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Appendices

Appendix 1. MEDLINE (OVID) search strategy

  1. exp Taste disorders/  

  2. Taste perception/                               

  3. (ageusia$ or hypogeusia$ or dysgeusia$ or parageusia$).mp.                             

  4. (taste adj3 (distort$ or dysfunction$ or disorder$ or alter$ or change$ or abnormal$ or blind$)).mp.                             

  5. (gustatory adj3 (perception$ or sensitive$ or distort$)).mp.                            

  6. or/1‐5

The above subject search was linked to the Cochrane Highly Sensitive Search Strategy (CHSSS) for identifying randomised trials in MEDLINE: sensitivity maximising version (2008 revision) as referenced in Chapter 6.4.11.1 and detailed in box 6.4.c of the Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011] (Higgins 2011).

1. randomized controlled trial.pt.
2. controlled clinical trial.pt.
3. randomized.ab.
4. placebo.ab.
5. drug therapy.fs.
6. randomly.ab.
7. trial.ab.
8. groups.ab.
9. or/1‐8
10. exp animals/ not humans.sh.
11. 9 not 10

Appendix 2. Cochrane Oral Health Group Trials Register Search Strategy

#1 ((ageusi* or hypogeusi* or dysgeusi* or parageusi*):ti,ab) AND (INREGISTER)
#2 ((taste and (distort* or dysfunction* or disorder* or alter* or change* or abnormal* or blind*)):ti,ab) AND (INREGISTER)
#3 ((gustatory and (perception* or sensitiv* or distort*)):ti,ab) AND (INREGISTER)
#4 (#1 or #2 or #3) AND (INREGISTER)

Appendix 3. Cochrane Central Register of Controlled Trials (CENTRAL) Search Strategy

#1 [mh "Taste disorders"]
#2 [mh ^"Taste perception"]
#3 (ageusi* or hypogeusi* or dysgeusi* or parageusi*)
#4 (taste near/3 (distort* or dysfunction* or disorder* or alter* or change* or abnormal* or blind*))
#5 (gustatory near/3 (perception* or sensitiv* or distort*))
#6 #1 or #2 or #3 or #4 or #5

Appendix 4. EMBASE (OVID) Search Strategy

1. Taste disorder/
2. (ageusi$ or hypogeusi$ or dysgeusi$ or parageusi$).mp.
3. (taste adj3 (distort$ or dysfunction$ or disorder$ or alter$ or change$ or abnormal$ or blind$)).mp.
4. (gustatory adj3 (perception$ or sensitiv$ or distort$)).mp.
5. or/1‐4

The above subject search was linked to the Cochrane Oral Health Group filter for identifying RCTs in EMBASE via OVID:

1. random$.ti,ab.
2. factorial$.ti,ab.
3. (cross‐over$ or cross‐over$ or cross‐over$).ti,ab.
4. placebo$.ti,ab.
5. (doubl$ adj blind$).ti,ab.
6. (singl$ adj blind$).ti,ab.
7. assign$.ti,ab.
8. allocat$.ti,ab.
9. volunteer$.ti,ab.
10. CROSS‐OVER PROCEDURE.sh.
11. DOUBLE‐BLIND PROCEDURE.sh.
12. RANDOMIZED CONTROLLED TRIAL.sh.
13. SINGLE BLIND PROCEDURE.sh.
14. or/1‐13
15. (exp animal/ or animal.hw. or nonhuman/) not (exp human/ or human cell/ or (human or humans).ti.)
16. 14 NOT 15

Appendix 5. CINAHL (EBSCO) Search Strategy

S1 (MH "Taste disorders+")
S2 TI ( (ageusi* or hypogeusi* or dysgeusi* or parageusi*) ) OR AB ( (ageusi* or hypogeusi* or dysgeusi* or parageusi*))
S3 TI ( (taste N3 (distort* or dysfunction* or disorder* or alter* or change* or abnormal* or blind*)) ) OR AB ( (taste N3 (distort* or dysfunction* or disorder* or alter* or change* or abnormal* or blind*)))
S4 TI ( (gustatory N3 (perception* or sensitiv* or distort*)) ) OR AB ( (gustatory N3 (perception* or sensitiv* or distort*)))
S5 S1 or S2 or S3 or S4

The above subject search was linked to the Cochrane Oral Health Group filter for identifying RCTs in CINAHL via EBSCO:

