[Olfactory acuity and improvement of olfaction after total laryngectomy].

OBJECTIVE: To test and evaluate the olfactory function of patient after total laryngectomy, seek to a practical method to ameliorate olfactory function and rise the qualitative character of these patients. METHODS: Using the T&T olfactory examination to evaluate the olfactory function of 60 cases. Four cases olfactory mucosae were observed by electron microscope. Observing relation among the remains olfaction, the time after operation and whether or not undergone the voice reconstruction. And analyse the reasons of the above hyposomnia. Using the closing-mouth and nasal out-word airflow maneuver (CNOAM) as the intervention in the patients of tracheoesophageal fistula voice reconstruction after total laryngectomy to observe the amelioration after intervention. RESULTS: It shows various degree of hyposmia and anosmia in the cases after total laryngectomy with or without tracheoesophageal fistula voice reconstruction, with significant deference (P < 0.01) compared to the normal person respectively. There are precisely correlation among the time after operation and whether or not undergone the voice reconstruction. The longer time leads to less remaining olfaction. The patients after total laryngectomy without tracheoesophageal fistula voice reconstruction have lost their olfaction thoroughly within 5 years. But for the patients after total laryngectomy with tracheoesophageal fistula voice reconstruction, they have a middle hyposmia within 5 years, with significant deference (P < 0.01) between the patients in 5 years and after 5 years. There were significant differences (P < 0.01) between the values of patients with and without tracheoesophageal fistula voice reconstruction. The ultrastructure of 4 cases of olfactory epithelium shows the apoptosis change. After the treatment of CNOAM, the remaining olfaction of most patients were improved, with significant deference (P < 0.01) compared to those before the treatment of CNOAM. CONCLUSIONS: The proceed hypofunction of olfaction may be influenced by the reform of respiratory air, the extinction of air velocity bypass the nasal cavity and the apoptosis of epithelial cells in the patients after total laryngectomy. But if we give an early intervention study such as tracheoesophageal fistula voice reconstruction and CNOAM, the olfactory function may be maintenance. During the intervention, the ending of olfactory nerves may be get uninterrupt stimulation. This may help the patients keep a better existing quality than those fail to accept the interventions.

[Acoustic analysis of the voice restored by using a tracheoesophageal slit-like fistula].

OBJECTIVE: To evaluate the quality of voice restored by using a tracheoesophageal slit-like fistula objectively through acoustic analysis. METHODS: Seven objective voice parameters (fundamental frequency, intensity, duration, formant F1, F2, F3 and their energy, jitter, and shimmer) of esophageal speech, Blom-Singer prosthesis voice, tracheoesophageal slit-like fistula voice, primary or modified surgical restored, and normal voice were analyzed and compared. RESULTS: T test was used for statistical analysis. The maximum phonation time of slit-like fistula voice was shorter than that of normal voice, longer than that of esophageal voice, no significant difference compared with that of Blom-Singer prosthesis voice. Its sound intensity of it was similar to that of normal voice and Blom-Singer voice, better than that of esophageal voice. Its fundamental frequency was lower than that of normal voice. Its shimmer and jitter was more than that of normal voice, less than that of esophageal voice, and similar to that of Blom-singer one. Compared with esophageal voice, all formants but F1 of it were not statistically different. No statistical difference between the 2 groups of slit-like fistula patients, i.e., the instant slit-like fistula construction after total laryngectomy and the second stage slit-like fistula construction. CONCLUSION: The voice quality of the patients with tracheoesophageal slit-like fistula is similar to that of the normal and could meet the needs of daily life.