Risberg-Berlin Birgit, Rydén Anna, Möller Riitta Ylitalo, Finizia Caterina
Division of Logopedics and Phoniatrics, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
BMC Ear Nose Throat Disord. 2009 Jul 29;9:8. doi: 10.1186/1472-6815-9-8.
As total laryngectomy results in loss of airflow through the nose, one of the adverse effects for a majority of patients is the reduced or complete loss of olfactory function. However, with the introduction of a new method, the Nasal Airflow-Inducing Maneuver (NAIM), an important technique is available for laryngectomized patients to regain the ability to smell. The purpose of the present study was to assess changes in olfaction, health-related quality of life (HRQL) and communication 3 years after NAIM rehabilitation.
18 patients (15 men and 3 women; mean age, 71 years) who had undergone laryngectomy and NAIM rehabilitation were followed longitudinally for 3 years. For comparison an age and gender matched control group with laryngeal cancer treated with radical radiotherapy was included. Olfactory function was assessed using the Questionnaire on Odor, Taste and Appetite and the Scandinavian Odor Identification Test. HRQL was assessed by: 1) the European Organization for Research and Treatment for cancer quality of life questionnaires; and 2) the Hospital Anxiety and Depression Scale. Communication was assessed by the Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer. Descriptive statistics with 95% confidence interval were calculated according to standard procedure. Changes over time as well as tests between pairs of study patients and control patients were analyzed with the Fisher nonparametric permutation test for matched pairs.
Thirty-six months after rehabilitation 14 of 18 laryngectomized patients (78%) were smellers. There were, with one exception (sleep disturbances), no clinically or statistically significant differences between the study and the control group considering HRQL and mental distress. However, statistical differences (p < 0.001) were found between the study and the control group concerning changes in communication.
Olfactory training with NAIM should be integrated into the multidisciplinary rehabilitation program after total laryngectomy. Our study shows that patients who were successfully rehabilitated concerning olfaction and communication had an overall good HRQL and no mental distress. Moreover, the EORTC questionnaires should be complemented with more specific questionnaires when evaluating olfaction and communication in laryngectomized patients.
由于全喉切除术导致气流无法通过鼻腔，大多数患者的一个不良反应是嗅觉功能减退或完全丧失。然而，随着一种新方法——鼻气流诱导动作（NAIM）的引入，为喉切除患者提供了一种重要的恢复嗅觉能力的技术。本研究的目的是评估NAIM康复3年后嗅觉、健康相关生活质量（HRQL）和沟通能力的变化。
对18例接受喉切除术和NAIM康复的患者（15例男性和3例女性；平均年龄71岁）进行了3年的纵向随访。为作比较，纳入了一个年龄和性别匹配的接受根治性放疗的喉癌对照组。使用气味、味觉和食欲问卷以及斯堪的纳维亚气味识别测试评估嗅觉功能。HRQL通过以下方式评估：1）欧洲癌症研究与治疗组织生活质量问卷；2）医院焦虑抑郁量表。通过瑞典喉癌后沟通经历自我评估来评估沟通能力。根据标准程序计算95%置信区间的描述性统计数据。使用配对的Fisher非参数置换检验分析随时间的变化以及研究患者与对照患者之间的测试结果。
康复36个月后，18例喉切除患者中有14例（78%）恢复了嗅觉。除了一个例外（睡眠障碍），在考虑HRQL和精神痛苦方面，研究组与对照组之间在临床或统计学上没有显著差异。然而，在沟通变化方面，研究组与对照组之间存在统计学差异（p < 0.001）。
全喉切除术后应将NAIM嗅觉训练纳入多学科康复计划。我们的研究表明，在嗅觉和沟通方面成功康复的患者总体HRQL良好且无精神痛苦。此外，在评估喉切除患者的嗅觉和沟通时，欧洲癌症研究与治疗组织问卷应辅以更具体的问卷。