S1 MH Random Assignment or MH Single‐blind Studies or MH Double‐blind Studies or MH Triple‐blind Studies or MH Cross‐over design or MH Factorial Design
S2 TI ("multicentre study" or "multicenter study" or "multi‐centre study" or "multi‐center study") or AB ("multicentre study" or "multicenter study" or "multi‐centre study" or "multi‐center study") or SU ("multicentre study" or "multicenter study" or "multi‐centre study" or "multi‐center study")
S3 TI random* or AB random*
S4 AB "latin square" or TI "latin square"
S5 TI (crossover or cross‐over) or AB (crossover or cross‐over) or SU (crossover or cross‐over)
S6 MH Placebos
S7 AB (singl* or doubl* or trebl* or tripl*) or TI (singl* or doubl* or trebl* or tripl*)
S8 TI blind* or AB mask* or AB blind* or TI mask*
S9 S7 and S8
S10 TI Placebo* or AB Placebo* or SU Placebo*
S11 MH Clinical Trials
S12 TI (Clinical AND Trial) or AB (Clinical AND Trial) or SU (Clinical AND Trial)
S13 S1 or S2 or S3 or S4 or S5 or S6 or S9 or S10 or S11 or S12

Appendix 6. AMED (OVID) Search Strategy

1. Taste disorders/
2. (ageusi$ or hypogeusi$ or dysgeusi$ or parageusi$).mp.
3. (taste adj3 (distort$ or dysfunction$ or disorder$ or alter$ or change$ or abnormal$ or blind$)).mp.
4. (gustatory adj3 (perception$ or sensitiv$ or distort$)).mp.
5. or/1‐4

Appendix 7. US National Institutes of Health Trials Registry Search Strategy

Condition = Taste disorder
Condition = Taste disturbance

Appendix 8. metaRegister of Controlled Trials Search Strategy

taste AND disorder
taste AND disturbance

Appendix 9. WHO International Clinical Trials Registry Search Strategy

taste disorder
taste disturbance

Appendix 10. International Federation of Pharmaceutical Manufacturers & Associations (IFPMA) Clinical Trials Portal Search Strategy

taste disorder
taste disturbance

Appendix 11. International Association of Dental Research (IADR) Conference Abstracts

taste disorder

dysgeusia

Appendix 12. Association for the Research in Otolaryngology Conference Proceedings

taste disorder

dysgeusia

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 1

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.

Study flow diagram.
Figuras y tablas -
Figure 2

Study flow diagram.

Comparison 1 Zinc verses placebo, Outcome 1 Taste acuity improvement ‐ Patient reported outcome.
Figuras y tablas -
Analysis 1.1

Comparison 1 Zinc verses placebo, Outcome 1 Taste acuity improvement ‐ Patient reported outcome.

Comparison 1 Zinc verses placebo, Outcome 2 Taste acuity improvement ‐ Objective outcome ‐ Continuous data.
Figuras y tablas -
Analysis 1.2

Comparison 1 Zinc verses placebo, Outcome 2 Taste acuity improvement ‐ Objective outcome ‐ Continuous data.

Comparison 1 Zinc verses placebo, Outcome 3 Taste acuity improvement for different taste sensations.
Figuras y tablas -
Analysis 1.3

Comparison 1 Zinc verses placebo, Outcome 3 Taste acuity improvement for different taste sensations.

Comparison 1 Zinc verses placebo, Outcome 4 Cross‐over study.
Figuras y tablas -
Analysis 1.4

Comparison 1 Zinc verses placebo, Outcome 4 Cross‐over study.

Comparison 1 Zinc verses placebo, Outcome 5 Taste acuity improvement ‐ Objective outcome ‐ Dichotomous.
Figuras y tablas -
Analysis 1.5

Comparison 1 Zinc verses placebo, Outcome 5 Taste acuity improvement ‐ Objective outcome ‐ Dichotomous.

Comparison 1 Zinc verses placebo, Outcome 6 Adverse events.
Figuras y tablas -
Analysis 1.6

Comparison 1 Zinc verses placebo, Outcome 6 Adverse events.

Comparison 2 Acupuncture versus sham control, Outcome 1 Taste discrimination.
Figuras y tablas -
Analysis 2.1

Comparison 2 Acupuncture versus sham control, Outcome 1 Taste discrimination.

