Optical Coherence Tomography Assessment of Tongue Papillary Atrophy and Patient-Reported Impact on Taste Following Head and Neck Cancer Therapy

TL;DR

This study uses optical coherence tomography to assess tongue papilla changes in cancer survivors and links these changes to reported taste loss.

Contribution

The study introduces OCT as a non-invasive method to assess tongue papillary atrophy and its association with taste impairment in cancer patients.

Findings

Cancer patients had significantly reduced papilla height and width compared to controls.

Severe fungiform atrophy was strongly associated with patient-reported taste impairment.

Interobserver agreement for OCT assessments was substantial.

Abstract

Background: Taste disturbances are common after head and neck cancer treatment and can impair nutrition and quality of life. Aim: The aim of this study was to characterise tongue papilla morphology using optical coherence tomography (OCT), apply an ordinal atrophy grading system, and evaluate associations between structural changes and patient-reported taste outcomes. Materials and Methods: A case–control study was conducted including 53 participants: 33 head and neck cancer survivors (radiotherapy, chemotherapy, or combined treatment) and 20 healthy controls. OCT was used to assess papilla height, width, and signal intensity, and a five-point ordinal atrophy scale was applied to fungiform and filiform papillae. Taste outcomes were assessed using the UW-QOL (v4). Interobserver reliability was evaluated using Cohen’s kappa. Results: Cancer patients exhibited significantly reduced papilla height and width compared with controls (fungiform mean difference −350 µm; filiform −250 µm; all p < 0.001). Radiotherapy and combined therapy were associated with more severe atrophy than chemotherapy alone. Severe fungiform atrophy was strongly associated with patient-reported taste impact (UW-QOL taste domain; Spearman ρ = 0.80), with up to 90% reporting impairment at the highest atrophy grades. After controlling for age, the association attenuated but remained statistically significant (partial Spearman ρ = 0.39, p = 0.04; regression β = 0.14, 95% CI 0.03–0.25, p = 0.01), and it was further attenuated after additional adjustment for xerostomia (UW-QOL saliva domain; β = 0.09, 95% CI −0.02–0.20, p = 0.11). Interobserver agreement was substantial. Conclusions: OCT enables non-invasive, high-resolution assessment of tongue papillary atrophy and its cross-sectional association with patient-reported taste impact after head and neck cancer therapy. Findings should be interpreted as associative; age-matched and longitudinal studies incorporating objective taste testing are warranted.

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