Page 35 - Olfaction regained_Flipbook-subtitles

Specific extra exercises for the base of the tongue may help to increase control over the tongue. See Chapter 4, Guide for specific situations. Rehabilitation usually begins with teaching the polite yawning technique because it is easier to learn by the obvious visibility of the movements. It goes without saying that patients who are able to make the correct movements for the refined polite yawning technique from onset do not have to start the rehabilitation with learning the basic movements. Improving taste The olfactory organ plays a leading role in the smell process, but is also of importance for taste. Retronasal airflow is also an essential factor in sensing flavours. Laryngectomees still experience this airflow, unlike orthonasal airflow, but it is limited. Breathing out no longer happens via the nose. Retronasal airflow is still generated while eating and swallowing, by movement of the tongue necessary for displacement of food and swallowing (Burdach and Doty, 1987). If the patient suffers from hypogeusia it may be advisable to have him/her use the tongue more actively during eating. Moving the tongue towards the roof of the mouth will create retronasal airflow. This tongue movement, in fact the opposite of that used during the polite yawning technique, is actually the most suitable. Laryngectomees are usually oncology patients. It may be so that for this patient group the taste is not or insufficiently improved by a conscious effort to use the described tongue movement. This may be caused by a (temporary) taste disorder brought on by chemotherapy and/or radiotherapy. To help these patients to make eating an enjoyable process, they should be advised to concentrate on the basic taste groups of sweet, salt, sour and bitter. Consciously experiencing the colour, structure, temperature and spiciness of a dish, together with the physical presentation of the food may help improve the attractiveness of eating for these patients (Van Toller, 1999). Automating When the laryngectomee has full control over the polite yawning technique and he is able to smell and classify the practice odours, he will need to use this (or the refined technique) in daily life. Using the technique in authentic daily situations will help implementation into the actual daily life. This is the only way that the warning function of olfaction can be rehabilitated and that smelling will most resemble the situation prior to surgery. This may be achieved by using the polite yawning technique regularly at certain points of time during the day. For instance, every time the patient enters a different room, or every time he meets another person. 34