Context: While clinical successes and descriptions have been reported in a few texts, no data exist to define the utility of flow phonation to improve voice quality in patients with laryngeal hyperfunction. Aims: To provide pilot data regarding the utility of three exercises (gargling, cup bubble blowing, and stretch-and-flow) to improve phonatory airflow during voicing in patients with laryngeal hyperfunction. Settings and Design: Outpatient Voice and Swallowing Center in a University Medical Center. Materials and Methods: Participants received five treatment sessions and were evaluated prior to treatment and after each session using a Phonatory Aerodynamic System to measure airflow during voicing tasks. Noise-to-harmonic ratio and perceptual voice measures were also obtained, as was self-perception of voice handicap. Statistical Analysis Used: Repeated All increased airflow and decreased laryngeal airway resistance over five sessions. Measures Analysis of Variance. Results: Six participants completed the protocol. All participants decreased self-perception of voice handicap and improved on noise-to-harmonic ratio and perceptual ratings of vocal quality. Conclusions: Data derived on a small sample of patients in an exploratory investigation suggest further research into the use of these three exercises to improve airflow with voicing and improve vocal quality in patients with laryngeal hyperfunction is warranted.

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Background: Aging larynx can cause changes in the voice. Knowledge about the normal changes in voice parameters is important in differentiating it from pathological voices. This study is a preliminary investigation on the age related changes in the parameters of voice in geriatric normal subjects, which has been scarcely reported in the Indian literature. Materials and Methods: Our study focused on the changing acoustic parameters of voice due to aging in normal geriatric subjects. The acoustic parameters of males and females with normal voice between the age groups of 60 to 80 were studied. 20 subjects in each category (male and female) were included in the study. All the subjects were taken after clearance from ENT to rule out any vocal pathology. The parameters taken were fundamental frequency, formants (f1, f2), jitter and shimmer. Results and Discussion: Our study shows that there are not any significant changes in the acoustic parameters either in males or in females across the age of 60 years to 80 years. However when compared to adult norms (18-25 yrs) the acoustic values are showing a difference both in males as well as in females in fundamental frequency. Comparison was also done between males and females between the age group of 60 to 80 years. Males differed from females significantly for the parameters of fundamental frequency and formant frequencies (f1 and f2 ) only and not for the parameters of jitter and shimmer.

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Objectives: To adapt the voice handicap index (VHI) for usage in Hindi and evaluate its internal consistency, reliability, and clinical validity in cases of dysphonia. Setting: Tertiary healthcare centers. Materials and Methods: The original VHI was translated into Hindi and was completed by 175 patients with voice disorders and 84 asymptomatic subjects. Internal consistency was analyzed through Cronbach's alpha coefficient. For test-retest reliability, the Hindi VHI was filled twice by 63 randomly selected patients and assessed through the Spearman rank correlation coefficient test. For the clinical validity assessment, the scores obtained in the pathological group were compared with those found in asymptomatic individuals through the Kruskal-Wallis test. Also, the correlation between VHI and the patients' self-perceived grade of voice disorder was assessed. Finally, the effect of age and gender on overall VHI and its three subscales was analyzed. Results: Internal consistency was found to be good (alpha = 0.95); the test-retest reliability was high (r = 0.95). Nonparametric Kruskal-Wallis analysis revealed that the control group scored significantly lower than the dysphonics. The overall VHI score positively correlated with the patients' self-perceived grade of voice disorder (r = 0.44). In the voice-disorder group, age and gender were not correlated to the overall VHI score and to their three domains. Conclusion: The Hindi VHI so developed is a valid and reliable measure for use in the Hindi-speaking population.

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Objective: To evaluate the contribution of 24 hour pharyngeal pH monitoring of patient presenting with symptoms of hoarseness, globus, throat clearing, and sore throat. Study Design: Retrospective case study. Setting: Tertiary laryngology practice. Materials and Methods: Results of 167 pharyngeal pH studies performed for complaints of hoarseness, globus, and throat clearing in an outpatient private practice setting from 5/09-12/09 were analyzed for pharyngeal reflux pattern and severity. Patient records were reviewed for chief complaint, symptom duration, ten item Voice Handicap Index (VHI-10) and Reflux Symptom Index (RSI) scores. Nonparametric testing was used to compare symptom duration, VHI-10 scores, and RSI scores between those patients with and without abnormal pharyngeal pH studies. Results: 71 studies (43%) were normal with zero events below pH 5.5. 32 studies (19%), or 33% of all positive studies showed supine pharyngeal reflux only. 46 studies or 48% of all positive studies showed combination upright daytime reflux events and supine reflux. 18 studies or 19% of all positive studies had only upright events. There was no significant difference in presenting symptoms, symptom duration, or severity scores in the patients that had negative vs. positive pharyngeal pH studies. Conclusion: 24 hour pharyngeal pH study eliminates the diagnosis of reflux in a significant percentage of patients with hoarseness. Severity or duration of symptoms of hoarseness, globus, or throat clearing does not reliably predict presence of reflux.

