Page 25 - Olfaction regained_Flipbook-subtitles

specific directions required at the moment they need it is next to impossible. Even training two patients at the same time is more difficult than two individual training sessions, both for the SLP and the patients. However, one should realize that there are also patients, who, in contrast, may be more motivated during group training. Rehabilitation of olfaction involves various aspects requiring special attention. On the CD-rom a Checklist for the SLP can be found, which may be useful at the beginning of training. The checklist gives an overview of the aspects to be addressed during training. Rehabilitation of olfaction, pre-operative If olfactory rehabilitation is included as a part of the complete rehabilitation program following total laryngectomy, the patient should be informed of the preliminary loss of the sense of smell and its later rehabilitation early on in the process. Besides all other consequences of total laryngectomy, the consequences and possibilities for olfaction should already be discussed during the pre-operative visit. First, the reason why the sense of smell is decreased after surgery should be explained. Figures 5 and 6 may be used for this purpose. The SLP should also check with the patient how he thinks his sense of smell is at that moment. Testing olfactory acuity with an odour test helps to find more objective answers to these questions. Unfortunately, it is not always possible to carry out an odour test pre-operatively. Patients may have difficulty concentrating, because they are nervous for the surgery or do not feel well. In those cases, the opinion of the patient on his sense of smell will have to suffice. Conducting a pre-operative odour test is, however, preferred. If the (test) results show that the patient has a good sense of smell, the SLP should discuss the polite yawning technique with the patient. She/he should point out that this technique will allow restoration of olfaction after surgery and she/he should let the patient know at which point in time rehabilitation will be started. It is not necessary to give detailed information about the use of the technique at that point. It should also be stated that the sense of smell never will be as passive as it was before surgery. In order to be able to smell, the polite yawning technique will have to be carried out actively. If the odour test shows that the patient is already hyposmic or anosmic before surgery, it is advisory to let the patient consult an otolaryngologist. An otolaryngology examination may clarify the reasons for the smell disorder and some sort of treatment may be started. Odour tests For various reasons, an odour test is the necessary starting point for rehabilitation of olfaction. Ideally, for patients who will be taught the polite yawning technique immediately during the post-operative period, the same odour test should be carried out at three points in time: pre-operatively, post-operatively and at the end of the olfactory rehabilitation. Pre-operatively, the test is used to establish if and how well the patient is able to smell. Post-operatively, this should also be established as well as observing the 24