Volume 5, Issue 8, August – 2020 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Post-Tonsillectomy Taste Disturbance;

An Unusual Complication of Tonsillectomy
1
Md. Ashraful Islam, Professor and Head,
Otolaryngology-Head & Neck Surgery,
Bangladesh Medical College Hospital
2 3 4
Nazmul Hossain Chowdhury, Tareq Mohammad, Assistant Towsif Bin Mamoon, Assistant
Assistant Professor, Registrar, Registrar,
Dept. of ENT-HNS, Bangladesh Dept. of ENT, Bangladesh Medical Dept. of ENT, Bangladesh Medical
Medical College Hospital College Hospital College Hospital
5 6 7
Saif Rahman Khan, ASM Lutfur Rahman, Farid Uddin Milki,
Assistant registrar, Resident Surgeon, Consultant ENT,
Dept. ENT, National Institute of ENT Bangladesh Medical College Hospital Bangladesh Medical College Hospital

Abstract:- Tonsillectomy is a very common operation to II. ANATOMY AND PHYSIOLOGY OF TASTE
the otolaryngologist and relatively safe in expert hand.
Sometimes it bothers the surgeon for its acute and Taste is a special sensation associated with the
chronic post-operative complications like reactionary primary organ tongue that contains taste reception. There
hemorrhage, throat pain, referred otalgia, dehydration, are other taste receptors on the tonsillar pillars, palate,
velopharyngeal incmpetnce, burns of uvula, soft-tissue epiglottis and upper esophagus5. Three types of papillae
injury, dento-mandibular trauma, and respiratory namely circumvallate, fungiform and foliate present on
compromise. Although rare, it is often associated with different sites of the tongue. Developmentally anterior 2/3rd
altered taste and temporary or long continued loss of of the tongue originates from the 1st and 2nd pharyngeal
taste sensation. In this article, the authors reported 39 arches. This part gets its somatosensation from the
(3.9%) cases of disturbance of taste sensation among mandibular division of the trigeminal nerve and taste
1000 post-tonsillectomy patients during the period 2015 sensation from the chorda tympani branch of the facial
to 2018 in the Bangladesh medical College Hospital. Age nerve. The greater superficial petrosal branch of this nerve
of the patents was ranged in between 20 to 30 year. The innervates taste buds on the soft palate. The posterior 1/3rd
study was aimed to find out the possible cause of taste of the tongue develops from the third pharyngeal arch; and
disturbance in the post-tonsillectomy patients and derives both taste and somatosensation from the
obtain informed written consent prior to tonsillectomy. Glossopharyngeal nerve. It also innervates the upper part of
epiglottis. Rest of epiglottis, esophageal area, tonsillar
Keywords:- Post-Tonsillectomy, Taste Disturbance, pillars and root of the tongue derive from the branches of
Complication. vagus nerve6,7.

I. INTRODUCTION These three cranial nerves carry taste sensation to the

medulla then to the thalamus and finally to the primary
Tonsillectomy is the most commonly performed gustatory cortex which is responsible for taste sensation. It
operation in otolarynological practice. The surgery is is mentioned here that there is a close relation between taste
relatively safe but occasionally it gives horrifying troubles and smell sensation; and as such when this area receives
to the surgeon for its acute and chronic complications. The signals from taste buds, it also receives information about
complications are mostly hemorrhage, painful throat, the smell as well8. However, ultimately they can recognize
difficulty in swallowing, referred otalgia, burns of uvula, the different forms of tastes include salty, acidic, sweet,
soft-tissue injury, dento-mandibular trauma, bitter, and umami (protein).
velopharyngeal incompetence and respiratory compromise.
Although rare, it is often associated with altered taste and III. TASTE DISTURBANCE
temporary or long continued loss of taste sensation that is
an unusual complication of tonsillectomy. Taste gives Taste may be disturbed in various conditions namely
pleasure in eating and drinking. It satisfies hunger and common cold, allergic rhinitis, injury to the chorda tympani
carries important physiologic functions which helps to nerve, Bell palsy, radiation therapy and many more. It
distinguish nutrients from toxins, facilitates digestion; and causes a refractory to decrease in appetite leading to less
regulates salt and energy intake1. Malnourishment, weight food intake causing weight loss. Adenoid hypertrophy
gain or loss happen mostly due to taste disorders. The study disturbs taste in relation with smell8. Zinc deficiency and
was aimed to find out the possible cause of taste many drugs like metronidazole, antibiotics and antifungal
disturbance in the post-tonsillectomy patients and obtain may affect taste9, 10. Many surgeries such as tonsillectomy11,
12
informed written consent prior to tonsillectomy. , middle ear surgery13-15, direct laryngoscopy16,

