Olfactory rehabilitation and olfactory bulb volume changes in patients after total laryngectomy: a prospective randomized study / Reabilitação olfatória e alterações do volume do bulbo olfatório em pacientes pós-laringectomia total: um estudo prospectivo randomizado

Abstract Introduction: After total laryngectomy, decreased olfactory function and olfactory bulb volume shrinkage have been reported to occur due to olfactory deprivation caused by nasal airflow interruption. There is evidence that the olfactory system can be modulated by repeated exposure to odors in a procedure called olfactory training. However, it is not known whether any recovery of the lost olfactory bulb volume is possible by eliminating olfactory deprivation via olfactory rehabilitation long after laryngectomy. Objective: This study examined the recovery of olfactory function and the change in olfactory bulb volume via long-term olfactory rehabilitation after total laryngectomy. Methods: Possible causes of olfactory dysfunction in the study participants were evaluated by collecting detailed anamnesis. As olfactory tests, orthonasal butanol threshold and odor discrimination tests were performed. Three-dimensional olfactory bulb volumes were calculated using manual segmentation on T2-weighted coronal magnetic resonance images. In olfactory rehabilitation, four different odors were applied to all patients orthonasally, using a larynx bypass technique for 30 min per day for 6 months. Olfactory tests were performed before the rehabilitation and after 6 months of rehabilitation, and olfactory bulb volume measurements were performed using magnetic resonance images. Results: Eleven patients diagnosed with advanced laryngeal cancer who underwent total laryngectomy and postoperative radiotherapy with a follow-up of 5-10 years were included in the study. All patients were male, and the mean age was 58.18 ±4.17 years. In total laryngectomized patients, the olfactory bulb volumes measured on magnetic resonance images were 42.25 ± 12.8 mm3 before and 55.5 ± 11.22 mm3 after rehabilitation, and this increase was highly significant. Olfactory test scores were 2.3 ± 1.27 before and 4.39 ± 0.86 after rehabilitation, and this increase was also highly significant. Conclusion: As a result of the olfactory rehabilitation applied by providing orthonasal air flow, the olfactory function lost after total laryngectomy was improved considerably, and the olfactory bulb volume was significantly increased. The increase in olfactory bulb volume in total laryngectomy patients via olfactory rehabilitation to eliminate olfactory deprivation due to nasal airflow interruption was demonstrated for the first time in this prospective longitudinal study.

Resumo Introdução: Após a laringectomia total, foi relatada a ocorrência de diminuição da função olfatória e redução do volume do bulbo olfatório devido à privação olfatória causada pela interrupção do fluxo aéreo nasal. Há evidências de que o sistema olfatório pode ser modulado pela exposição repetida a odores em um procedimento denominado treinamento olfatório. Entretanto, não se sabe se qualquer grau de recuperação do volume perdido do bulbo olfatório é possível ao eliminar a privação olfatória através de reabilitação muito tempo depois da laringectomia. Objetivo: Este estudo avaliou a recuperação da função olfatória e a mudança no volume do bulbo olfatório através da reabilitação olfatória de longo prazo após a laringectomia total. Métodos: As possíveis causas de disfunção olfatória nos participantes do estudo foram avaliadas através da anamnese detalhada. Como testes olfatórios, foram feitos os testes de limiar de butanol ortonasal e de discriminação de odores. Os volumes tridimensionais do bulbo olfatório foram calculados com segmentação manual em imagens de ressonância magnética coronal ponderadas em T2. Na reabilitação olfatória, quatro odores diferentes foram aplicados a todos os pacientes ortonasalmente com uma técnica de bypass laríngeo por 30 minutos por dia durante 6 meses. Os testes olfatórios foram feitos antes da reabilitação e 6 meses após a reabilitação e as medidas do volume do bulbo olfatório foram feitas por imagens de ressonância magnética. Resultados: Foram incluídos no estudo 11 pacientes com diagnóstico de câncer de laringe avançado, submetidos à laringectomia total e radioterapia pós-operatória em um seguimento de 5 a 10 anos. Todos os pacientes eram do sexo masculino e a média de idade foi de 58,18 ± 4,17 anos. Em pacientes com laringectomia total, os volumes do bulbo olfatório medidos por imagens de ressonância magnética foram de 42,25 ± 12,8 mm3 antes e 55,5 ± 11,22 mm3 após a reabilitação e esse aumento foi altamente significante. Os escores dos testes olfatórios foram 2,3 ± 1,27 antes e 4,39 ± 0,86 após a reabilitação e esse aumento também foi altamente significante. Conclusão: Como resultado da reabilitação olfatória aplicada através do fornecimento de fluxo de ar ortonasal, a função olfatória perdida após a laringectomia total melhorou consideravelmente e o volume bulbo olfatório mostrou aumento significativo. O aumento no volume do bulbo olfatório em pacientes submetidos a laringectomia total através da reabilitação olfatória para eliminar a privação olfatória devido à interrupção do fluxo aéreo nasal foi demonstrado pela primeira vez neste estudo longitudinal prospectivo.

