Chorda tympani nerve function after middle ear surgery

Objective: To assess chorda tympani nerve function before and after different types of middle ear surgery. The hypothesis was that in cases with cholesteatoma, iatrogenic injury to the nerve results in less postoperative taste disturbance than those undergoing myringoplasty or stapedectomy. Study Design: Prospective questionnaire study. Setting: ENT Department of a district general hospital in England. Patients: Adult patients undergoing middle ear surgery in which there would be elevation of the anulus. Main Outcome Measure: Patients' change in taste sensation after surgery with follow-up to demonstrate subsequent recovery. Results: A significantly higher incidence of taste disturbance follows myringoplasty and stapedectomy than for procedures in which the initial diagnosis was cholesteatoma, regardless of the extent of injury sustained by the nerve. The most common complaint after chorda tympani nerve injury is of a metallic taste sensation. Conclusion: Despite the small patient cohort, the results support the hypothesis that iatrogenic chorda tympani nerve injury in surgery for cholesteatoma results in less postoperative taste disturbance than that for otosclerosis. This may be because the disease process of cholesteatoma renders the nerve hypofunctional. The situation after myringoplasty is less clear. A larger study may help validate these findings.