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September 11, 1991

Salty and Bitter Taste-Reply

Author Affiliations

The Taste and Smell Clinic Washington, DC

The Taste and Smell Clinic Washington, DC

JAMA. 1991;266(10):1360. doi:10.1001/jama.1991.03470100052024

In Reply.  —I was pleased to learn that Dr Hirsch has been able to care for patients with phantogeusia1 since it is such a pervasive and distressing symptom. However, his letter distorts the intent of my response2 and the actual cause in patients who present with the symptom. In the first in-depth discussion of this symptom,3I described 49 patients in whom 39% had an idiopathic cause, but 31% developed the symptoms following influenza, 14% following a head injury, 6% associated with allergic rhinitis, 4% after some operative procedure unrelated to the oral cavity, and the remainder with a variety of medical conditions. To emphasize exclusively an idiopathic cause for this symptom neglects the majority of patients who present with known, specific medical diagnoses.Most patients are distressed by their phantogeusia and some element of anxiety and depression is present since they perceive a disturbing oral symptom