The impact of tracheostomy on the nose

Abstract

To establish the effect of tracheostomy on nasal function and quality of life. Teaching Hospital, Scotland, UK. Cross-sectional case-control study. Two groups of patients were selected; a group of ten patients who underwent surgical tracheostomy and a control group of ten patients with confirmed or suspected head and neck malignancy that did not require tracheostomy. Two questionnaires, the SNOT-22 quality of life instrument, and the Rhinogram nasal symptoms score were used to evaluate each group. For the Rhinogram questionnaire the median total score was 13.5 for the tracheostomy group and 2 for the control group (P = 0.02) whilst for the SNOT-22, the mean total scores were 39 and 29, respectively (P = 0.205). The tracheostomy group scored worse for all Rhinogram questions, and for the anosmia score this was independently statistically significant (5 vs. 0 units, P = 0.001). The tracheostomy group most commonly identified "loss of smell & taste" as their most important symptom, compared with only 2 subjects in the control group. Tracheostomy can give rise to nasal symptoms. This needs to be addressed in the routine follow up of these patients.

Nasal Mucociliary Clearance in Prolonged Tracheostomy Patients: A Prospective Case–Control Study

“…A study was done by Tsikoudas A et al in 2011 on 10 subjects in cases and control arms respectively, where the author used SNOT-22, and Rhinogram nasal symptoms score questionnaires and found that tracheostomy group had a median Rhinogram score of 13.5 vs. 2 for the control arm (p = 0.02), and similarly SNOT-22 scores for tracheostomized patients and controls were 39 and 29 respectively (p = 0.205), thereby observing that the tracheostomy group had more nasal symptoms due to worsening of mucociliary clearance, which supports the hypothesis of this present study and author concluded by stressing that this impairment in nasal mucociliary clearance following tracheostomy should be addressed in follow up as altered nasal function can predispose patients to sinonasal diseases and a reduction in olfaction causing poor identification of smell of food leading to a poor quality of life and could become potentially dangerous in situations like gas leak [1].…”

“…Hypothetically this altered nasal airflow in patients with prolonged tracheostomy could lead to nasal mucociliary dysfunction. There are very few studies in the medical literature that evaluates the effects of prolonged tracheostomy on nasal physiology [1]. Hence this study was done to assess the impact of prolonged tracheostomy on nasal mucociliary clearance.…”

Assessing the impact of the five senses on quality of life in mucopolysaccharidoses

“…In addition, continuous upper airway infection can cause chronic production of infected mucus, altering smell and taste. Tracheostomy, a procedure often performed in MPS patients with progressed upper airway disease, may give rise to impaired nasal function [27]. However, there is a lack of publications describing the impairments of smell and taste in patients with MPS.…”

Ethical and legal issues of tracheostomy ventilation in patients with amyotrophic lateral sclerosis

“…34,35 Due to the reduced nasal breathing as a result of the tracheostomy, patients may also have reduced smell and taste. 36 Due to the relentless progression of the underlying neurodegenerative disease, patients would eventually lose swallowing capabilities. 6…”

“…6 -Patients may have reduced smell and taste due to the reduced nasal breathing. 36 -Although TV provides better secretion clearance compared to NIV, there is still an increased risk of pneumonia due to more bronchial secretions being generated. 6 The sensation of shortness of breath may persist despite adequate ventilation.…”