Total laryngectomy (TL) is associated with olfactory dysfunction, which can lead to a reduction in olfactory-specific QOL, an effect patients need to be made aware of in preoperative counseling, according to a study published by Marianne Abouyared, MD, and colleagues in the American Journal of Otolaryngology Head and Neck Medicine and
“Although TL may be indicated for oncologic cure or for health [and] safety for dysfunctional larynges, patients are often faced with the decision to weigh quantity [versus] QOL when pursuing treatment,” Dr. Abouyared and colleagues wrote. “After removal of the larynx, QOL is impacted through anatomical and physiological alterations that can permanently affect phonation, pulmonary function, swallowing function, and olfaction.”
As a result, “characterizing the impact on QOL is essential for setting expectations during preoperative counseling, as well as swift implementation of techniques to facilitate rehabilitation after surgery,” the researchers noted.
The study prospectively enrolled 30 patients (median age, 71; 93% White; 87% men) who underwent TL; 63% had a history of tobacco use. Indications for TL included squamous cell carcinoma (57%), dysfunctional larynges (37%), and papillary thyroid carcinoma (6%).
All patients completed the Questionnaire of Olfactory Disorders Negative Statements (QOD-NS) and the Sino-Nasal Outcome Test-22 (SNOT-22), which are validated, widely used, patient-reported outcomes measures used to examine the impact of olfactory and sino-nasal symptoms on QOL, respectively. Based on their responses, patients were classified in two groups using the validated cut-off scores on these assessments: abnormal QOD-NS (≤38.5)
versus normal QOD-NS (>38.5) and normal/mild SNOT-22 (≤20) versus moderate/severe SNOT-22 (>20). The time to questionnaire completion from the date of surgery was approximately 2 years.
Olfactory Changes After TL Impact QOL
Collectively, the average QOD-NS score was 37.9±11.4, with an abnormal QOD-NS score observed in nine patients and a normal QOD-NS score observed in 21 patients. When comparing these patients, those with an abnormal QOD-NS score had a greater percentage of former smokers (77.8%) versus those with a normal score (58.1%). There was also a longer duration between the date of surgery and questionnaire completion in those with an abnormal QOD-NS (904 days) versus those with a normal QOD-NS (477 days), but this finding was not statistically significant.
The average SNOT-22 score was 32.0±3.8, with 19 patients (63.3%) scoring in the moderate/ severe category (>20) and 11 patients (36.7%) scoring in the normal/mild category (≤20). On this questionnaire, “decreased sense of smell/taste” received the highest average score of 3 (ie, moderate problem), with “runny nose” and “need to blow
nose” receiving the next highest scores and bordering on being a moderate problem (scores >2.5 and >2, respectively; Figure).
Worse QOL Associated With Smoking Status
As observed with the QOD-NS questionnaire, patients who fell into the moderate/severe group on the SNOT-22 were more likely to be former smokers, compared with those who fell into the normal/ mild group (68.4% vs 54.5%); however, differences between the normal/mild group and the moderate/ severe group on the SNOT- 22 questionnaire were not statistically significant. The median time from the date of surgery to SNOT-22 completion was 860 days in the normal/mild group and 489 days in the moderate/severe group, though this finding was not statistically significant.
When comparing the QOD-NS and SNOT-22 scores for associations, the researchers reported a moderate negative correlation between them (P<0.001). Because the two measures use opposite scoring systems, with lower QOD-NS scores and higher SNOT-22 scores both corresponding to worse QOL, SNOT-22 scores increased as QODNS scores decreased.
“This study is the first to demonstrate that alterations in olfaction associated with TL result in blunting of olfactory-specific QOL,” Dr. Abouyared and colleagues wrote. “The group of patients with worse QOL contained a greater percentage of smokers, as well as increased time from surgery. Although olfactory dysfunction had a negative effect on QOL, the overall impact was less than anticipated, suggesting that QOL is multifaceted and the importance of evaluating other contributing factors.”