Reimbursement and Outcome Measurement in Otolaryngology Practices: What the Government Can Do to You and for You

As Dr. Kizer said, Rapid change is possible in a large politically sensitive, financially stressed, publicly administered health care system if the simultaneous goals are improved quality, better service, and reduced costs.

Laryngoscope Highlights

Gustatory Impairment in Patients Receiving Head and Neck Radiation Therapy

The goal of radiation therapy is to cure; however, preservation of form and function in the head and neck region is also a factor when making treatment decisions, and side effects must be considered. One potential complication of radiation therapy to the head and neck is taste dysfunction, which can manifest itself as hypogeusia (partial loss), ageusia (complete loss), or dysgeusia (taste distortion). Although compromised taste function can have serious consequences for patients’ health, little protection has been afforded to the taste system during radiation therapy. The Triological Society candidate’s thesis presented by Natasha Mirza, MD, and colleagues reports on a study performed to establish the influences of ionizing radiation on both taste function and structure of patients with head and neck cancer.

The researchers studied eight patients who were to receive radiation therapy to the oral cavity; 17 patients receiving radiation for cancer in other areas of the body served as a control group. Testing was conducted for all subjects about two weeks before radiation therapy was begun, two weeks after therapy was completed, and two months and six months after radiation was completed. A well-validated regional taste test of the lingual region was used, using four stimulants: sucrose (sweet), sodium chloride (salty), citric acid (sour), and caffeine (bitter). The primary outcomes were the four test identification scores and the papillae and pore counts.

Analysis of test results for bitter and salty tastes showed a significant group effect, but no significant time effects or interaction. Sour taste analysis indicated borderline significant effects for time and a significant group-by-time interaction. Sweet taste analysis showed no significant effects of time, group, or interaction between the two factors.

Papillae and pore counts were plotted over time and by group. Significant decreases were observed from pretreatment to the first post-treatment assessment for pore count. For papillae count, there was a significant group effect but no significant time effects or interactions, and for pore count, there were significant effects for both group and group-by-time interaction.

The researchers conclude that the taste function of the head and neck cancer patients was more severely compromised than that of the control group, when there was a compromise at all. In this study, bitter, salty, and sweet tastes were not significantly impaired following radiation therapy; however, sour taste was affected significantly relative to the control group at the first postradiation test. The study also indicated a loss of lingual papillae after exposure to radiation, but by six months postradiation, papillae counts had recovered to the same level as those of the control group.