Modified Olfactory Training Is an Effective Treatment Method for COVID-19 Induced Parosmia.

OBJECTIVES: Coronavirus disease (COVID-19) infection often causes olfactory dysfunction and parosmia may occur in some patients with olfactory dysfunction. In this study, we retrospectively investigated the effectiveness of modified olfactory training (MOT) for the treatment of COVID-19-induced parosmia. STUDY DESIGN: This study presents results of MOT performed with 12 odors for 36 weeks in patients with olfactory dysfunction following COVID-19 infection. A total of 75 participants were included in the study (mean age 33 years, range 16-60 years). METHODS: The patients were separated into two groups: 1) Treatment group consisted of parosmia patients who received MOT with three sets of four different odors sequentially. 2) Control group consisted of parosmia patients who did not perform any olfactory training. Both groups were matched for age and sex distribution of participants. TDI scores were compared at the time of application and at the end of the 9th month by the Sniffin' Sticks Test. The results of the 0th and 9th months were recorded by applying the parosmia assessment scale to both groups. The results were analyzed statistically, and p < 0.05 was considered significant. RESULTS: When the treatment group and the control group were compared, a significant improvement was observed in both groups at the third, sixth, and ninth month, however the improvement in the treatment group was found to be better than in the control group (P < .001). Extending the treatment from 6 to 9 months in the treatment group was found to be effective in mitigating parosmia complaints and improving discrimination scores (P < .001). CONCLUSION: This study has shown that modified olfactory training is effective in the treatment of parosmia following COVID-19 infection. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:1433-1438, 2022.

Olfactory rehabilitation and olfactory bulb volume changes in patients after total laryngectomy: a prospective randomized study.

INTRODUCTION: After total laryngectomy, decreased olfactory function and olfactory bulb volume shrinkage have been reported to occur due to olfactory deprivation caused by nasal airflow interruption. There is evidence that the olfactory system can be modulated by repeated exposure to odors in a procedure called olfactory training. However, it is not known whether any recovery of the lost olfactory bulb volume is possible by eliminating olfactory deprivation via olfactory rehabilitation long after laryngectomy. OBJECTIVE: This study examined the recovery of olfactory function and the change in olfactory bulb volume via long-term olfactory rehabilitation after total laryngectomy. METHODS: Possible causes of olfactory dysfunction in the study participants were evaluated by collecting detailed anamnesis. As olfactory tests, orthonasal butanol threshold and odor discrimination tests were performed. Three-dimensional olfactory bulb volumes were calculated using manual segmentation on T2-weighted coronal magnetic resonance images. In olfactory rehabilitation, four different odors were applied to all patients orthonasally, using a larynx bypass technique for 30 min per day for 6 months. Olfactory tests were performed before the rehabilitation and after 6 months of rehabilitation, and olfactory bulb volume measurements were performed using magnetic resonance images. RESULTS: Eleven patients diagnosed with advanced laryngeal cancer who underwent total laryngectomy and postoperative radiotherapy with a follow-up of 5-10 years were included in the study. All patients were male, and the mean age was 58.18 ±â€¯4.17 years. In total laryngectomized patients, the olfactory bulb volumes measured on magnetic resonance images were 42.25 ±â€¯12.8 mm3 before and 55.5 ±â€¯11.22 mm3 after rehabilitation, and this increase was highly significant. Olfactory test scores were 2.3 ±â€¯1.27 before and 4.39 ±â€¯0.86 after rehabilitation, and this increase was also highly significant. CONCLUSION: As a result of the olfactory rehabilitation applied by providing orthonasal air flow, the olfactory function lost after total laryngectomy was improved considerably, and the olfactory bulb volume was significantly increased. The increase in olfactory bulb volume in total laryngectomy patients via olfactory rehabilitation to eliminate olfactory deprivation due to nasal airflow interruption was demonstrated for the first time in this prospective longitudinal study.

