agent with a control intervention or any non-pharmacological agent with a control intervention. We also included cross-over trials in the review.

Data collection and analysis: 

Two pairs of review authors independently, and in duplicate, assessed the quality of trials and extracted data. Wherever possible, we contacted trial authors for additional information. We collected adverse events information from the trials.

Main results: 

We included 10 trials (581 participants), nine of which we were able to include in the quantitative analyses (566 participants). We assessed three trials (30%) as having a low risk of bias, four trials (40%) at high risk of bias and three trials (30%) as having an unclear risk of bias. We only included studies on taste disorders in this review that were either idiopathic, or resulting from zinc deficiency or chronic renal failure.

Of these, nine trials with 544 people compared zinc supplements to placebo for patients with taste disorders. The participants in two trials were children and adolescents with respective mean ages of 10 and 11.2 years and the other seven trials had adult participants. Out of these nine, two trials assessed the patient-reported outcome for improvement in taste acuity using zinc supplements (risk ratio (RR) 1.40, 95% confidence interval (CI) 0.94 to 2.09; 119 participants, very low-quality evidence). We meta-analysed for taste acuity improvement using objective outcome (continuous data) in idiopathic and zinc-deficient taste disorder patients (standardised mean difference (SMD) 0.44, 95% CI 0.23 to 0.65; 366 participants, three trials, very low-quality evidence). We also analysed one cross-over trial separately using the first half of the results for taste detection (mean difference (MD) 2.50, 95% CI 0.93 to 4.07; 14 participants, very low-quality evidence), and taste recognition (MD 3.00, 95% CI 0.66 to 5.34; 14 participants, very low-quality evidence). We meta-analysed taste acuity improvement using objective outcome (dichotomous data) in idiopathic and zinc-deficient taste disorder patients (RR 1.42, 95% 1.09 to 1.84; 292 participants, two trials, very low-quality evidence). Out of the nine trials using zinc supplementation, four reported adverse events like eczema, nausea, abdominal pain, diarrhoea, constipation, decrease in blood iron, increase in blood alkaline phosphatase, and minor increase in blood triglycerides.

One trial tested taste discrimination using acupuncture (MD 2.80, 95% CI -1.18 to 6.78; 37 participants, very low-quality evidence). No adverse events were reported in the acupuncture trial.

None of the included trials could be included in the meta-analysis for health-related quality of life in taste disorder patients.

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