Nasal Bitter Taste Testing as A Screening Tool for Chronic Rhinosinusitis.

Nasal Bitter Taste Testing as A Screening Tool for Chronic Rhinosinusitis. | Authorea try { document.documentElement.classList.add('js'); } catch (e) { } var _gaq = _gaq || []; _gaq.push(['_setAccount', 'G-8VDV14Y67G']); _gaq.push(['_trackPageview']); (function() { var ga = document.createElement('script'); ga.type = 'text/javascript'; ga.async = true; ga.src = ('https:' == document.location.protocol ? 'https://ssl' : 'http://www') + '.google-analytics.com/ga.js'; var s = document.getElementsByTagName('script')[0]; s.parentNode.insertBefore(ga, s); })(); Skip to main content Preprints Collections Wiley Open Research IET Open Research Ecological Society of Japan All Collections About About Authorea FAQs Contact Us Quick Search anywhere Search for preprint articles, keywords, etc. Search Search ADVANCED SEARCH SCROLL Clinical Otolaryngology This is a preprint and has not been peer reviewed. Data may be preliminary. 5 February 2025 V1 Latest version Share on Nasal Bitter Taste Testing as A Screening Tool for Chronic Rhinosinusitis. Authors : Shankar Ramasundram , Ramiza Ramza 0000-0001-8196-321X [email protected] , Norasnieda Md Shukri , Sakinah Mohamad , and Sivakumar Kumarasamy Authors Info & Affiliations https://doi.org/10.22541/au.173873372.22450239/v1 353 views 156 downloads Contents Abstract Supplementary Material Information & Authors Metrics & Citations View Options References Figures Tables Media Share Abstract not-yet-known not-yet-known not-yet-known unknown Objectives. The expression and functionality of bitter taste receptors (T2Rs) in the sinonasal mucosa have been linked to variations in chronic rhinosinusitis (CRS) severity and susceptibility, suggesting a potential therapeutic target for managing this chronic condition. This study is aimed at developing a screening method to detect the bitter taste receptor in the nose and its sensitivity between healthy individuals and those with CRS using available bitter ligands therefore coming up with a suitable titration of this ligand for future use. Methods. A cross-sectional study of 84 adults (42 with chronic rhinosinusitis and 42 healthy controls) evaluated nasal glucose levels and phenylthiocarbamide (PTC) taste sensitivity. Colorimetric and statistical tests were used to analyse PTC threshold values and nasal glucose levels. Results. Based on 0.13% as the most suitable dilution for intranasal testing of PTC, there is an association between nasal bitter taste testing among CRS and control groups with a P value of <0.001. Conclusions. The bitter taste testing on the nose seems to be a simple and inexpensive way for screening patients with CRS. The titration and intranasal sites suggested in this study can be used as a basis for further prospective studies to view the outcome of patients with CRS. Targeting these receptors in diagnostic could open a new window of opportunity in the management of patients with CRS. Nasal Bitter Taste Testing as A Screening Tool for Chronic Rhinosinusitis. Abstract Objectives. The expression and functionality of bitter taste receptors (T2Rs) in the sinonasal mucosa have been linked to variations in chronic rhinosinusitis (CRS) severity and susceptibility, suggesting a potential therapeutic target for managing this chronic condition. This study is aimed at developing a screening method to detect the bitter taste receptor in the nose and its sensitivity between healthy individuals and those with CRS using available bitter ligands therefore coming up with a suitable titration of this ligand for future use. Methods. A cross-sectional study of 84 adults (42 with chronic rhinosinusitis and 42 healthy controls) evaluated nasal glucose levels and phenylthiocarbamide (PTC) taste sensitivity. Colorimetric and statistical tests were used to analyse PTC threshold values and nasal glucose levels. Results. Based on 0.13% as the most suitable dilution for intranasal testing of PTC, there is an association between nasal bitter taste testing among CRS and control groups with a P value of Conclusions. The bitter taste testing on the nose seems to be a simple and inexpensive way for screening patients with CRS. The titration and intranasal sites suggested in this study can be used