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Frans J. M. Hilgers, MD, PhD; Helma A. Jansen, MSc; Corina J. van As, PhD; Marianne F. Polak; Martin J. Muller, MSc; Frits S. A. M. van Dam, PhD

Arch Otolaryngol Head Neck Surg. 2002;128:648-654.

Objectives  To study the long-term results of the nasal airflow–inducing maneuver (NAIM) as an olfaction rehabilitation tool after laryngectomy and to investigate the effectiveness of a new, simpler odor detection test (ODT) called the smell disk test (SDT), or Zürcher Geruchstest.

Design  Intervention study.

Settings  National cancer center.

Patients  Forty-one laryngectomees who received olfaction rehabilitation training with the NAIM 4 months to 2 years earlier. This so-called polite yawning maneuver creates an "underpressure" in the oral cavity, which, in turn, generates a nasal airflow that enables odor molecules to again reach the olfactory epithelium.

Main Outcome Measures  Olfaction acuity testing with a standard ODT, along with a questionnaire, providing a subjective olfaction score (present odor perception scale [POPS]), and the SDT, as well as assessment of the patients' correct execution of the NAIM by speech-language pathologists on video recordings made during odor testing and long-term assessment of olfaction acuity.

Results  The correlation between the previously used ODT-POPS combination and the SDT was = 0.56 (P<.001). Based on these results, we preferred to use the much simpler SDT instead of the laborious combination of the ODT-POPS. Based on the SDT results, 19 (46%) of the 41 laryngectomees were "smellers" and could be considered normosmic. There was a significant relationship (P = .03) between the patient's correct execution of the NAIM and whether or not the laryngectomee was a smeller according to the SDT.

Conclusions  The effectiveness of the NAIM, or so-called polite yawning technique, for the rehabilitation of olfaction in individuals who have undergone total laryngectomy was reconfirmed. Long-term olfaction rehabilitation was achieved in about 50% of the patients, but more intensified training may be needed to increase the percentage of successfully rehabilitated individuals. The SDT is an effective and simple test for the assessment of olfaction acuity after laryngectomy.

From the Departments of Otolaryngology–Head and Neck Surgery (Drs Hilgers and van As and Ms Polak) and Psychosocial Research and Epidemiology (Mr Muller and Dr van Dam), Netherlands Cancer Institute, and the Institute of Psychology, University of Amsterdam (Ms Jansen and Dr van Dam), Amsterdam, the Netherlands.

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