Effects of total laryngectomy on olfactory function, health-related quality of life, and communication: a 3-year follow-up study

Abstract

BackgroundAs total laryngectomy results in loss of airflow through the nose, one of the adverse effects for a majority of patients is the reduced or complete loss of olfactory function. However, with the introduction of a new method, the Nasal Airflow-Inducing Maneuver (NAIM), an important technique is available for laryngectomized patients to regain the ability to smell. The purpose of the present study was to assess changes in olfaction, health-related quality of life (HRQL) and communication 3 years after NAIM rehabilitation.Methods18 patients (15 men and 3 women; mean age, 71 years) who had undergone laryngectomy and NAIM rehabilitation were followed longitudinally for 3 years. For comparison an age and gender matched control group with laryngeal cancer treated with radical radiotherapy was included. Olfactory function was assessed using the Questionnaire on Odor, Taste and Appetite and the Scandinavian Odor Identification Test. HRQL was assessed by: 1) the European Organization for Research and Treatment for cancer quality of life questionnaires; and 2) the Hospital Anxiety and Depression Scale. Communication was assessed by the Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer. Descriptive statistics with 95% confidence interval were calculated according to standard procedure. Changes over time as well as tests between pairs of study patients and control patients were analyzed with the Fisher nonparametric permutation test for matched pairs.ResultsThirty-six months after rehabilitation 14 of 18 laryngectomized patients (78%) were smellers. There were, with one exception (sleep disturbances), no clinically or statistically significant differences between the study and the control group considering HRQL and mental distress. However, statistical differences (p < 0.001) were found between the study and the control group concerning changes in communication.ConclusionOlfactory training with NAIM should be integrated into the multidisciplinary rehabilitation program after total laryngectomy. Our study shows that patients who were successfully rehabilitated concerning olfaction and communication had an overall good HRQL and no mental distress. Moreover, the EORTC questionnaires should be complemented with more specific questionnaires when evaluating olfaction and communication in laryngectomized patients.

Acuidade olfatória e qualidade de vida após a laringectomia total

“…Some authors demonstrate the close relation between the olfaction and taste functions on the perception of food tastes and that these function alterations would result in nutritional losses, on the appetite and even influence on weight loss 10,11,14 .…”

Adaptação transcultural do Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) para o Português Brasileiro

“…For this reason, the loss of speech is an important issue when considering the quality of life of patients undergoing laryngectomy. This aspect, however, as previously said, is not given the proper emphasis in cancer questionnaires (5) . The Self-Evaluation of Communication Experiences after Laryngectomy (SECEL) questionnaire was created to meet this need.…”

Função olfatória e qualidade de vida após a reabilitação do olfato em laringectomizados totais

“…The scientific literature suggests that the correct execution of the maneuver depends on constant and intensive training, which ensures olfactory improvement and maintenance of long-term effects (5,9,26,27) . Improvement of olfactory perception after intervention was also observed when the results of the olfactory acuity questionnaires were compared in the pre-and post-olfaction rehabilitation periods.…”

“…Discontinuation of the airflow in the nasopharyngeal airways due to total laryngectomy prevents the odorant molecules from reaching the olfactory epithelium, precluding its stimulation and causing hyposmia or even anosmia (5,7,8) . Olfactory deterioration contributes to loss of appetite and weight and often compromises the nutritional status of individuals, affecting their quality of life (6,9) . Studies conducted with patients following total laryngectomy have shown that olfaction rehabilitation improves quality of life (2,5,(8)(9)(10) .…”

“…Olfactory deterioration contributes to loss of appetite and weight and often compromises the nutritional status of individuals, affecting their quality of life (6,9) . Studies conducted with patients following total laryngectomy have shown that olfaction rehabilitation improves quality of life (2,5,(8)(9)(10) . This concept is defined by the World Health Organization (WHO) as "[...] the individuals' perception of their position in life in the context of the cultural and value system in which they live and in relation to their goals, expectations, standards, concerns and social relations [...]" (11:1403) .…”