as a basis for further prospective studies to view the outcome of patients with CRS. Targeting these receptors in diagnostic could open a new window of opportunity in the management of patients with CRS. Key words: Bitter taste testing, Chronic rhinosinusitis, Phenylthiocarbamide (PTC), Nasal taste receptors, Serial dilution method, Bitter taste receptors, Phenylthiocarbamide Five succinct key points 1. Bitter Taste Receptors as Diagnostic Tools: To screen for chronic rhinosinusitis (CRS), the study investigates the possibility of employing nasal bitter taste receptors (T2Rs) as a non-invasive, economical method. It implies that identifying a person’s sensitivity to bitter tastes in the nose can aid in distinguishing between healthy people and those who have CRS. 2. Study Design and Population: Eighty-four adults, equally split between CRS patients and healthy controls, participated in a cross-sectional study. To assess the existence and functionality of nasal bitter taste receptors, the study assessed nasal glucose levels and phenylthiocarbamide (PTC) taste sensitivity. 3. Results and Findings: With a P value of less than 0.001, the study discovered a strong correlation between nasal bitter taste testing and CRS. It was shown that 0.13% was the best dilution for intranasal PTC testing. Nasal glucose concentrations were greater in CRS patients than in healthy controls. 4. Implications for CRS Management: According to the results, testing for nasal bitter taste may be a quick and efficient way to check for CRS. This method may lessen the need for more costly and intrusive diagnostic techniques like CT imaging and nasal endoscopy. 5. Future Research Directions: The study emphasises the necessity of more prospective research to support the application of nasal bitter taste testing in clinical settings. Additionally, it implies that focussing on bitter taste receptors may lead to novel approaches to the treatment and management of CRS. INTRODUCTION Chronic rhinosinusitis (CRS) afflicts about 28.5 million persons (15.5%) in the United States, making it the second most common chronic disease. Incidence in Europe and South Korea stands at 10.9% and 6.95%, respectively 1-3 . CRS poses a significant socioeconomic burden, with 11.6 million doctor appointments in 2000, high medical costs averaging USD$921 per patient per annum, and over USD$150 million in antibiotics expenses per annum, in addition to 257,000 annual elective sinus operations 1,4 . Protocols, such as those developed in the European Position Paper on Rhinosinusitis and Nasal Polyp (EPOS) 2020, emphasize patient stratification for increased efficacy and reduced cost of care 1 . Bitter taste receptors (T2Rs) are emerging as novel regulators of innate immunity in the respiratory tract 8,9 . Originally identified in type II taste receptor cells of the tongue, T2Rs protect against the consumption of harmful substances, which includes bacterial products from spoiled food 10 . T2Rs are G protein-coupled receptors expressed in the cilia of human bronchial and sinonasal epithelial cells, in which their activation increases ciliary beat function and thus mucociliary clearance 8,11,12 . Robert J. Lee and Noam A. Cohen (2013) concluded that TAS2R38, a specific member of the T2R family known for detecting bitter compounds like phenylthiocarbamide (PTC), has significant clinical implications. They suggested that TAS2R38 genotyping could potentially predict susceptibility to infection and the need for surgical intervention, though further validation is required 8 . They have stratified the individuals with CRS into the “Supertaster” and “Non-taster” groups based on their in vitro studies of T2RS38. This genotyping study showed that “Supertasters” their CRS will resolve with medical therapy and the “non-tasters” will more likely require sinus surgery. As an alternative to genotyping, they recommended the use of taste testing on CRS patients, which can aid in stratifying them into groups requiring medical treatment or surgical intervention. Currently there is not a direct method that can detect the presence of bitter taste in the nose and the difference in its sensitivity between healthy and individuals with CRS. While the EPOS 2020 provides detailed guidelines for CRS management, the first