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5.3.3.4 Efficacy of speech therapy interventions with reduced intelligibility\u000DThe efficacy of articulation therapy after head and neck cancer has not fully crystallised yet (Kreeft, van der Molen et al. 2009). However, the literature supports the application of speech and swallowing exercises, especially when compensatory techniques must be acquired. Several studies provide evidence for the effectiveness of targeted therapy. Furia et al. show that speech training after a glossectomy is effective and that the patient\u2019s speech intelligibility improves, even after major resection (Furia, Kowalski et al. 2001). In patients with a resected tongue carcinoma, function- targeting speech therapy, in which the focus is on consonant production, apical sounds and conversation, is shown to be significantly more effective than therapy focusing solely on correct phonation (Li, Li et al. 2004). A study by Jongmans et al. shows that targeted speech training with tracheoesophageal speakers leads to improved intelligibility of the consonants and increased speaker satisfaction (Jongmans 2008). In a study by Logemann et al. on the effectiveness of range of motion (ROM) exercises, the patient group who performed the ROM exercises adequately showed significantly better swallowing scores and better intelligibility than the group who did not perform them (Logemann, Pauloski et al. 1997). Furthermore, patients who received therapy in the first three months after treatment showed better outcomes than patients who entered rehabilitation later on. Early rehabilitation therefore appears to be evidence-based and meaningful.\u000D5.3.4 Deterioration of olfaction after laryngectomy\u000DAfter a total laryngectomy a disruption of olfaction is a frequently occurring (and significant) problem (Ackerstaff, Hilgers et al. 1994, Trotti 2000, Lennie, Christman et al. 2001), with an incidence of between 68% (Van Dam, Hilgers et al. 1999) and 100% (Welge-Luessen, Kobal et al. 2000). This variance is due to the different research methods used by the researchers.\u000DThere are two forms of olfaction: passive and active. Passive olfaction takes place during normal nasal breathing, whereas active olfaction (sniffing) occurs when an odour sensation requires further assessment. After a total laryngectomy inhalation occurs through a permanent stoma in the neck, because of which the air no longer passes through the nose, the olfactory organ. The loss of this airflow is the primary cause of reduced/lost (passive) olfaction in laryngectomees (Moore-Gillon 1985, Schwartz, Mozell et al. 1987, Doty and Frye 1989).\u000DDisrupted olfaction is an important negative side effect of a total laryngectomy. After all, intact olfaction is essential to a good quality of life (Miwa, Furukawa et al. 2001, Blomqvist, Bramerson et al. 2004). Research has furthermore shown that changes in taste and smell especially in cancer patients may lead to reduced intake, malnourishment and in some cases even anorexia (DeWys and Walters 1975, Nitenberg and Raynard 2000).\u000D5.3.4.1 Olfaction assessment methods\u000DOlfaction ability/sense of smell after total laryngectomy can be assessed in several ways. Usually, validated questionnaires and \u2018rating scales\u2019 are used, and/or various commercial or other olfaction tests. These tests often differentiate between absent (anosmia), reduced (hyposmia) and normal olfactory function (normosmia). There is currently no consensus in the literature (yet) on which method best assesses deterioration of olfaction. Outcome measures that discriminate between anosmia and normosmia appear to be more reliable than outcome measures that differentiate\u000D113\u000D