## 4 Discussion  
Sensory properties of foods are principally the outcome of the interaction of food characteristics/quality (such as physical structure and chemical/nutritional properties) and the consumer's characteristics (gender, age, attitude, and physiological/psychological state) and its environment (family, cultural traditions, and education) [1; 2; 3; 40; 5; 4]. Among sensory and personal factors, health conditions significantly influence consumer choice [3; 40]. It has been reported that the decline in olfactory and gustatory function greatly affects food sensory perception and eating behavior [6; 7; 8; 9; 10; 11; 13; 14; 15; 16]. Olfactory and gustatory dysfunctions limit the individual's liking for food and beverages, leading to poor appetite, possible malnutrition, and worsening of other diseases [16]. Several studies evaluated the effect of olfactory/gustatory disorders on food-related experiences using a self-rated questionnaire [14; 31], whereas sensory testing using real food items under controlled test conditions in patients with sensory impairment has rarely been used [11; 24; 31]. In this study, we assessed for the first time the perception of odor/taste sensory characteristics and acceptance of the bitter herbal myrtle liqueur Mittamaro in subjects with hyposmia and with hypogeusia compared to healthy controls. Myrttle leaves, berries, seeds, and essential oils are amply used for the food aromatization and cosmetic/pharmaceutical applications due to their anti-inflammatory and antioxidant activities [26; 28; 30; 41]. Taking into consideration the growing popularity of the bitter taste among consumers [25; 26; 27; 28; 29], Mirtomaaro was prepared by the maceration of myrtle leaves and berries together to a complex secret blend of aromatic and bitter Mediterranean plants/herbs [26; 28]. Aromatic plants and spices are traditionally used in the Mediterranean area to prepare beverages and the most used plants for conferring bitterness to aromatic bitter liqueurs belong to _Gentiana_, _Artemisia_, and _Achillea_ species [28]. The herbal liqueur Mittamaro is characterized by a strong bitter taste and balsamic, spicy, and citrus flavor [26]. Initially, the occurrence of significant changes in olfactory and gustatory perception was explored in subjects with hyposmia and hypogeusia compared to healthy controls. Our results showed a marked decline in the olfactory function (OThr, ODi, and OId) in subjects with hyposmia. Moreover, these subjects perceived sweet, salty, sour, and total taste as less intense than healthy participants. Participants with hypogeusia showed a marked reduction in sweet, salty, sour, and bitter perception versus healthy participants, coupled with an impairment of the olfactory function. Interestingly, the presence of significant positive correlations between total olfactory and total taste scores (TDI/TT) in participants with hyposmia and hypogeusia indicated a marked interconnection between olfactory and gustatory function in consumers with chemosensory deficits. The olfactory function is well-known to be closely associated with the gustatory function [11]. Both gustatory and olfactory systems send their inputs to associative brain areas which play an important role in food ingestion or rejection and food quality determination [42]. Food perception is a multisensory event determined by the integration of gustatory function, smell, physical sensations, such as food temperature and consistency, and trigeminal perceptions [3; 4; 5; 42]. Previous studies evidenced a high rate of comorbidity between gustatory and olfactory impairment [7; 11]. Then, differences in the perception of sensory characteristics (odor and taste) and acceptance of the bitter herbal myrtle liqueur Mittamaro were assessed in subjects with hyposmia and hypogeusia compared to healthy controls.