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No taste anymore? Causes from post-COVID and zinc deficiency to medications and dental problems, tests, treatment, and when to see a doctor.
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When to see a doctor: taste disorder lasting more than 4 weeks, loss with accompanying symptoms, one-sided form, neurological accompanying symptoms, weight loss from loss of appetite
A taste disorder — medically dysgeusia — refers to any change in normal taste perception. This ranges from mild impairment to an altered or distorted taste and all the way to a complete loss of taste (ageusia). Taste disorders are common — about 5 percent of the population in Germany are affected on a lasting basis, considerably more from age 60.
An important distinction is between taste and smell disorders. Many people who complain of a loss of taste actually have a smell disorder — most of our "taste experience" while eating is actually smell that reaches the nose retronasally (via the throat). True isolated taste disorders — in which the taste buds themselves are affected — are rarer than smell disorders.
Taste disorders can considerably limit quality of life: food loses its appeal, which can lead to loss of appetite, weight loss, and social withdrawal. Some people experience persistently unpleasant tastes (metallic, bitter, salty) that turn every bite into an ordeal. At the same time, a taste disorder can be an early sign of serious conditions — from neurological disorders to tumors in the head and neck region.
Compared with the other senses, the sense of taste is built remarkably simply. On the tongue — and to a lesser extent on the palate and in the throat — there are about 2,000 to 5,000 taste buds, which perceive in five basic taste categories: sweet, sour, salty, bitter, and umami (savory).
These five basic tastes are carried to the brain via three different cranial nerves: the facial nerve (VII) for the front two-thirds of the tongue, the glossopharyngeal nerve (IX) for the back third, and the vagus nerve (X) for the throat and larynx region. The complex taste experience while eating only arises through the interplay with the sense of smell: as we chew, odor compounds rise via the throat to the olfactory mucosa — so-called retronasal perception. It accounts for about 80 percent of what we perceive as "taste."
From this follows the most important practical conclusion: anyone who can no longer tell coffee, wine, cheese, or a seasoned dish apart almost always has a smell disorder — the taste buds distinguish only five basic qualities. Anyone who can no longer taste simple sweetness, sourness, or saltiness, on the other hand, has a true taste disorder. In everyday clinical practice, this distinction is often what leads to the correct diagnosis in the first place.
ENT medicine distinguishes several clinical forms that are relevant in different ways for diagnosis and treatment:
Clinically, phantogeusia in particular is problematic, because it is constantly present in the background and can severely affect quality of life. It occurs especially with certain medications, after radiotherapy to the head and neck region, with chronic dental disease, or as a rare neurological manifestation.
By far the most common cause: acute viral respiratory infections. With colds and sinus infections, the nose and olfactory mucosa are congested or inflamed — the retronasal smell component largely drops out and food tastes "bland." After the infection subsides, the sense of taste usually returns fully within 1 to 2 weeks.
Chronic sinusitis can lead to a lasting retronasal ventilation problem and thus to a persistently reduced taste experience. An ENT examination with nasal endoscopy and, if needed, a CT scan of the sinuses clarifies the picture. Treatment: conservative (nasal rinses, decongestant sprays, steroid sprays) or surgical (functional endoscopic sinus surgery, FESS).
Allergic rhinitis (allergic runny nose) and nasal polyps can also strongly reduce the taste experience. Here, treating the underlying cause is part of restoring taste.
With the COVID-19 pandemic, taste and smell disorders entered everyday clinical practice as a leading symptom. SARS-CoV-2 directly damages the supporting cells of the olfactory mucosa and, secondarily, taste perception too. In the acute phase, taste and smell disorders affect 30 to 80 percent of those who fall ill, depending on the virus variant.
Course: most of those affected recover fully within 1 to 4 weeks. In about 5 to 10 percent the complaints persist for more than 6 months — this is then referred to as post-COVID dysgeusia or post-COVID anosmia. Characteristic here, not rarely, are parageusias and parosmias ("coffee tastes of gasoline," "meat smells of rot") — these can be tormenting and often take many months, sometimes years, to recede.
Treatment of post-COVID taste disorder: the most clearly proven option is olfactory training — even though it is primarily the smell disorder that is in the foreground, the taste experience benefits along with it. Patients systematically smell 4 different scents twice a day (classically: rose, eucalyptus, lemon, clove) over at least 12 weeks. If a zinc deficiency is documented, zinc supplementation can be useful. With pronounced parageusia, medications such as gabapentin or local anesthetics can be considered in individual cases — in a specialized clinic. More under loss of smell.
More than 200 medications are described as having taste disorders as a side effect. A medication-related dysgeusia is therefore one of the most important and most easily remedied causes — if it is recognized:
Important: do not stop suspect medications on your own. With pronounced dysgeusia, discuss it with a doctor — a dose reduction, a switch to a comparable substance, or supportive treatment often helps. More: drug interactions, taking medication correctly.
Zinc deficiency is one of the most important and treatable causes of taste disorders — zinc is a central component of gustin, a key protein in the taste buds. A documented deficiency leads to reduced taste and smell perception.
