The Nose after Laryngectomy

Abstract

Summary: Previous studies of nasal function after laryngectomy have suggested that patients must accept complete and irreversible anosmia as an inevitable consequence of the operation, and that this is due to interruption of a poorly defined neuronal interaction between larynx and nose. In this study nasal function was investigated in 23 laryngectomees and 10 patients about to undergo laryngectomy. Scanning electron microscopy showed a more densely ciliated nasal epithelium in the laryngectomees compared with the preoperative controls, and nasal mucociliary transport, measured by saccharine clearance, was significantly faster (P<0.01) in laryngectomees. Olfactory acuity, as determined by the threshold for detection of insufflated pyridine vapour, was normal in laryngectomees. Some laryngectomees did have a relatively normal sense of smell; these were shown to be those who had discovered a technique of sniffing using buccopharyngeal rather than respiratory musculature.These findings have obvious implications for the rehabilitation of laryngectomees, many of whom may otherwise have to contend with distressing anosmia as well as the other physical and psychological consequences of the operation.

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.…”

“…1 There have been many attempts to improve patients' ability to speak after laryngectomy. However, researchers are now aiming to improve the sense of smell because of its impact on quality of life.…”

“…The most common factor affecting post-operative quality of life is voice loss. 1,2 However, recent studies have revealed the importance of loss of smell in post-laryngectomy life satisfaction. [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.…”

“…[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.…”