Summary of findings for the main comparison. Zinc compared to placebo for the management of taste disturbances

Zinc compared to placebo for the management of taste disturbances

Patient or population: patients with taste disturbances
Settings:
Intervention: zinc
Comparison: placebo

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Placebo

Zinc

Taste acuity improvement ‐ Patient reported outcome
Visual analog scale (VAS)/questionnaire
Follow‐up: mean 3 months

Study population

RR 1.45
(1.0 to 2.10)

119
(2 studies)

⊕⊝⊝⊝
very low1,2,3

˗407 per 1000

590 per 1000
(407 to 854)

Moderate

382 per 1000

554 per 1000
(382 to 802)

Taste acuity improvement ‐ Objective outcome ‐ Continuous ‐ Overall taste improvement
Different taste detection and recognition methods
Follow‐up: mean 3 months

The mean taste acuity improvement ‐ objective outcome ‐ continuous ‐ overall taste improvement in the intervention groups was
0.44 standard deviations higher
(0.23 to 0.65 higher)4

366
(3 studies)

⊕⊕⊕⊝
moderate3

SMD 0.44 (0.23 to 0.65)

Taste acuity improvement ‐ Objective outcome ‐ Continuous ‐ Taste recognition

The mean taste acuity improvement ‐ objective outcome ‐ continuous ‐ taste recognition in the intervention groups was
1.26 standard deviations higher
(0.07 to 2.44 higher)

14
(1 study)

⊕⊝⊝⊝
very low2,5,6

Standardised mean difference (SMD) 1.26 (0.07 to 2.44)

Taste acuity improvement ‐ Objective outcome ‐ Dichotomous ‐ Idiopathic and zinc deficient taste disorders
Follow‐up: mean 3 months

Study population

RR 1.7
(1.2 to 2.01)

73
(1 study)

⊕⊕⊝⊝
low1,3

444 per 1000

756 per 1000
(533 to 893)

Moderate

444 per 1000

755 per 1000
(533 to 892)

Adverse events

Study population7

RR 6.21
(1.12 to 34.37)

335
(3 studies8)

1 per 1000

6 per 1000
(1 to 34)

Moderate

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Risk of bias: unclear randomisation and blinding and high risk of bias due to attrition in Sakai 2002. Downgraded by 1 level.
2 Serious Imprecision: The CI of the effect estimate indicates no difference as well as appreciable benefit with zinc. Downgraded by 1 level.
3 Publication bias: Data from Jprn‐C 2013 (awaiting classification) with 150 participants, is unavailable as the authors refused to share data prior to publication.
4 Data from Mahajan 1980 and Eggert 1982 are not included in this analysis. In the Mahajan 1980 trial, zinc was appreciably better than placebo for salt, sweet and bitter taste acuity but not for sour taste. In the Eggert 1982 trial, taste detection and recognition improved in the zinc group compared to placebo.
5 Incomplete data due to attrition bias and other bias, such as inclusion of one 3‐year old child, possibility of carry‐over effect.
6 Inconsistency in outcome assessment: smile or grimace were considered as outcome for 6 month‐old, 3‐ and 5‐year old children.

7Risk of one per 1000 assumed in placebo group (as it was zero).

8Sakagami 2009 was not included in the grading of evidence as the number of patients reporting adverse events was not reported.

Figuras y tablas -
Summary of findings for the main comparison. Zinc compared to placebo for the management of taste disturbances
Summary of findings 2. Acupuncture compared to sham control for patients with taste disturbances

Acupuncture compared to sham control for patients with taste disturbances

Patient or population: patients with taste disturbances
Settings: hospital
Intervention: acupuncture
Comparison: sham control

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

No of Participants
(studies)

Quality of the evidence
(GRADE)

Comments

Assumed risk

Corresponding risk

Sham control

Acupuncture

Taste discrimination

The mean taste discrimination in the intervention groups was
2.8 higher than sham control
(‐1.18 to 6.78)

37
(1 study)

⊕⊕⊝⊝
low1,2

*The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval;

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate.

1 Single‐blinded study.
2 The CI of the effect estimate indicates no difference as well as appreciable benefit with acupuncture. Downgraded by 1 level.

Figuras y tablas -
Summary of findings 2. Acupuncture compared to sham control for patients with taste disturbances
Table 1. Ikeda 2013 ‐ Continuous data

Outcome

Gp A

Gp B

Time when measured

Mean*

S.D.

n=

Mean*

S.D.

n=

Change of the mean 4 basic taste

sensitivity scores from baseline

‐0.52

0.68

108

‐0.47

0.61

111

4 weeks

‐0.90

0.85

108

‐0.67

0.73

111

8 weeks

‐1.17

0.93

108

‐0.85

0.75

111

12 weeks

‐1.28

0.94

108

‐0.97

0.76

111

4 weeks after treatment

*Minus change score means better by filter paper disc method by Tomita

Figuras y tablas -
Table 1. Ikeda 2013 ‐ Continuous data
Table 2. Ikeda 2013 ‐ Dichotomous data