Risk factors for zinc deficiency: chronic gastrointestinal diseases (celiac disease, Crohn's disease, ulcerative colitis), bariatric surgery, a vegan/vegetarian diet without adequate supplementation, chronic alcohol use, older age with reduced absorption, long-term use of PPIs or diuretics, severe burns, and chronic liver disease.
Diagnosis: measurement of zinc in the serum (a fasting blood draw, as values fluctuate over the course of the day!). A value below the reference range justifies a therapeutic trial over 8 to 12 weeks with 25–50 mg of zinc per day, taken orally. Important: take zinc 2 hours apart from iron supplements, calcium, and tetracycline or fluoroquinolone antibiotics — they inhibit each other's absorption.
Other micronutrients related to taste: vitamin B12 (relevant especially in vegans and older people, and it can also lead to a burning tongue), folic acid, and iron (chronic iron-deficiency anemia). A full micronutrient screen is worthwhile with persistent taste disorders that have no other identifiable cause.
Dry mouth (xerostomia) is an extremely common, often overlooked cause of a reduced taste experience. Saliva is essential for transporting taste compounds to the taste buds. Common causes of xerostomia: many medications (antidepressants, antihistamines, diuretics, opioids), radiation to the head and neck region, Sjögren's syndrome, mouth breathing, and older age. Moisturizing mouth sprays, pilocarpine, and drinking enough fluids can improve the taste experience.
Poor oral hygiene and dental disease — caries, periodontitis, chronic gingivitis, oral thrush (Candida infection) — affect the taste experience. Bad breath and taste disorders also frequently go together. A dental overhaul with professional teeth cleaning is part of the basic workup for any unclear taste disorder.
Poorly fitting dentures can cover the palate or the back taste zones and reduce the taste experience — an adjustment by the dentist solves this. With burning mouth syndrome (BMS), taste disorders frequently occur at the same time — a specialized dental or pain-medicine assessment is sensible.
One of the more common neurological causes — in falls, traffic accidents, or sports injuries, the taste and, above all, smell nerves can be damaged. Taste and smell disorders after trauma have a rather guarded prognosis, but can recover in part.
After strokes in certain brain regions, one-sided taste disorders can occur — usually combined with other neurological deficits. In Parkinson's disease and Alzheimer's dementia, taste and especially smell disorders can be early signs — sometimes years before the motor or cognitive symptoms.
In relapses, temporary taste and smell disorders can occur. They are usually combined with other neurological symptoms such as visual disturbances or paralysis.
Tumors in the head and neck region (floor-of-mouth carcinoma, tongue carcinoma, brain tumors near the taste centers) can cause one-sided or asymmetric taste disorders — usually with further symptoms such as palpable lumps, pain, or swallowing difficulties. Very important: smoking and alcohol use markedly increase the risk.
Internal-medicine conditions also affect the taste experience: poorly controlled diabetes with autonomic neuropathy, chronic kidney disease (a uremic taste), liver cirrhosis, thyroid disorders, Sjögren's syndrome and other autoimmune diseases, and vitamin-deficiency states. A basic internal-medicine workup is part of the evaluation for persistent complaints.
With increasing age, taste perception declines physiologically — from around age 60 the number of functioning taste buds falls, saliva production decreases, and several medications affecting taste come together. Studies show that about 30 percent of people over 70 have a relevant hypogeusia — most of them without being evaluated by a doctor.
These changes are not only a comfort issue: they can lead to malnutrition and weight loss, because eating brings less pleasure. At the same time, people often over-season with salt and sugar — which is problematic with high blood pressure and diabetes. Geriatric co-management with targeted food choices (intensely flavored herbs, well-seasoned dishes, appealing presentation) can markedly improve quality of life.
See a doctor promptly if:
The workup depends on the history and accompanying symptoms:
More: preparing for a doctor's appointment, understanding blood test results.
Treatment depends on the cause — there is no single treatment for dysgeusia. The most important approaches:
With viral respiratory infections, usually spontaneous recovery within 1–2 weeks. With chronic sinusitis: nasal rinses, topical steroid sprays, and, if needed, surgical correction. With allergic rhinitis: consistent anti-allergy treatment.
Olfactory training over at least 12 weeks — smell 4 different scents twice a day for 20–30 seconds each. Supplementation in case of zinc deficiency. With pronounced parageusia, possibly gabapentin or topical local anesthetics in a specialized clinic. The course is often prolonged, but in most of those affected there is a marked improvement over the course of months to 2 years.
Identification and a doctor-guided adjustment of the suspect medication — dose reduction, switch, or discontinuation (always with medical supervision). For medications that are strictly necessary, symptomatic support with oral care, taste modification, and, if needed, zinc supplementation.
With a documented deficiency, oral supplementation: zinc 25–50 mg/day over 8–12 weeks, B12 parenterally or orally in case of deficiency, iron depending on the cause. Recheck the values after 8 to 12 weeks.
Saliva substitutes, artificial saliva, pilocarpine (with documented Sjögren's syndrome), adjustment of medication-related causes, drinking enough fluids, sugar-free gum to stimulate saliva.
A specialized clinic — treatment options: clonazepam (topically as a lozenge), gabapentin, low-dose tricyclic antidepressants, capsaicin mouth rinses, and behavioral therapy. Often prolonged courses requiring interdisciplinary care.
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