Riitta Ylitalo Möller

Effects of total laryngectomy on olfactory function, health-related quality of life, and communication: a 3-year follow-up study

BackgroundAs total laryngectomy results in loss of airflow through the nose, one of the adverse effects for a majority of patients is the reduced or complete loss of olfactory function. However, with the introduction of a new method, the Nasal Airflow-Inducing Maneuver (NAIM), an important technique is available for laryngectomized patients to regain the ability to smell. The purpose of the present study was to assess changes in olfaction, health-related quality of life (HRQL) and communication 3 years after NAIM rehabilitation.Methods18 patients (15 men and 3 women; mean age, 71 years) who had undergone laryngectomy and NAIM rehabilitation were followed longitudinally for 3 years. For comparison an age and gender matched control group with laryngeal cancer treated with radical radiotherapy was included. Olfactory function was assessed using the Questionnaire on Odor, Taste and Appetite and the Scandinavian Odor Identification Test. HRQL was assessed by: 1) the European Organization for Research and Treatment for cancer quality of life questionnaires; and 2) the Hospital Anxiety and Depression Scale. Communication was assessed by the Swedish Self-Evaluation of Communication Experiences after Laryngeal Cancer. Descriptive statistics with 95% confidence interval were calculated according to standard procedure. Changes over time as well as tests between pairs of study patients and control patients were analyzed with the Fisher nonparametric permutation test for matched pairs.ResultsThirty-six months after rehabilitation 14 of 18 laryngectomized patients (78%) were smellers. There were, with one exception (sleep disturbances), no clinically or statistically significant differences between the study and the control group considering HRQL and mental distress. However, statistical differences (p < 0.001) were found between the study and the control group concerning changes in communication.ConclusionOlfactory training with NAIM should be integrated into the multidisciplinary rehabilitation program after total laryngectomy. Our study shows that patients who were successfully rehabilitated concerning olfaction and communication had an overall good HRQL and no mental distress. Moreover, the EORTC questionnaires should be complemented with more specific questionnaires when evaluating olfaction and communication in laryngectomized patients.

Development and validation of a laryngopharyngeal reflux questionnaire, the Pharyngeal Reflux Symptom Questionnaire.

Abstract Objective. To develop and validate the Pharyngeal Reflux Symptom Questionnaire (PRSQ), a comprehensive, disease-specific, self-administered questionnaire for laryngopharyngeal reflux (LPR) disease. Material and methods. The PRSQ was developed based on empirical evidence from a literature review and expert input from physicians and patients and tested in a pilot study. In this validation study, a total of 228 patients were included and classified according to the Reflux Symptom Index (RSI) cut-off score. Patients with an RSI score > 13 were defined as abnormal, i.e. having LPR disease (n = 102), and those with a score between 0 and 13 were defined as normal controls (n = 126). Psychometric properties of the PRSQ were evaluated by exploring the factor structure and by evaluating internal consistency and item convergent and discriminant validity. Convergent and discriminant validity were determined by using the Laryngopharyngeal Reflux–Health Related Quality of Life questionnaire (LPR-HRQL), the RSI and the Short Form-36. Results. The PRSQ was well accepted by the patients. Compliance was satisfactory and missing item rates were low. After item reduction, due to items not being conceptually relevant or scaling errors and/or low factor loadings, a construct was achieved with no scaling errors and high internal consistency (Cronbachs alpha 0.79–0.93). The correlations between the PRSQ and similar dimensions in the RSI and LPR-HRQL were generally strong. Discriminant validity was satisfactory as the questionnaire discriminated between patients with and without LPR disease. Conclusion. The PRSQ showed good psychometric properties and may become a valuable instrument for assessing LPR disease.