Outcome

Gp A events (Improved)

Gp A total

Gp B events

Gp B total

Time when measured

Improved/not improved

60

108

48

111

12 weeks

Figuras y tablas -
Table 2. Ikeda 2013 ‐ Dichotomous data
Table 3. Sakagami 2009 ‐ Continuous data

Outcome

Gp A

(Placebo)

N = 27

Gp B

(17 mg zinc)

N = 27

Gp C

(34 mg zinc)

N = 25

Gp D

(68 mg zinc)

N = 28

Time when measured

Secondary outcome

Mean

Std Dev

Mean

Std Dev

Mean

Std Dev

Mean

Std Dev

12 weeks

Mean filter paper disk test scores (filter paper disk)

4.095

1.148

4.350

1.030

3.448

0.928

3.454

1.138

Mean serum zinc level

1.8

12.7

5.7

13.5

11.4

16.6

20.6

21.3

Gp A

Gp B

Gp C

Gp D

Increase in the average score of subjective symptoms

0.6

0.9

1.2

1.0

Figuras y tablas -
Table 3. Sakagami 2009 ‐ Continuous data
Table 4. Sakagami 2009 ‐ Dichotomous data

Primary outcome: quantitative analysis of taste

perception using filter paper disk method

Event (success)

Cured + improved

No event (fail)

Unchanged, neither cured nor improved nor worsened;

aggravated

Total

Experimental intervention (17 mg Zinc)

SE= 14

FE= 13

NE= 27

Control intervention

(Placebo)

SC= 17

FC= 10

NC= 27

RR = 0.824; OR = 0.634; RD = 0.447

Experimental intervention (34 mg Zinc)

SE= 20

FE= 5

NE= 25

Control intervention

(Placebo)

SC= 17

FC= 10

NC= 27

RR = 0.318; OR = 2.353; RD = 0.17

Experimental intervention (68 mg Zinc)

SE= 25

FE= 3

NE= 28

Control intervention

(Placebo)

SC= 17

FC= 10

NC= 27

RR = 1.418; OR = 4.902; RD = 0.263

RR = risk ratio: risk of event in experimental group/risk of event in control group.

OR = odds ratio: odds of event in experimental group/ odds of event in control group.

RD = risk difference: risk of event in experimental group – risk of event in control group.

Figuras y tablas -
Table 4. Sakagami 2009 ‐ Dichotomous data
Table 5. Sakai 2002

Filter paper disk method

Event (success)

Improved (+cured)

No event (fail)

Unchanged

Total (N = 73)

Experimental intervention (Zinc picolinate)

SE= 28

FE= 9

NE= 37

Control intervention (Placebo)

SC= 16

FC= 20

NC= 36

RR = 1.703; OR = 3.889; RD = 0.312

Experimental intervention (Zinc picolinate)

SE= 22

FE= 12

NE= 34

Control intervention (Placebo)

SC= 18

FC= 17

NC= 35

RR = 1.258 ; OR = 1.732; RD = 0.133

RR = risk ratio: risk of event in experimental group/risk of event in control group.

OR = odds ratio: odds of event in experimental group/ odds of event in control group.

RD = risk difference: risk of event in experimental group – risk of event in control group.

Figuras y tablas -
Table 5. Sakai 2002
Table 6. Heckman 2005 ‐ Continuous data

Outcome

Gp A

(Zinc treatment)

Gp B

(Placebo)

Time when

measured

Mean

Std Dev

N=

Mean

Std Dev

N=

At the end of

3 months

Primary outcome

Taste test (32 filter paper strip method by Muller et al 2003)

25.7

6.5

26

21.2

5.7

24

Self rated impairment in %

(VAS scale of 10 cm length equivalent to 100%;

0 to 10. 0 = no impairment and 10 = extremely impaired)

45.0

4.4

26

43.8

3.6

24

Secondary outcome

Beck Depression Inventory (BDI)

7.5

7.0

26

11.3

10.9

24

von Zersen Mood Scale (ZMS)

10.7

7.5

26

18.8

14.6

24

Zinc in serum (microgram/dL)

81.53

19.61

26

72.01

10.22

24

Figuras y tablas -
Table 6. Heckman 2005 ‐ Continuous data
Table 7. Heckman 2005 ‐ Dichotomous data

Type of Intervention

Event (success)

Improved

No event (fail)

Total

Experimental intervention (Zinc)

SE= 13

FE= 13

NE= 26

Control intervention

SC= 6

FC= 18

NC= 24

RR = 2; OR = 3; RD = 0.25

RR = risk ratio: risk of event in experimental group/risk of event in control group.

