We aim to propose a new protocol for olfaction rehabilitation after total laryngectomy based on training of sensory perception levels using the Nasal Airflow-Inducing Maneuver.
This is a randomized clinical trial including patients undergoing total laryngectomy between March 2010 and March 2019. Patients with nasal or oral abnormalities, prior olfaction impairment, a muco-ciliary transport time higher than 30 min, positive history for feeding, and neurological disorders were excluded. Thirty-three patients were enrolled and were randomized into two groups: an Experimental group, submitted to the new protocol (olfactory perception rehabilitation after total laryngectomy-OPRAT) and a Control group that did not receive any treatment. Subjective Olfactometry, Chemosensory Complaints Score, and University of Washington Quality of Life version 4 questionnaires were used to assess the outcomes before and after treatment, and at 3-month, 6-month, and 10-month follow-up.
Among the 33 patients included (32 men and 1 woman; mean age, 67.94 ± 5.64 years), 17 were subjected to olfaction rehabilitation and 16 did not receive any treatment.
At baseline evaluation, there were not significant differences between the two groups. At the end of treatment, the rehabilitated group improved their olfaction capability significantly. Such improvement remained stable over time, and after 10 months, only the Experimental group had significant improvements in all outcome measures.
The OPRAT may guarantee excellent results in the short- and long-term time with positive effects on the Quality of Life.
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Hilgers FJ, Ackerstaff AH, Aaronson NK et al (1990) Physical and psychosocial consequences of total laryngectomy. Clin Otolaryngol Allied Sci 15:421–425
Van Dam FS, Hilgers FJ, Emsbroek G et al (1999) Deterioration of olfaction and gustation as a consequence of total laryngectomy. Laryngoscope 109:1150–1155
Ackerstaff AH, Hilgers FJ, Aaronson NK, Balm AJ (1994) Communication, functional disorders and lifestyle changes after total laryngectomy. Clin Otolaryngol Allied Sci 19:295–300
Hilgers FJ, Ackerstaff AH (2000) Comprehensive rehabilitation after total laryngectomy is more than voice alone. Folia Phoniatr Logop 52:65–73
Miwa T, Furukawa M, Tsukatani T et al (2001) Impact of olfactory impairment on quality of life and disability. Arch Otolaryngol Head Neck Surg 127:497–503
Alvarez-Camacho M, Gonella S, Ghosh S et al (2016) The impact of taste and smell alterations on quality of life in head and neck cancer patients. Qual Life Res 25:1495–1504
Baharvand M, ShoalehSaadi N, Barakian R, Moghaddam EJ (2013) Taste alteration and impact on quality of life after head and neck radiotherapy. J Oral Pathol Med 42:106–112
Kubrak C, Olson K, Jha N et al (2013) Clinical determinants of weight loss in patients receiving radiation and chemoradiation for head and neck cancer: a prospective longitudinal view. Head Neck 35:695–703
Hutton JL, Baracos VE, Wismer WV (2007) Chemosensory dysfunction is a primary factor in the evolution of declining nutritional status and quality of life in patients with advanced cancer. J Pain Symptom Manag 33:156–165
Mumovic G, Hocevar-Boltezar I (2014) Olfaction and gustation abilities after a total laryngectomy. Radiol Oncol 48:301–306
Göktas O, Lammert I, Berl J, Schrom T (2005) Rehabilitation of the olfactory sense after laryngectomy [the larynx bypass]. Laryngorhinootologie 84:829–832
Mozell MM, Schwartz DN, Youngentob SL et al (1986) Reversal of hyposmia in laryngectomized patients. Chem Sense 11:397–410
Schwartz DN, Mozell MM, Youngentob SL, Leopold DL, Sheehe PR (1987) Improvement of olfaction in laryngectomized patients with the larynx bypass. Laryngoscope 97:1280–1286
Goektas O, Fleiner F, Frieler K, Scherer H, Paschen C (2008) The scent-diffusing ventilator for rehabilitation of olfactory function after laryngectomy. Am J Rhinol 22:487–490
Fujii M, Fukazawa K, Hatta C, Yasuno H, Sakagami M (2002) Olfactory acuity after total laryngectomy. Chem Senses 27:117–121
Hilgers FJ, Van Dam FS, Keyzers S et al (2000) Rehabilitation of olfaction after laryngectomy by means of a nasal air flow-inducing maneuver: the “polite yawning” technique. Arch Otolaryngol Head Neck Surg 126:726–732
Tatchell RH, Lerman JW, Watt J (1985) Olfactory ability as a function of nasal air flow volume in laryngectomies. Am J Otolaryngol 6:426–432
Hilgers FJ, Jansen HA, Van As CJ et al (2002) Long-term results of olfaction rehabilitation using the nasal airflow-inducing (“polite yawning”) maneuver after total laryngectomy. Arch Otolaryngol Head Neck Surg 128:648–654
Risberg-Berlin B, Ylitalo R, Finizia C (2006) Screening and rehabilitation of olfaction after total laryngectomy in Swedish patients: results from an intervention study using the Nasal Airflow-Inducing Maneuver. Arch Otolaryngol Head Neck Surg 132:301–306
Risberg-Berlin B (2007) Effectiveness of olfactory rehabilitation with the nasal airflow-inducing maneuver after total laryngectomy: one-year follow-up study. Arch Otolaryngol Head Neck Surg 133:650–654
Schindler A, Borghi E, Tiddia C et al (2008) Adaptation and validation of the Italian MD Anderson Dysphagia Inventory (MDADI). Revue de laryngol-otol-rhinol 129:97–100
Risberg-Berlin B, Ryden A, Moller RY, Finizia C (2009) Development of a clinical instrument improving rehabilitation of olfaction with the Nasal Airflow-Inducing Maneuver in Swedish laryngectomized. Acta Otolaryngol 129:1026–1032
Hummel G, Kobal H, Gudziol A et al (2007) Normative data for the “Sniffin’ Sticks” including tests of odour identification, odour discrimination, and olfactory thresholds: an upgrade based on a group of more than 3,000 subjects. Eur Arch Otorhinolaryngol 264:237–243
Heald AE, Pieper CF, Schiffman SS (1998) Taste and smell complaints in HIV-infected patients. AIDS 12:1667–1674
Lowe D, Rogers SN (2012) University of Washington quality of life questionnaire (UW-QOL v4). https://www.headandneckcancer.co.uk/sites/default/files/assets/pages/UW-QOL-update-2018.pdf.
Rogers SN, Lowe D, Yueh B, Weymuller EA (2010) The Physical Function and Social-Emotional Function Subscales of the University of Washington Quality of Life Questionnaire. Arch Otolaryngol Head Neck Surg 136:352–357
Santos CG, Bergmann A, Coça KL, Garcia AA, Valente TC (2016) Olfactory function and quality of life after olfaction rehabilitation in total laryngectomees. Codas 28:669–677
Croy I, Nordin S, Hummel T (2014) Olfactory disorders and quality of life-an updated review. Chem Senses 39:185–194
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Longobardi, Y., Parrilla, C., Di Cintio, G. et al. Olfactory perception rehabilitation after total laryngectomy (OPRAT): proposal of a new protocol based on training of sensory perception skills. Eur Arch Otorhinolaryngol 277, 2095–2105 (2020). https://doi.org/10.1007/s00405-020-05918-8
- Total laryngectomy
- Quality of life
- Head and neck surgery