diagnosis of CRS remains difficult, especially in basic care settings. Current diagnosis methods rely mainly on symptom-based criteria, nasal endoscopy, and computed tomography (CT) imaging, each with its own limitations 13-16 . This study aims to assess nasal T2Rs discriminatory function in healthy subjects and CRS patients through a PTC taste challenge. The study sets a 0.13% dilution of PTC for use in intranasal testing and tests its efficacy through nasal mucosa responsiveness to T2Rs. In addition, the study compares CRS and healthy controls’ nasal concentrations of glucose and finds them to be high in CRS subjects. It tests the usability and viability of nasal bitter taste tests as a simple, non-invasive, and cost-effective CRS screening tool and considers susceptibility factors for bitter tastes, such as gender and racial factors, and addresses implications for CRS diagnostics in relation to such factors. Validated nasal bitter taste testing could represent a rapid, non-invasive method for testing T2Rs function, and, in turn, an individual’s susceptibility to CRS or reaction to therapeutic interventions 17 . MATERIALS AND METHODS Study Design and Population A comparative cross-sectional study was conducted to assess nasal glucose concentration and PTC taste sensitivity in the nose. The study involved 84 adults, split into two groups: 42 with CRS and 42 healthy controls. Participants were selected based on specific criteria, excluding those with Diabetes Mellitus (DM) or recent/ongoing upper respiratory tract infection (URTI). The tests were performed in the Otorhinolaryngology, Head and Neck Surgery (ORL-HNS) clinic at a tertiary centre hospital. Sample Size Determination The sample size was determined according to predicted sensitivity to bitter taste in both healthy subjects and CRS subjects, and a total of 42 subjects in each group ensued. To counteract bias, propensity score matching (PSM) was utilized, allowing for subjects to be balanced according to predicted probability of therapy or intervention. Logistic regression analysis was utilized to calculate propensity scores, including covariates such as gender and ethnicity, allowing for controlling for variation between CRS subjects and healthy controls. Bitter Taste Testing Procedure The bitter taste testing involved preparing and applying PTC solutions at different dilutions. A 0.13% PTC solution (Dilution 4) was prepared by dissolving 130 mg of PTC in 100 ml of water, followed by serial dilutions: Dilution 3 (50 ml of Dilution 4 mixed with 50 ml of distilled water), Dilution 2 (50 ml of Dilution 3 mixed with 50 ml of distilled water), and Dilution 1 (placebo, distilled water). Each solution was applied to the nasal mucosa at three sites: nasal septum, inferior turbinate (IT), and middle turbinate (MT). The application started with the placebo (Dilution 1) and proceeded to the highest concentrated bitter reagent (Dilution 4). Responses were classified as positive if participants detected a stinging sensation at the highest dilution (0.13% PTC) and negative if no sensation was detected at this concentration or lower dilutions. The intensity of the taste sensation was measured using a Visual Analogue Scale (VAS), ranging from 0 (no sensation) to 10 (extremely intense sensation). Nasal Glucose Concentration Measurement Fasting blood glucose was obtained for patients to exclude diabetic subjects. The Technique of Harris and Kalmus for threshold measurement was used in this study 19 . Nasal glucose concentration was measured using a colorimetric assay, complementing the bitter taste testing results. This method was adopted from the work of Robert J. Lee et al 10 . Statistical Analysis Data were collected and compiled into Excel and SPSS for analysis. Cochran’s Q test was used to determine the suitable dilution of PTC, while chi-square analysis was performed to compare nasal PTC tasting among CRS patients and control patients. Descriptive statistics were used to describe numerical data in mean and standard deviation (SD) and categorical data in frequency and percentage. not-yet-known not-yet-known not-yet-known unknown Ethical Considerations The study was approved by the ethics committee and the National Ministry of Health, Ethics and Research Committee. RESULTS A total of 86 individuals were involved in this study, one of which was excluded. 