Page 43 - Olfaction regained_Flipbook-subtitles

anything. What exactly can go wrong and what can be done to correct it is described in the following paragraphs. Stationary liquid Stationary liquid When fluid remains stationary, there is no orthonasal or retronasal airflow. Attempt to use the other nostril first to see if there is any improvement. Usually stationary fluid is caused by the absence of tongue movements or by defective tongue movements. To improve tongue movements, make use of the exercises in the paragraph Functional problems, in this chapter. The soft palate may be inflexible if the patient makes the tongue movements too tightly, causing blockage of the airflow. Lack of nasal airflow may also be caused by a poor closure of the lips. If the liquid remains stationary, a conductive olfactory disorder may be the cause. This must always be considered. The larynx-bypass may be useful in proving this. Minimal movement of liquid If the opposite nostril is not closed, there will be some difficulty in getting the fluid to move. It is therefore suggested that when using the manometer, the nostril be closed. Tongue movement may also be responsible for minimal movement of the liquid, especially if the movement is made with little effort. The liquid in the manometer will move upwards into the direction of the nose, but only minimally. The patient should practice further moving the fluid upwards every time. This can only be achieved by using more powerful and active movements of the tongue. Specific tongue exercises may help in this, as well. Hyperkinetic movement of the tongue must be avoided. The lips should also be closed constantly. Extra pressure may be created by allowing the patient to breathe in, occlude the tracheostoma and then perform the polite yawning technique. Usually the liquid in the 42