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Quality of life and olfactory rehabilitation after total laryngectomy

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Background: Total laryngectomy is a radical surgery often performed for advanced laryngeal cancer, that alters the upper respiratory anatomy and quality of life. Although this type of radical surgery can be life-saving, the repercussions in the patients psychology due to loss of normal speech as well as loss of nasal breathing caused the cessation of airflow, thereby preventing stimulation of the olfactory epithelium. Method: The European Organisation for Research and Treatment of Cancer Core Questionnaire Version 3.0 (EORTC QLQ-C30) in conjunction with the disease-specific Head & Neck Cancer Module (QLQ-H&N35) are used. The EORTC core module is a patient-based, self-administered modular instrument designed to assess the health-related QOL of a broad range of cancer patients (Aaronson et al, 1993). Reliability, validity and cross-cultural applicability have been confirmed (Aaronson et al 1991; Sherman et al 2000). In case of olfactory rehabilitation Polite yawning technique is one successful method.

Results: In the case of total laryngectomy, respiration is also affected due to the redirection of the trachea resulting in the elimination of an upper respiratory tract. The possibility of olfactory rehabilitation is an important factor in postoperative treatment, and positive results are very stimulating for patients and surgeons. To achieve a better quality of life for laryngectomised patients, olfactory rehabilitation should be undertaken as soon as possible, to re-establish nasal airflow (and with it, the sense of smell). Polite yawning technique is one successful method of olfactory rehabilitation. Upon completing rehabilitation, 46% (Hilgers et al.16) of patients had normosmic olfactometry results. Discussion: Rehabilitation programmes that consider and aim to improve emotional and social functioning post total laryngectomy are essential. Providing adequate information about the long-term consequences of total laryngectomy in a timely manner -not just before the surgery- may help reduce such worries.

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