42 out of the above were diagnosed with CRS. Sixty-four percent (n=27) of the CRS patients were males (Table 1). A total of 43 individuals were controlled. Most of the subjects were Malays, which comprised 70.6% followed by Indians (17.6%), Chinese (10.6%) and other races, which only comprised of 1.2% (Table 1). Among the CRS patients, 57%(n=24) were CRS with nasal polyp (CRSwNP) and 43%(n=18) were CRS without nasal polyp (CRSsNP). PSM analysis conducted on the CRS and control groups, which offers significant insights into demographic characteristics and potential biases in observational studies. The matched dataset included both CRS and control groups, with propensity scores indicating the likelihood of each participant being in the CRS group. A CRS patient with a propensity score of 0.6243 was matched with a control subject with a similar score. PTC was tested on three nasal sub-sites: septum, IT, and MT. The prevalence of nasal bitter taste detection was similar at all sub-sites (Table 2), indicating testing can be done on either side of the nose. Distilled water, which was used as a placebo, was not detected in both study and control groups at all the 3 tested sites (Table 1). The control group detected both dilution 1 and dilution 2 at 32.6% and 41.9% respectively. However, the CRS patients were not able to detect both these dilutions. A total of 60.5% of patients from the control group and 3 patients from the CRS group were able to detect dilution 3 (Figure 2). Based on Cochran’s Q test, dilution 3 seems to be the most detectable with a P value ≤ 0.05. All the 3 CRS patients who were able to detect the bitter taste had grade 1 polyps. The patients who were able to detect the bitter taste were mainly females comprising 69%. From the taster group, 79.3% were Malays, 13.8% were Indians, and 6.9% were Chinese. Based on dilution 3 as the most suitable dilution, there is an association between nasal bitter taste testing among CRS and control groups. The control group seems to have better detection compared to the CRS group (Figure 3). The overall responses of patients to the taste testing in the nose were either perception of a stinging sensation or a bitter sensation itself (Table 3). Only 2 individuals from the control group were able to detect a bitter sensation and the remaining 24 subjects detected a stinging sensation. All the 3 patients from the CRS groups had a stinging sensation towards the reagent. The median nasal glucose concentration is higher among CRS patients as compared to controls, with a P-value <0.001. CRS patients had higher glucose concentrations in their nasal secretion compared to healthy individuals (Figure 3). No reported side effects from the procedure done in this study. not-yet-known not-yet-known not-yet-known unknown DISCUSSION T2Rs in the tongue detect a range of bitter compounds, and these act to cause humans to refrain from consuming potentially toxic compounds through elicitation of unpalatable sensations. T2Rs have been detected in the respiratory epithelial cells in a range of locations in the sinonasal cavity, including in the IT, uncinate process, septum, and MT. In allergic rhinitis, the first two regions have an association with inflammation and pain, but in the latter two regions, a high density of solitary chemosensory cells (SCC) is seen. Stimulation of SCC with an irritant, such as pathogen-infused mucus, heightens ciliary activity, and through this, infection and irritants can be cleared out. T2Rs, including T2RS38, are expressed in SCC and ciliated cells of the upper respiratory tract10,20,21. Acyl-homoserine lactones from gram-negative bacteria stimulate this receptor, producing bactericidal nitric oxide12. Our data shows that bitter taste detection in different nasal sites is consistent within individuals for a given PTC concentration. However, not all participants were tested on the middle turbinate (MT) due to visualization difficulties or discomfort. The number of non-tasters was higher than in previous oral PTC studies. Most intranasal PTC tasters were females (69%), similar to oral PTC studies (67.9%), while the rate in males was lower (31%) compared to oral PTC tasters (64.8%)18. However, all the 3 