Evaluation of the factors affecting the necessity for revision surgery in choanal atresia.

OBJECTIVE: This study aims to compare the effects of different surgical techniques for congenital choanal atresia (CCA), and particular emphasis is given to the analysis of the factors affecting the surgical outcome. The necessity for revision surgery and surgical outcomes were retrospectively investigated in patients undergoing revision surgery according to a recently proposed classification system. MATERIAL AND METHOD: A retrospective study was conducted on patients operated for CCA between January 2007 and December 2018 at a university hospital. Data in the medical records, including patient age when the initial surgery was performed, gender, additional anomalies and medical conditions, the duration of gestation, side and type of atresia, type of surgery and need for revision surgery were reviewed. RESULTS: Forty-five patients treated for CCA in our university hospital were screened. The mean follow-up duration was 82.16 months. Revision surgery was required in 9 of 26 cases, which are included in the study (34.6%). Fourteen patients presented with bilateral CCA, while 12 were unilateral cases. Sixteen patients (61.5%) had comorbid medical conditions. While the removal of vomer and mucoperiosteal flap use affects successful surgical repair, no differences were observed in choanal atresia type, laterality, use of stent and the presence of additional medical conditions. CONCLUSION: The most important factors affecting surgical success for CCA are the removal of the vomer and closure of all bare bone tissues using a mucoperiosteal flap. Use of stents provides no additional benefit, apart from preventing synechiae formation.

Free Flap Reconstruction of the Head and Neck Region: A Series of 127 Flaps Performed by Otolaryngologists.

OBJECTIVE: To determine flap success rate and complications in patients who underwent microvascular free tissue reconstruction after major head and neck ablative surgery and to report the improvement in the results. METHODS: Medical records of 124 patients who were operated on in 2012 to 2019 were retrospectively reviewed. Indications for different free flap types, success rates and re-exploration rates, donor site morbidities, and reasons for flap loss were analyzed. Patients were divided into two groups to identify the effects of the anticoagulant and the antiaggregant treatments on postoperative results. RESULTS: There were 127 flaps in 124 patients, including two different free flaps each in three patients that were harvested and used in the same surgical session. Of the total 127 flaps, 82 (64.6%) were radial forearm flaps, 39 (30.7%) were fibula flaps, and 6 (4.7) were rectus abdominis flaps. Four patients were re-explored for flap perfusion problems, and 18 patients were re-explored for hematoma drainage (n=22/124, %17.3). The rate of hematoma and re-exploration was higher in patients who received anticoagulant and antiaggregant treatments synchronously (p=0.02). Three flaps were lost, and the overall success rate was 97.6%. Two patients died from perioperative complications. No major complications were observed at the donor site; minor complications were observed in 30 patients. CONCLUSION: The success rate for the 127 flaps in 124 patients were found comparable to those reported in the literature. These results show that successful outcomes can be achieved with experience and a head and neck team dedicated to improving the results in microsurgical reconstruction, and flap failure rarely occurs if perioperative care of the patients is given meticulously.

A simple method for olfactory rehabilitation following total laryngectomy.