A more than 10-year prospective, follow-up study of esophageal and pharyngeal acid exposure, symptoms and laryngeal findings in healthy, asymptomatic volunteers

Objective. To evaluate the development of pharyngeal and esophageal acid exposure, symptoms, and laryngeal findings in previously healthy subjects. Material and methods. Thirty-three subjects, previously included in a normative pH monitoring study, completed symptom questionnaires, a video laryngoscopic examination, and ambulatory 24-h pharyngeal and esophageal pH monitoring after a mean follow-up of 14 years. Results. Twenty-four subjects (15 F, 9 M, mean age 57 years) completed the study. The number of subjects with pathological esophageal reflux increased from 5 (21%) at baseline to 8 (33%) at follow-up (p=0.23), whereas the proportion with pharyngeal acid exposure of at least 0.1% decreased from 42% to 13% (p=0.04). Heartburn and/or regurgitation developed in 11 of the 24 (46%) subjects and airway symptoms in 10 (42%) subjects. Laryngeal pathology was found in 9 of 23 subjects (39%). Airway symptoms were equally common among subjects with and those without laryngeal findings or with and without pharyngeal reflux. Conclusions. Esophageal acid exposure increases over time in previously symptom-free, healthy subjects. The increase in airway symptoms or laryngeal abnormalities is not directly related to increased acid exposure.

Development of a clinical instrument improving rehabilitation of olfaction with the Nasal Airflow-Inducing Maneuver in Swedish laryngectomized patients

Conclusion: The protocol is a useful and reliable tool for evaluating the use of the Nasal Airflow-Inducing Maneuver (NAIM) in patients who have undergone total laryngectomy. It facilitates the optimization and improvement of olfactory treatment with NAIM and is sensitive to changes over time. However, further modification of the protocol is needed before a broad implementation into routine clinical practice can be recommended. Objectives: To develop and assess whether a protocol evaluating NAIM variables is sensitive and reliable to study olfactory function after total laryngectomy. Subjects and methods: Video documentation from 21 laryngectomized patients receiving olfactory rehabilitation during the study period 2002–2005 was used. The patients’ execution of NAIM was evaluated using a protocol with identified NAIM variables. Olfactory acuity was tested with the Scandinavian Olfactory Identification Test (SOIT). Data from the first (baseline) and third (after treatment) intervention sessions and from follow-up at 6 and 12 months are reported. Results: According to the NAIM evaluation protocol patients significantly improved their execution of the NAIM technique over time and these improvements were associated with improvements in olfactory acuity (SOIT). Using the protocol important key variables for improvement of the NAIM technique were identified. The inter- and intra-rater reliability for the NAIM evaluation protocol was moderate to good.

3 Year Follow-Up; NAIM Rehab in Laryngectomized Patients

tuberculosis by fine needle aspiration in this group. Among the 154 patients of reactive hyperplasia in fine-needle aspiration biopsy, 64 patients showed neutropenia or lymphocytosis. There were one tuberculous lymphadenitis and three benign masses without malignancy. In contrast, among the 90 patients with normal differential count, there were 18 tuberculous lymphadenitis, seven benign mass, and eight malignant tumors. CONCLUSION: The differential count can help the decision making of excisional biopsy in patients whose aspiration cytology was benign or reactive hyperplasia.

S201 – The Progress of Reflux-Related Symptoms in Healthy Persons

Objectives To evaluate prospectively the progress of pharyngeal and esophageal symptoms in previously healthy subjects. Methods 33 healthy persons (mean 57 yrs) earlier included in a normative pH monitoring study were contacted. After a mean follow-up period of 13 years, the subjects completed 2 symptom questionnaires, Short Form 36, and ambulatory 24-hour pharyngeal and esophageal pH monitoring. Results 24 subjects, 9 males and 15 females (mean age, 57 years), completed the study. All subjects were symptom-free at baseline. At follow-up, 11 of the 24 (46%) subjects (p=0.001) reported typical reflux symptoms, e.g. heartburn or regurgitation, of mild to moderate severity. Extraesophageal symptoms occurring at least 1–2 days/week developed across time in 10 of the 24 (42%) subjects. The most common symptoms were throat clearing, excessive phlegm, and daytime cough, in that order. There was no statistically significant correlation between reflux parameters and the occurrence of symptoms (p>0.01). The esophageal, or airway symptoms, or combination of them were similar among persons with and without LPR at baseline and at the follow-up. The perceived health by 10 subjects who had upper airway symptoms at follow-up, or those 8 subjects who had pharyngeal reflux at follow-up, as reflected by the domain specific and summary SF-36 scores, was not significantly different from the age- and gender-matched randomly selected sample from the Swedish normative database. Conclusions The increase in the upper airway as well as esophageal symptoms across time is not correlated to perceived health, or increase in the occurrence of reflux.