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Background: Since the past 10 years, the call center industry has expanded rapidly in India. Effective and healthy voice is a primary need for these professionals. Voice problems may threaten both the working ability and occupational health and safety of call center operators (CCOs). Western literature reports higher prevalence of voice problems in CCOs: Yet such investigations are not reported in India. Hence, the present study was focused on investigating the prevalence of voice problems among CCOs and its impact on their working performance. Materials and Methods: A cross sectional survey study was conducted using self-reported questionnaires. Data for the present study were obtained through convenient sampling by distributing 2000 questionnaires in 11 voice-based call centers in Bengaluru, Karnataka, India. The results of the study are analyzed and discussed, based on 1093 eligible questionnaires. Results: The career and point prevalence of voice problems in CCOs were observed to be 59% and 27%, respectively, with no significant gender difference (P > 0.05). The impact of the voice problem in terms of missing work was found to be significantly greater in female CCOs as compared with their male counterparts. Conclusions: This study supports the findings in the literature that CCOs are at greater risk of developing voice problems and that voice problems affect their performance. Thus, there is a great need to identify the risk factors associated with these voice problems and educate the CCOs and employers/organizations about the consequences of voice problems for monitoring effective functioning of CCOs.

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Leukoplakia of larynx has remained a debatable topic in laryngeal pathology for decades as per classification, histology and treatment is concerned. Smoking and alcohol are the major causes and there is sufficient evidence implicating gastroesophageal reflux and human papilloma virus in its pathogenesis. A wide range of therapeutic strategies are available for different grades of dysplasia. Despite this, a significant proportion of patients progress to carcinoma for which the patients with dysplasia need to be kept in regular follow-up.

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Endotracheal intubation is one of the most common procedures performed in the Operating Theatre, Intensive Care Unit or wards, either on an elective or emergency basis. Recurrent laryngeal nerve injury leading to vocal cord paralysis is a lesser known but important complication of intubation. It is important to identify and monitor these patients to prevent confusion with regard to etiology and outcome. This article explores the etiopathogenesis of recurrent laryngeal nerve palsy following intubation and the various risk factors and possible mechanisms which contribute to this complication. Techniques to prevent and recognize this injury are also discussed. PubMed was the main database searched for articles related to the topic which were found through the period 1972–2017.

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The treatment of bilateral immobile vocal cords (BAP) is a balance between phonation, airway and swallowing. Various techniques of endoscopic approach for the treatment of bilateral vocal fold immobility have been proposed and have been modified by various surgeons. Trans oral CO ₂ laser endoscopic arytenoidectomy has become the most common method for its management. CO ₂ laser is arguably the most appropriate tool for cordectomy with the advantage of increased precision, better hemostasis and minimal tissue handling. We describe the procedure of posterior cordectomy with partial arytenoidectomy using trans oral CO ₂ laser for management of BAP. The present modality of preservation of part of shelf of arytenoid and use of laser in super pulse mode contribute to good results with minimum complication

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Introduction: The oral transit time (OTT) and pharyngeal transit time (PTT) are measures that indicate the time taken for bolus transit in oral and pharyngeal cavities, respectively. These measures vary with respect to bolus type and quantity and reflect on the efficiency of the swallow. Objectives: The study aimed to compare OTT and PTT measures for thin (water) and thick (honey) liquid bolus consistencies in 88 typical participants (44 typical adults and 44 typical geriatric persons including males and females) and 10 persons with swallowing disorders. Materials and Methods: OTT and PTT measures for liquid bolus were derived using the equipment Digital Swallowing Workstation-Swallowing Signal Laboratory (DSW-SSL) (Kay/Pentax, Lincoln, New Jersey) Model 7120. In the absence of cited standard procedures to measure OTT and PTT, the measures of OTT and PTT were specifically defined in this study based on the measures obtained from three modules/tests of the DSW-SSL: (a) Tongue array (used to measure the tongue pressure during swallow), cervical auscultation (used to measure the swallow sound), nasal cannula (used to measure the respiratory-swallow coordination). Results and Discussion: The mean group scores of OTT and PTT measures were compared across gender, age, and consistency of bolus and treated with the appropriate statistical procedure. Results revealed that: (i) PTT for honey was longer than water in typical adults and geriatric persons. (ii) There was no significant difference in OTT for honey across age groups. (iii) Atypical patterns in the morphology of tongue pressure, swallow sound and respiratory-swallow coordination during swallow were noted across age and consistency of bolus in typical and atypical population. Conclusion: The OTT and PTT measures can serve as sensitive indices to understand swallow physiology in oral and pharyngeal phase. Increase in PTT is observed for thicker liquid like honey. There are more instances of nonhomogenous patterns across typical and atypical swallows for tongue pressure, swallow sound, and respiratory-swallow coordination.

