Olfactory mucosa histological findings in laryngectomees

Abstract

After total laryngectomy, the patients often report immediate and marked olfactory deficit. The aim of this study was to determine whether hyposmia in laryngectomees reflects olfactory epithelial damage. Ten laryngectomized patients and ten rhinologically normal subjects were subjected to olfactory testing, after which histological examination of biopsied olfactory mucosa was performed. Olfactory testing in laryngectomees revealed a marked reduction in odor perception. Histological examination of olfactory mucosa specimens showed that in laryngectomees some neuroepithelial structural features were comparable with those found in normal subjects. However, additional signs of damage were also observed, consisting mainly of various degrees of epithelial degeneration, above and beyond those that are characteristic of physiological epithelium turnover. These different degenerative features consisted of severe damage to the neuroepithelium, culminating in complete topical loss. Bowman's glands were also observed to be involved in the degenerative process. Laryngectomy-induced hyposmia seems to be correlated with the almost complete loss of nasal airflow due to the disconnection between the upper and lower airways, which prevents odor molecules from reaching the olfactory area, together with degenerative phenomena, which affect the neuroepithelium, and consequent failure in neurosensorial performance.

Endoscopy findings affect subjective smell rehabilitation in post-laryngectomy patients using the nasal airflow-inducing manoeuvre

“…In particular, nasal endoscopy findings of non-use rhinitis and other nasal endoscopy characteristics can be considered probable effective factors. 1,6 In our case series, patients experienced an average overall improvement of 24.2 ± 18.1, representing a 61 per cent improvement over the pre-intervention status. These results are comparable with other case series, suggesting that sense of smell deficits after laryngectomy are reversible and that the nasal airflowinducing manoeuvre can benefit many patients.…”

“…8,10 However, we did not find a significant relationship between the smell rehabilitation programme outcome and other nasal endoscopy findings. This could result from our small sample size or from differences in endoscopy findings for non-use rhinitis and neuroepithelial changes to the olfactory cleft, as claimed by Miani et al 6 Further studies with larger sample sizes are therefore needed to identify the effective elements of the nasal airflow-inducing manoeuvre.…”

“…[2][3][4][5] Separation of the airway passage from the nose prevents odorous particles reaching the olfactory cleft, leading to deterioration in the sense of smell and taste. [1][2][3][4][5][6][7][8] Olfactory epithelial damage is also reported to be a consequence of laryngectomy, 1,3,6,7,9 although this is controversial. 10 Much effort has been put into overcoming this problem, 4,5,11 but most attempts have been unsuccessful.…”

“…16 However, nasal endoscopy findings such as non-use rhinitis can be considered probable effective factors. 1,6 Changes in appetite and taste perception after rehabilitation manoeuvres were also considered. These outcomes have not been adequately addressed in previous studies.…”

Acuidade olfatória e qualidade de vida após a laringectomia total

“…A study developed with the loss of nasal air flow contributes to olfaction disorders in total laryngectomized patients 9,30 .…”