PURPOSE: The aim of the study is to demonstrate the effectiveness of spraying odor particles using sinus rinse kits for olfactory rehabilitation in patients with total laryngectomy. METHODS: Olfactory rehabilitation was performed by applying four different odorant particles orthonasally using a sinus rinse kit pump for 30 min each day for a duration of 6 months. Olfactory function was evaluated by performing olfactory tests before the rehabilitation and at sixth month after the rehabilitation process. RESULTS: The average CCCRC score prior to olfactory rehabilitation was 2.28 ± 0.79 (between 1.50 and 3.75), while it was 4.46 ± 0.5 (between 3.50 and 5.25) out of a maximum score of 7 after 6 months of olfactory rehabilitation (p value < 0.0001) CONCLUSION: Our results suggest that the use of sinus rinse kits is very simple, inexpensive, easy-to-use, and effective in providing passive olfaction to patients requiring olfactory rehabilitation.

The effects of indwelling voice prosthesis on the quality of life, depressive symptoms, and self-esteem in patients with total laryngectomy.

This study aims to evaluate the effects of voice rehabilitation with indwelling voice prosthesis on quality of life, depression, anxiety, self-esteem, and sexual functions in laryngectomy patients. Provox-1 was applied to 30 patients who underwent total laryngectomy by opening a tracheoesophageal fistula. WHO Quality of Life-BREF, Beck Depression Inventory, Beck Anxiety Inventory, Rosenberg Self-Esteem Scale, Arizona Sexual Experience Scale forms were asked to be filled out by the patients before voice prosthesis application. These tests were asked to be filled out again 3 months later after the voice prosthesis application. Paired samples and Wilcoxon tests were used to compare before and after operation values. Indwelling voice prosthesis was found to improve quality of life, self-esteem, and sexual function (p < 0.05). Additionally, symptoms of depression and anxiety were regressed (p < 0.05). Indwelling voice prosthesis was found to especially increase the quality of life and decrease depression (p < 0.05). This study is an uncontrolled single-arm study comparing patients' psychosocial statuses pre- and post-voice prosthesis.

Lymphangioma of the tongue: report of four cases with dental aspects.

Lymphangiomas are rare congenital malformations which are commonly seen in the head and neck region. The disease can be histologically differentiated from other vascular disorders such as cavernous or capillary hemangioma with the lymphatic endothelium-lined cystic spaces. The onset of lymphangiomas are either at birth (60 to 70%) or up to two years of age (90%). It is rare in adults. The therapeutic strategy is mainly based on the surgical removal of the lesion. The risk of recurrence is high in incomplete removal of the lesion. In this article, we discuss the major clinical manifestations, disease-related impairments and dental problems which patients may face as well as treatment options for lymphangioma of the tongue. Within this context, we present four cases of lymphangioma of tongue, including two with a giant macroglossia leading problems in dentition and related dental problems.

Carcinoma of the tongue: a case-control study on etiologic factors and dental trauma.

BACKGROUND: Carcinoma of the tongue is the most common intra-oral malignancy in Western countries. Incidence and mortality rates have increased in recent years, and survival has not improved. This study aimed to determine etiologic factors for tongue cancer with age-sex matched case-control data. MATERIALS AND METHODS: 47 patients with carcinoma of the tongue referred to our oral medicine clinic between years 2005-2006 were analyzed and compared with control group data. The medical records , including family history of cancer, dental trauma, and history of abuse of alcohol and tobacco products was recorded for all subjects. Chi square comparison tests and linear regression analysis were performed using the SPSS program for statistics. RESULTS: Patient and randomly selected control groups each consisted of 30 male and 17 female subjects with mean ages 53.2 (± 12.6) and 52.6 (± 11.5) years respectively. Smoking and alcohol abuse proportions were significantly higher in the patient group (p=0.0001, p<0.0001 respectively). Chronic mechanical trauma was observed in 44.7% of the patients and 17.0% of the control group (p=0.004). Similarly, family history of cancer of any type (for the first degree relatives) was found to be more common in the patient group (p=0.009). On regression analysis, alcohol abuse, family history of cancer, smoking, chronic mechanical traumas appeared as significant etiologic factors (p=0.0001). CONCLUSIONS: We believe that field cancerization may become evident in oral and oropharyngeal mucosa with multiple steps of molecular changes starting from the first sign of dysplasia with chronic exposure to etiological factors. Chronic trauma cases need particular attention to search for very early signs of cancer.