individuals with CRS who were PTC tasters were males. By accounting for gender and race disparities, PSM improves the validity of comparisons between the two groups. The matching technique successfully aligned the CRS and control groups, eliminating confounding bias and allowing for more accurate interpretations of CRS effects. The computed propensity scores, with a mean of 0.6243 for the CRS group, show a moderate chance of classification based on demographic parameters, which is backed by reliable confidence ranges. This analysis allows for a more accurate assessment of the differences in outcomes between CRS patients and healthy controls, enhancing the validity of subsequent analyses. While PSM helps reduce bias, it cannot account for unobserved confounders. Three serial dilutions of PTC were used in our study. The most concentrated of them, 0.13% of PTC (Dilution 4), was statistically significant to be used to detect the presence of intranasal bitter receptors. Previous work used 14 serial dilutions of PTC to detect the tasting ability 18. As this research is conducted in the nose, which is a more confined and sensitive area, we decided to use only 3 dilutions and one placebo. Previous work demonstrated that individuals with a taster form of T2Rs could detect certain bitter ligands tested on their tongue as compared to a non-taster form of T2Rs 22. This is attributed to their genetic polymorphism. In our work, we have managed to gather the perception of individuals toward bitter ligands, namely PTC, in different sub-sites of the nose. There was a significant difference in the rate of detection of PTC among individuals with CRS and healthy. This could further support previous work, which suggested bitter taste tests could be used as an indicator for aggressive therapy in patients with CRS 12. Nasal glucose concentration is kept at low levels in healthy individuals. It is usually around 0.5 mM, which is about 10-fold lesser than serum glucose concentration 23. In our study, all the individuals had glucose concentrations below 0.5mM. However, CRS patients had higher nasal glucose concentrations compared to healthy individuals. Only one sample from our study had to be excluded, as it was contaminated with blood. Based on previous works, glucose measurement in nasal secretion from non-diabetic patients with CRS (with or without polyps) had elevated glucose concentration 10. CRS patients have an increased glucose concentration in their nasal secretions which are formed from sera via epithelial transudate or exudate seeping through the epithelial barrier 10. This varies in everyone with CRS and is a result of persistent infection or inflammation and insult to the epithelium. The function of T2Rs, however is regulated by sweet taste receptors, i.e., T1R, in an antagonistic nature, and this also reveals the importance of taste signalling to mucosal innate immunity 10. T1Rs are also expressed in SCC 20. In the current hypothesis, T1R2/3 mediated inhibition of T2Rs may exist to modulate the full release of AMPs during times of relative health 10. In the case of an acute bacterial infection, bacteria may consume available glucose, leading to a sudden decrease in glucose, which will not activate T1R2/3, therefore removing the inhibition of the T2Rs response needed to secrete AMPs 10. Certain chronic conditions such as DM, have shown increased glucose concentration in the nose, which in turn makes the T1R2/3 become overactive and chronically inhibit the T2Rs activation, resulting in reduced AMP secretion 23. Data suggest glucose concentration of 1.5mM and above can completely inhibit T2Rs-mediated AMP secretion, which in turn prevents efficient bacterial killing in an infected airway 10. The role of T2Rs-mediated sensing in bacterial detection is critical in the nasal cavity, a key part of respiratory protective mechanisms. Robert J. Lee and coworkers (2014) acknowledged airway taste receptors as a novel part of human respiratory innate immunity, involved in the detection of pathologic compounds and in modulating antimicrobial peptide expression 10. Genetic variation in these receptors could impact individual susceptibility to respiratory pathogens, providing potential new therapeutic targets. In addition, Lee et al. (2012) showed that