Page 41 - Olfaction regained_Flipbook-subtitles

Chapter 4 Guide for specific situations Laryngectomy and the common cold A laryngectomized patient with a cold will have symptoms dissimilar to non-laryngectomees. They will normally sneeze differently and less often, and they do not feel they have a stuffed nose. In this way, it is difficult to figure out if they are dealing with a cold or not. Due to the swelling of the nasal mucosa, which is exhibited by both laryngectomees as well as non-laryngectomees, nasal airflow is reduced and thereby olfaction is also reduced (Huttenbrink, 1995). Hyposmia is then a result of a conductive disorder. When the laryngectomee, who is learning to smell, has more nasal mucous than normal, has perhaps an altered taste, is unable to get the manometer moving, smells less after the larynx-bypass (even though he never previously complained of hyposmic or anosmic problems), then we may be dealing with an olfaction disorder due to a common cold. The otolaryngologist may determine endoscopically with more certainty the origin of the hyposmia in such cases. If the problem is actually a common cold, the otolaryngologist may prescribe a nasal spray to decrease the swelling of the nasal mucosa, thereby aiding passage through the nose. Laryngectomy and olfactory disorders Laryngectomees may have olfactory disorders, which people with a normal anatomy also have. To prevent endless endeavours teaching the patient the polite yawning technique without result, olfactory disorders must be diagnosed in an early stage. The diagnosis during the pre-operative interview and the odour test help to recognize existing olfactory disorders. If olfaction seems to have worsened post-operatively, then a larynx-bypass may help determine the state of olfaction for the patient (see figures 7 and 14a and b). A larynx-bypass connects the tracheostoma to the mouth, and thereby the nose to the lungs, so that the patient may breath through his nose again, as he did prior to the total laryngectomy. 40