Rehabilitation of olfaction after laryngectomy by means of a nasal airflow-inducing maneuver - The "polite yawning" technique

Objective: To develop a nasal airflow-inducing maneuver and apply it in the olfactory rehabilitation of patients who have undergone laryngectomy. Design: Intervention study; before-and-after trial. Setting: National cancer center. Patients: Forty-four patients who underwent laryngectomy: 34 men and 10 wom en; mean age, 64 years (range, 42-80 years): mean time since surgery, 6 yea rs (range, 8 months to 18 vears). Intervention: In a prospective clinical intervention study, we assessed the effectiveness of a nasal airflow-inducing maneuver ("polite yawning," ie, yawning with closed lips). Speech therapists trained the patients in the ma neuver, and its effectiveness in inducing nasal airflow was checked with di gital and water manometers. Main Outcome Measures: Olfactory acuity was assessed before and after the i ntervention by means of an odor detection test and a structured questionnai re concerning olfaction, taste, and appetite. Patients were categorized as "smellers" and "nonsmellers" on the basis of the results of the odor detect ion test and the present odor perception scale derived from the questionnai re. Results: The nasal airflow-inducing maneuver could be taught to all patient s, mostly in only one 30-minute therapy session. Fifteen of the 33 patients in the pretreatment nonsmeller category converted to smellers, for a succe ss rate of 46% (P<.001). Conclusion: The nasal airflow-inducing maneuver (the "polite yawning" techn ique) allowed almost half of the patients to recover their sense of smell.