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

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.