Effectiveness of Olfactory Rehabilitation With the Nasal Airflow-Inducing Maneuver After Total Laryngectomy

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Abstract
Total laryngectomy results in deterioration of pulmonary function and major decrease in sense of smell. This deterioration is a consequence of the permanent disconnection of the upper and lower airways. The most common method used to improve the sense of smell, larynx bypass, is somewhat troublesome for routine use, and other methods, for example, the glossopharyngeal press, have not been systematically evaluated. Recently, Hilgers et al1 introduced a patient-friendly olfaction rehabilitation technique, the nasal airflow-inducing maneuver (NAIM), that can restore the sense of smell in patients who have undergone laryngectomy. This “polite yawning” technique creates underpressure in the oral cavity, which, in turn, generates nasal airflow enabling odorous substances to reach the olfactory epithelium. Patients are trained to make an extended yawning movement while keeping their lips closed and simultaneously lowering their jaw, floor of mouth, tongue, base of the tongue, and soft palate. The first intervention study, performed in 33 patients who had undergone laryngectomy and categorized as nonsmellers, showed a success rate of 46% after only one 30-minute training session, and long-term rehabilitation effect was achieved in approximately 50% of these patients.1,2 In a previous study of 24 patients who had undergone laryngectomy, our group found that 18 patients (75%) had impaired olfaction and 14 patients (58%) had anosmia.3 Among these patients, the most common cited functions impaired by olfactory loss were detection of smoke and of breath and body odor, which caused psychic insecurity. After 6 weeks of olfactory rehabilitation with the NAIM, the sense of smell was improved in 13 of 18 patients (72%) with anosmia or hyposmia. The purpose of the present study was to evaluate systematically the long-term results of the NAIM by reexamining patients 6 and 12 months after primary rehabilitation.