polymorphisms in T2RS38 modulate susceptibility to upper respiratory infection, and that T2RS38 genotypes are important in respiratory protection 12. Nithin D. Adappa and coworkers (2014) confirmed that dysfunctional T2RS38 genotypes occur in a high proportion of surgical cases of CRS and emphasized T2RS38 as a causative risk factor for CRS 25. Limitations Further research was not done on genotyping for the known bitter taste receptor polymorphisms, such as TAS2R38, that could give more insight into genetic contributors to taste sensitivity. The procedure of testing the bitter taste in the nasal area is novel and may involve unidentified variables, since this kind of testing has not been conducted inside the nasal canal before. This would have improved the strength of this study and generalized the findings by increasing the sample size. Since it is a small sensitive area inside the nasal cavity, research can easily cause discomfort and complications and therefore is very challenging. REFERENCES 1. Fokkens WJ, Lund VJ, Hopkins C, et al. Executive summary of EPOS 2020 including integrated care pathways. Rhinology. 2020;58(2):82-111. https://doi:10.4193/Rhin20.601 2. Collins JG. Prevalence of selected chronic conditions: United States, 1990-1992. Vital Health Stat 10. 1997;(194):1-89. 3. Bachert C, Pawankar R, Zhang L, et al. ICON: chronic rhinosinusitis. World Allergy Organ J. 2014;7(1):25. Published 2014 Oct 27. doi:10.1186/1939-4551-7-25. https://doi:10.1186/1939-4551-7-25 4. Kim YS, Kim NH, Seong SY, Kim KR, Lee GB, Kim KS. Prevalence and risk factors of chronic rhinosinusitis in Korea. Am J Rhinol Allergy. 2011;25(3):117-121. https://doi:10.2500/ajra.2011.25.3630 5. Anand VK. Epidemiology and economic impact of rhinosinusitis. Ann Otol Rhinol Laryngol Suppl. 2004;193:3-5. https://doi:10.1177/00034894041130s502 6. Bhattacharyya N. The economic burden and symptom manifestations of chronic rhinosinusitis. Am J Rhinol. 2003;17(1):27-32. 7. Bhattacharyya N. Ambulatory sinus and nasal surgery in the United States: demographics and perioperative outcomes. 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Clin Genet. 2005;67(4):275-280. https://doi:10.1111/j.1399-0004.2004.00361.x 23. Garnett JP, Baker EH, Baines DL. Sweet talk: insights into the nature and importance of glucose transport in lung epithelium. Eur Respir J. 2012;40(5):1269-1276. https://doi:10.1183/09031936.00052612 24. Tizzano M, Cristofoletti M, Sbarbati A, Finger TE. Expression of taste receptors in solitary chemosensory cells of rodent airways. BMC Pulm Med. 2011;11:3. Published 2011 Jan 13. https://doi:10.1186/1471-2466-11-3 25. Adappa ND, Zhang Z, Palmer JN, et al. The bitter taste receptor T2R38 is an independent risk factor for chronic rhinosinusitis requiring sinus surgery. Int Forum Allergy Rhinol. 2014;4(1):3-7. https://doi:10.1002/alr.21253 Table 1. Demographic and Nasal Taste Sensitivity Characteristics of Study Participants n (%) n (%) n (%) Age 47.1 (14.19) a 35.4 (10.93) a 41.2 (13.88) a Gender Male 27 (64.3) 10 (23.3) 37 (43.5) Female 15 (35.7) 33 (76.7) 48 (56.5) Race Malay 22 (52.4) 38 (88.4) 60 (70.6) Chinese 7 (16.7) 2 (4.7) 9 (10.6) Indian 12 (28.6) 3 (7.0) 15 (17.6) Others 1 (2.4) 0 (0.0) 1 (1.2) Marital status Married 34 (81.0) 28 (65.1) 62 (72.9) Single 7 (16.7) 13 (30.2) 20 (23.5) Widow 1 (2.4) 1 (2.3) 2 (2.4) Divorced 0 (0.0) 1 (2.3) 1 (1.2) Nasal taste in Inferior Turbinate (IT) at placebo Detected 0 (0.0) 0 (0.0) 0 (0.0) Not detected 42 (100.0) 43 (100.0) 85 (100.0) Nasal taste in septum at placebo Detected 0 (0.0) 0 (0.0) 0 (0.0) Not detected 42 (100.0) 43 (100.0) 85 (100.0) Nasal taste in Middle Turbinate (MT) at placebo Detected 0 (0.0) 0 (0.0) 0 (0.0) Not detected 42 (100.0) 43 (100.0) 85 (100.0) a Mean (SD) This table presents the demographic variables and nasal taste sensitivity results for participants in the study, divided into two groups: those with chronic rhinosinusitis (CRS) and healthy controls. The variables include age, gender, race, marital status, and nasal taste detection at placebo in different nasal regions (Inferior Turbinate, Septum, and Middle Turbinate). Age is reported as mean (SD), while other variables are presented as frequencies and percentages. Table 2. The prevalence of nasal taste detection at IT, septum, and