Acute Taste Dysfunction in Oropharyngeal Cancer Patients after Transoral Robotic Surgery

Abstract

Objectives: To compare taste changes after transoral robotic surgery (TORS) to taste changes in healthy controls. Methods: Oropharyngeal 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. Results: Of 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. Conclusions: Patient-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 Evidence: 3 (non-randomized controlled cohort study) Laryngoscope, 133:3520–3528, 2023.