Rehabilitation of olfaction post-laryngectomy: a randomised control trial comparing clinician assisted versus a home practice approach.

OBJECTIVES

To determine (i) the prevalence of impaired olfaction in a group of individuals post-laryngectomy, and (ii) whether intensive, clinician-supported training of the Nasal Airflow Inducing Manoeuvre (NAIM) was more effective at improving olfactory acuity than intensive, home practice over a 6-week period.

DESIGNS

Cohort study followed by a randomised control trial of two treatments over a 6-week period with a 3-month review.

PARTICIPANTS

Olfactory acuity was evaluated in 43 laryngectomy patients. Results revealed 95% had impaired olfactory acuity (anosmic or hyposmic). From this group 40 eligible participants with reduced olfactory acuity were then randomly assigned into either the clinician-supported or home practice treatment group.

MAIN OUTCOME MEASURES

Olfactory acuity and functional impact measures relating to olfactory acuity (participation restriction, wellbeing/distress).

RESULTS

Although olfactory acuity significantly improved in both treatment groups following 6 weeks of therapy, results indicated significantly greater improvement in the clinician-assisted group immediately post-treatment. By 3 months, post-treatment effects were maintained. Both modes of treatment improved levels of patient wellbeing, however, only the clinician-assisted mode made a significant positive effect on levels of perceived participation restriction.

CONCLUSION

Reduced olfactory acuity is prevalent post-laryngectomy. Olfactory acuity can be significantly improved using either 6 weeks of clinician-assisted or home practice using the NAIM manoeuvre, although the current data suggest that intensive clinician-assisted treatment can assist patients to improve more rapidly and have a positive impact on functional state.