MT. not-yet-known not-yet-known not-yet-known unknown Detected Not detected n (%) n (%) Solution 1 Inferior Turbinate (IT) Detected 7 (100.0) 0 (0.0) <0.001 Not detected 0 (0.0) 50 (100.0) Nasal taste in the septum Detected 7 (100.0) 0 (0.0) <0.001 Not detected 0 (0.0) 50 (100.0) Solution 2 Inferior Turbinate (IT) Detected 1 (100.0) 0 (0.0) 0.020 Not detected 0 (0.0) 49 (100.0) Nasal taste in the septum Detected 1 (100.0) 0 (0.0) 0.020 Not detected 0 (0.0) 49 (100.0) Solution 3 Inferior Turbinate (IT) Detected 7 (100.0) 0 (0.0) <0.001 Not detected 0 (0.0) 42 (100.0) Nasal taste in the septum Detected 7 (100.0) 0 (0.0) <0.001 Not detected 0 (0.0) 42 (100.0) not-yet-known not-yet-known not-yet-known unknown a Fisher’s Exact test This table presents the prevalence of nasal taste detection at different nasal sites [Inferior Turbinate (IT), Septum, and Middle Turbinate (MT)] using various solutions. It includes the number and percentage of detections and non-detections, along with p-values from Fisher’s Exact test. Table 3. Response to bitter taste among all patients. n (%) n (%) n (%) Bitter 0 (0.0) 2 (7.7) 2 (6.9) Stinging 3 (100.0) 24 (92.3) 27 (93.1) This table summarizes the response to bitter taste among all patients, divided into CRS and control groups. It shows the number and percentage of patients reporting bitter or stinging sensations. Fig. 1. Methodology for Nasal Bitter Taste Testing in Chronic Rhinosinusitis Screening. : The start and end point of the study : Represent the key steps in the methodology of the nasal bitter taste test : Indicate the flow of the process from one step to the next, illustrating the sequence of actions taken during the study. not-yet-known not-yet-known not-yet-known unknown Fig. 2. Percentage of individuals able to detect PTC at different dilutions. Comparative Efficacy of Three Different Solutions Across CRS Patients, Controls, and an Overall Population. This bar graph illustrates the percentage efficacy observed in patients with CRS (Chronic Rhinosinusitis), control subjects without CRS (Control), and an overall combined population (Overall) when treated with three distinct solutions (Solution 1 - green; Solution 2 - blue; Solution 3 - red). Notably high efficacy is observed for Solution 2 in both control subjects (41.9%) and overall population (60.5%), as indicated by P-values less than <0.001 suggesting high statistical significance compared to other solutions within these groups. Fig. 3. Prevalence of PTC detection among healthy and CRS group. Left Pie Chart: This chart shows the detection rate of a specific entity or condition. The blue segment represents ‘Not detected’ cases, accounting for 65.9% (n=56), while the red segment represents ‘Detected’ cases, making up 34.1% (n=29). Right Pie Chart: This chart categorizes the control group. The purple segment labelled ‘Control’ includes 89.7% (n=26) of the cases, and the green triangular segment labelled ‘CRS’ includes 10.3% (n=3). Supplementary Material File (figures for clinical otolaryngology 2024 x3 figures.docx) Download 291.55 KB File (tables for clinical otolaryngology 2024 x3 tables.docx) Download 21.46 KB Information & Authors Information Version history V1 Version 1 05 February 2025 Copyright This work is licensed under a Non Exclusive No Reuse License. Collection Clinical Otolaryngology Authors Affiliations Shankar Ramasundram Hospital Penawar View all articles by this author Ramiza Ramza 0000-0001-8196-321X [email protected] Universiti Sains Malaysia Jabatan Otorinolaringologi-Pembedahan Kepala dan Leher View all articles by this author Norasnieda Md Shukri Universiti Sains Malaysia Jabatan Otorinolaringologi-Pembedahan Kepala dan Leher View all articles by this author Sakinah Mohamad Universiti Sains Malaysia Jabatan Otorinolaringologi-Pembedahan Kepala dan Leher View all articles by this author Sivakumar Kumarasamy Aurelius Hospital Nilai View all articles by this author Metrics & Citations Metrics Article Usage 353 views 156 downloads .FvxKWukQNSOunydq8rnd { width: 100px; } Citations Download citation Shankar Ramasundram, Ramiza Ramza, Norasnieda Md Shukri, et al. Nasal Bitter Taste Testing as A Screening Tool for Chronic Rhinosinusitis.. Authorea . 05 February 2025. 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