Patients with xerostomia complain of dry mouth and challenges with food sticking in the oral cavity. Individuals who have had prior radiation therapy usually are counseled to maximize hydration with decaffeinated liquids. Many pharmaceutical products are available to address xerostomia and provide artificial saliva and lubrication (Dietrich-Burns, Messing, & Farrell, 2006). Additionally, dietary modifications, like moistening drier foods with sauces, gravies, olive oil, and other condiments, may assist in bolus manipulation in the oral preparatory phase and ease transit through the pharynx.
Other senses also are affected after total laryngectomy. Dysosmia (decreased sense of smell) frequently arises as a consequence of altered respiration, rendering nasal breathing unsuccessful. The ability to smell when the oderant molecules reach the olfactory epithelium requires appropriate airflow through the nasal cavity, which is obliterated after laryngectomy (van Dam et al., 1999). Dysguesia (decreased sense of taste) is another problem that may arise due to changes in the mucosal lining of the oral cavity through to the pharyngo-esophageal segment, impairing taste bud function as a result of radiation, chemotherapy, or surgical alteration (Mirza et al., 2008). Dysosmia and dysguesia can negatively affect a patient's desire, not ability, to swallow certain foods and their overall appetite, which could then compromise nutrition.
Strategies for patients experiencing dysosmia and dysgeusia include experimenting with a variety of foods to determine which are most satisfying. Because foods may taste bland, patients are encouraged to add spices to determine which improve their enjoyment of eating. It should be noted that taste function is poorly understood in individuals undergoing cancer treatment and is an area needing further research to determine the exact nature of deficit and recovery, as well as impact on swallowing ability.
Dysphagia after total laryngectomy is a real and common problem that, in all likelihood, is underreported. Dysosmia, dysguesia, prolonged mealtimes, use of compensatory strategies, and diet alterations may decrease quality of life. Persistent difficulties with solid foods frequently may be overlooked as a symptom of dysphagia, but be bothersome to the otherwise asymptomatic patient who experiences difficulties only with very hard foods, like steak. There are numerous physiologic problems seen after laryngectomy that require careful surveillance and monitoring by the SLP. Therapeutic exercise frequently is recommended, and long-term follow-up is needed to ensure that problems do not develop in the future.
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