OR = odds ratio: odds of event in experimental group/ odds of event in control group.

RD = risk difference: risk of event in experimental group – risk of event in control group.

Figuras y tablas -
Table 7. Heckman 2005 ‐ Dichotomous data
Table 8. Brandt 2008

Outcome

Gp A

Gp B

Time when

measured

Mean

Std Dev*

N=17

Mean

Std Dev*

N=20

Taste discrimination

11.7 (before)/

17.5 (after)

4 (before)/
7 (after)

11.9 (before)/

14.7(after)

5 (before)/
5 (after)

Before and after treatment

Quality of life

Not estimable (changes per group only given for each of the 5 individual questions of the questionnaire, but no combined score/analysis stated) Only information given: ‘both treatments resulted in an increased quality of life, however, no statistically significant difference could be found’

Before and after treatment

Depressive symptoms

11 (before)/

6 (after)*

5 (before) /

4 (after)*

10,5 (before)/

10 (after)*

7 (before)/

7 (after)*

Before and after treatment

“The psychological well‐being of the intervention groups increased for 94,1% of all patients in the intervention group, but only for 60% of patients in the control group. This difference was statistically significant”

Subjective well‐being

16 (before)/

12 (after)*

10 (before)/

7 (after)*

20 (before)/

18 (after)*

9 (before)/

14 (after)*

Before and after treatment

“58.8% of all patients in the intervention group felt better, whereas only 45% of all patients in the control group felt better. This difference was not statistically significant”

*Only given in graph ‐> estimated from graph

Figuras y tablas -
Table 8. Brandt 2008
Table 9. Sakai 2002 ‐ Adverse events

Outcome

Gp A – Zinc picolinate

events

Gp A total

Gp B – Placebo

Events

Gp B total

Time when measured

Adverse events

6

37

0

36

3 months

Figuras y tablas -
Table 9. Sakai 2002 ‐ Adverse events
Table 10. Sakagami 2009 ‐ Adverse events

Outcome

Gp A ‐ 17 mg Zinc events

Gp A total

Gp B – 34 mg zinc Events

Gp B total

Gp C – 68 mg zinc events

Gp C total

Gp D ‐ Placebo events

Gp D total

Time when measured

Side effects

5

27

6

25

7

28

3

27

12 weeks

Figuras y tablas -
Table 10. Sakagami 2009 ‐ Adverse events
Comparison 1. Zinc verses placebo

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Taste acuity improvement ‐ Patient reported outcome Show forest plot

2

119

Risk Ratio (M‐H, Fixed, 95% CI)

1.45 [1.00, 2.10]

2 Taste acuity improvement ‐ Objective outcome ‐ Continuous data Show forest plot

3

366

Std. Mean Difference (IV, Fixed, 95% CI)

0.44 [0.23, 0.65]

3 Taste acuity improvement for different taste sensations Show forest plot

1

Mean Difference (IV, Fixed, 95% CI)

Totals not selected

3.1 Salt

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.2 Sweet

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.3 Sour

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

3.4 Bitter

1

Mean Difference (IV, Fixed, 95% CI)

0.0 [0.0, 0.0]

4 Cross‐over study Show forest plot

1

14

Mean Difference (IV, Fixed, 95% CI)

3.00 [0.66, 5.34]

5 Taste acuity improvement ‐ Objective outcome ‐ Dichotomous Show forest plot

2

Risk Ratio (M‐H, Fixed, 95% CI)

Subtotals only

5.1 Idiopathic and zinc deficient taste disorders

1

73

Risk Ratio (M‐H, Fixed, 95% CI)

1.70 [1.13, 2.56]

5.2 Taste disorder secondary to chronic renal failure

1

24

Risk Ratio (M‐H, Fixed, 95% CI)

25.0 [1.65, 379.57]

6 Adverse events Show forest plot

3

335

Risk Ratio (M‐H, Fixed, 95% CI)

6.21 [1.12, 34.37]

Figuras y tablas -
Comparison 1. Zinc verses placebo
Comparison 2. Acupuncture versus sham control

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Taste discrimination Show forest plot

1

37

Mean Difference (IV, Fixed, 95% CI)

2.80 [‐1.18, 6.78]

Figuras y tablas -
Comparison 2. Acupuncture versus sham control