How to improve olfaction and enhance quality of life after laryngectomy
Reviewed by Madhup K Chaurasia

Total laryngectomy diverts airflow away from the nose and, hence, olfaction is greatly impaired. Undoubtedly, this affects quality of life in terms of loss of taste and flavour. Surgery and devices to re-establish airflow into the nose can be difficult and not always predictable. This study focuses on a simple manoeuvre of ‘polite yawn’ which entails yawning with the lips closed and thus creating negative pressure. The negative pressure directs air into the hypopharynx and ultimately into the nose to facilitate olfaction. The authors established olfactory function by assessing the threshold using the Connecticut Chemosensory Clinical Research Test in which the subjects identified ‘stronger smell’ between de-ionised water and butanol in varying concentrations. The ‘identification test’ involved seven different odorants. A single ‘composite’ score ranged from 6.5 to two, the former indicating mild hyposmia and the latter indicating total loss of smell (anosmia). The composite baseline score (range 1-7, 7 indicating best olfaction) prior to laryngectomy was 4.01. This dropped to 0.44 in the two-week follow-up after the laryngectomy. After teaching patients to practise the nasal airflow-inducing manoeuvre, this rose to 3.05. Prior radiotherapy had no influence on these results. The authors have also applied a 29-item appetite, hunger and sensory perception questionnaire to assess quality of life, but details of this are not evident in the short follow-up. The study does seem to support the use of a simple manoeuvre (NAIM) which, if added to postop care, can improve quality of life in these patients.

Effect of nasal airflow inducing manoeuvre on olfaction and quality of life after laryngectomy.
Subbaraj R, Mathews SS, Bedford S, et al.
J LARYNGOL OTOL
2023;137(3):273-8.