Screening and Rehabilitation of Olfaction After Total Laryngectomy in Swedish Patients

Abstract

To examine the olfactory function in patients with laryngectomy and to assess the results of the Nasal Airflow-Inducing Maneuver (NAIM) odorrehabilitation technique. Design: A prospective intervention study. Setting: University hospital. Patients: Twenty-four patients, 21 men and 3 women, mean age 68 years, who underwent laryngectomy at least 5 months prior to intervention. Intervention: Speech therapists trained patients in the NAIM technique: simultaneous lowering of the jaw, floor of the mouth, tongue, base of the tongue, and soft palate while the lips are closed. Three interventions were given within 6 weeks. Main Outcome Measure: Olfactory testing with semistructured interview, the Questionnaire on Olfaction, Taste, and Appetite (QOTA), and the Scandinavian Odor-Identification Test (SOIT). Quality of life was measured with European Organization for Research and Treatment of Cancer QLQ-C30 and QLQ-H&N35 questionnaires. The patients were categorized as smellers or nonsmellers based on the SOIT results. Results: Before the treatment, 10 patients (42%) were smellers (ie, 6 had normosmia and 4 hyposmia), while 14 patients (58%) were nonsmellers (ie, all had anosmia). Thus, 18 patients had impaired olfaction. Using the NAIM technique, 13 (72%) of 18 patients with impaired olfaction showed improvement. Of the 14 nonsmellers, 7 converted to smellers after only 1 intervention session, giving us a success rate of 50% in anosmic patients after 1 session. Conclusions: Olfactory impairment is common in patients who underwent laryngectomy. The NAIM method is easy to learn and rapidly improves smell and taste. A single intervention session is sometimes sufficient, but many patients benefit from repeated training. The SOIT test is an effective and simple test for the assessment of olfaction acuity after laryngectomy.

Olfaction following total laryngectomy

“…[5] Published incidences of olfactory dysfunction post-TL range anywhere from 30% to 100%. [1,3,[6][7][8][9][10][11][12][13][14] A number of methodological differences explain the wide range in incidence rates between studies [ Table 1]. One influencing factor is the time post-surgery when patients are assessed.…”

“…[1] Another key factor is the assessment mode. [1,3,[6][7][8][9][10][11][12][13][14][15] The lowest reported incidence was found in a study which assisted passage of vaporized substances up into the nasal cavity, [6] a methodology which essentially replicated the effect of nasal inhalation. Higher rates of impairment are typically noted in studies which use odor detection tests, without assisting nasal inhalation, which is a preferred methodology to determine true functional olfactory ability [ Table 1].…”

“…Welge-Luessen et al [ Odor detection test [15] No Risberg-Berlin et al [12] 75% [16,17] However, the consequences of olfactory dysfunction can have a profound effect on daily functioning and quality of life. [9,[18][19][20] Deems et al [21] demonstrated a higher rate of depression (29%) in those with olfactory dysfunction in comparison with controls.…”

“…[76] Efficacy of converting non-smellers to smellers post-TL has been shown, both in the short-and long-term, with success rates ranging from 46% to 88%. [1,12,77] Methods of treatment delivery and intensity have varied in the literature [ Table 4], [1,11,12,14,[77][78][79][80] but there is a general consensus that although treatment can be effective with a single Figure 1: Schematic drawing of a larynx bypass used to bypass the upper airways to enable orthonasal airflow Figure 2: Schematic drawing of the Nasal Airflow Inducing Maneuver intervention, [1,11,80] further clinician-guided sessions lead to continued and more expeditious improvement in olfactory ability. [14] Research has also established the benefits of utilizing biofeedback to facilitate NAIM training.…”

Chemosenses, Aging, and Oropharyngeal Dysphagia

“…144,145 Taught by speech-language pathologists, this technique involves teaching patients to create negative intraoral breath pressure to elicit orthonasal airflow (and thus, ability to perceive smells) by drawing downward with the jaw and tongue while keeping the lips closed. Water manometry is used to train the technique, which has been reported to successfully improve olfaction perception for some individuals with a laryngectomy.…”