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Volume 5, Issue 8, August – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
uvulopalatopharyngoplasty17 may lead to taste disturbance. IV. PATIENTS AND METHODS
Appropriate history and physical examination are more
than ever essential to diagnose the post-tonsillectomy taste  Study design:
disturbance.  Study type: Retrospective study
 Study period: From 2015 to 2018.
This study was conducted in the Bangladesh Medical  Study place: Bangladesh Medical College
College Hospital from 20015 to 2018. 1000 adult patient Hospital
underwent tonsillectomy, age ranged in between 20-40  Study Sample number: 1000 patients
years. Among them 39 patients developed taste disturbance  Study population: Age ranged 20-40 year
after 1 month of operation. These patient kept under regular  Evaluation period: 1 month to 6 months after
surveillance and monitoring for a period of 6 months. operation.
 Sampling type: Random sampling
 Effects of tonsillectomy on taste
 Diagnosis and questionaries’ : Appropriate history and
Tonsillectomy is one of the most common surgeries in
physical examination
otolaryngological practice all over the world. Although
rare, taste dysfunction occurs in some patients. The
 Inclusion criteria:
possibilities are described differently in different literatures
and documented2-4:  Patient complaining of post-operative taste disturbance.
 Injury to nerve: direct or indirect damage to the  Patient not regaining taste sensation after 1 month of
glossopharyngeal nerve (GN) or its lingual branch operation.
(LBGN). The course of the LBGN to the muscle layer
of the palatine tonsillar bed is variable. They usually  Evaluation method:
travel between the superior and middle pharyngeal  Taste disturbance persisted up to 1 month post
constrictor muscles, but at times may remain partially operatively- Transient taste disturbance
exposed or adherent to the tonsillar capsule. During  Taste sensation regained within 6 month - Temporary
dissection, this can lead to the injury of the lingual taste disturbance
branch of the glossopharyngeal nerve11,12  Taste disturbance persisted after 6 month – permanent
 Operation duration: it is observed that jeopardy of the taste disturbance.
microcirculation to the tongue by tongue blade of mouth
gag due to prolong compression can lead damage to the  Exclusion criteria:
taste buds  Age below 20 years
 Injury to tonsillar bed: injury or damage to the muscle  Patient having history of rhinitis.
layer of the tonsillar bed or capsule lead to fibrosis of  Patient history of drug intake.
the muscles during healing process that in turn results  Patient having history of diabetes mellitus.
disorder of the LBGN.
 Operation:
 Objective:  Methods
The study was aimed to find out the possible cause of  Bipolar diathermy
taste disturbance in the post-tonsillectomy patients and  Dissection method
obtain informed written consent prior to tonsillectomy.  Operation time: 30 minutes average

V. RESULTS

Age in years Male (%) Female (%)

20-30 345 (35%) 230 (23%)
31-40 265 (27%) 170 (17%)
Table 1:- age and sex distribution (n 1000)

Temporary taste disturbance (%) Number of patents %

Male 17 1.7
Female 22 2.2
Table 2:- Taste disturbance post-tonsillectomy patients after 1 month (n 1000)

Taste regained No of patients %

Male 05 13
Female 04 10
Table 3:- Follow up after 3 month of operation (n 39)

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Volume 5, Issue 8, August – 2020 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Taste regained No of patients %
Male 12 40
Female 18 60
Table 4:- Follow up after 6 month of operation (n 30)

VI. DISCUSSION tissue for the normal functioning of the taste buds21. In our
study, operation time taken by all surgeons rating from
Taste disturbance is an uncommon complication trainee to an experienced surgeons was on average 30
following tonsillectomy. There are a few studies have been minutes. Experienced surgeon took only 10 to 15 minutes
found regarding post-tonsillectomy taste disturbances till to in our hospital setting.
date. This condition is so horrifying that may produce a
long-term nutritional deficiency resulting weight loss and VII. CONCLUSION
decrease quality of life10,18.
Taste disturbance after tonsillectomy is a rare
In our study we found complaints of taste disturbance complication but has a significant impact on quality of life
more common in 20-40 years of age and is slightly higher of patients. Meticulous dissection, avoidance of injuring the
in female which corresponds to other study19. lower pole of the tonsil and judicious use of
electrocautery/bipolar diathermy can save the LBGN. It
In this study it was relevant to the fact that following also reduce the time of operation for all-out safety of the
tonsillectomy most of the patients develop taste disturbance patients.
but all patients except 3.9 % regained their taste after 7 to
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