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Background: Knowledge of the size and proportions of the human larynx is essential for the diagnosis and treatment of laryngeal disorders. Objective of the present cadaveric study was to study dimensions of larynx, various laryngeal folds and laryngeal cavity of adult human larynx in the western Indian population. Materials and Methods: Sagittal section of the head and neck region was taken from the cadaver. Larynx was separated from tongue from the level of hyoid bone to 3 ^rd tracheal ring. The measurements of intact and split larynx were taken with the help of digital vernier caliper, thread, and scale. Data was analyzed using software StatistiXL. For each of the parameters, the mean, standard deviation (S.D.), and range was calculated. Z test was used to test the significance of difference between the two mean. Results: Height of larynx from floor of thyroid notch to lower margin of cricoid cartilage was 32.42 ± 3.41 mm. Height of larynx from upper border of hyoid to lower border of cricoid. (L2) was 54.39 ± 6.04 mm. Height of larynx from tip of epiglottis to lower margin of cricoid cartilage was 57.13 ± 7.32 mm. Total height of laryngeal cavity was 61.51 ± 6.84 mm. Bilateral symmetry was noted in the size of vocal and vestibular folds length. Conclusion: There was wide individual variation in the dimensions of the most of the parameters in the selected population. Bilateral asymmetry, though present in majority of specimens, was insignificant. Morphometrical data of the larynx may be very useful in otorhinolaryngology, laryngeal microsurgery, and evaluation of results of diagnostic techniques. These parameters can be helpful in evaluation of the damage and proper repair of the larynx.

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Purpose: The study aims to observe whether any systematic change in vocal fold configuration occurs during and after phonation into a tube using computerized tomography (CT). Materials and Methods: Ten participants diagnosed with functional dysphonia were included in the study. CT was performed when participants produced the sound (a:), phonated into a drinking straw and when repeating (a:) after the exercise. Similar procedure was performed with a stirring straw after 20 min of vocal rest. Anatomic variables included: (1) glottal area, (2) glottal width, (3) vertical vocal fold thickness, (4) vocal fold area, and (5) vocal fold length. Each vocal fold was separately analyzed. Results: Only glottal area for stirring straw was statistically different throughout the three time points. This variable increased during tube phonation compared to conditions pre- and post-tube. Discussion: Since vocal fold length did not change during tube phonation, the increment in glottal area was likely due to increased amplitude of vibration. Increased vibratory amplitude has been found in previous studies with high-speed imaging, suggesting an increased subglottic pressure. From the physiologic point of view, transglottal pressure plays an important role in vocal fold amplitude of vibration. Conclusions: Tube phonation seems to cause increased glottal area during exercise. This change is more prominent during exercise with a higher degree of airflow resistance. Therefore, the degree of flow resistance is an important clinical variable to be considered when choosing the right voice exercises regarding the voice status/phonatory pattern of patients during voice therapy.

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Introduction: The anatomical and physiological changes in the phonatory system due to aging have a major impact on voice. Widely researched parameters of voice such as fundamental frequency and the perturbation measures depend on the location of the exact pitch pulses, and it may yield unreliable results in case of a severely aperiodic voice. Aim of the Study: The present study focused on determining the cepstral characteristics of voice in healthy aging individuals. Methods: All the participants among the young adults, middle-aged adults, and old adults were required to sustain the vowel/a/. Voice samples were analyzed using Hillenbrand's Z tool software to obtain the cepstral measures. Results: Results showed that there was an increase in the cepstral measures with aging, thus suggesting that the harmonic structure of voice is not affected in healthy aged individuals. Gender also influences the cepstral measures in healthy aging population. Conclusion: The results of the present study could be used by the voice clinicians while assessing adults with voice disorders. It will also help the clinicians in delineating the age and gender differences in the vocal parameters.

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Early diagnosis of laryngeal cancer is important for favourable treatment outcome. Due to morbidity and difficulties associated with surgical biopsy, a need has always been felt for an easy, non invasive yet accurate tool for knowing histopathological nature of mucosal lesions. Contact Endoscopy (CE) is one such technique which is capable of providing real time and magnified images of cellular structure of superficial layers of various mucosal surfaces with obvious advantages and potential for wide clinical application. In this review, a summary of role and efficacy of CE in diagnosis, treatment and follow up of various laryngeal mucosal lesions is presented. We searched Pubmed, Medline, Cochrane and Google scholar for articles on CE for mucosal lesions of larynx. For better understanding of the technique, articles on CE of other non-laryngeal sites of head and neck were also reviewed. Article selection was limited to human studies without restriction to language and year of publication. Reference lists from identified articles were also searched. Six prospective original articles, three descriptive studies and one review article on CE of laryngeal lesions are included in this review and their findings summarized. Common findings on examination of cellular architecture and vascular patterns described by various authors are also tabulated. The literature revealed high sensitivity (90-94.7%), specificity (81-100%) and accuracy (88-94%) of CE in diagnosis of laryngeal lesions across the published studies. CE is a promising non invasive tool for evaluation of laryngeal mucosal lesions. However, further prospective, randomized, double blinded studies as well as research to improve the technique to overcome the existing limitations are required before defining its precise role in clinical practice.

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Vallecular cyst in an infant is uncommon, and it finds infrequent mention in the literature as well. However when present, it accounts for severe inspiratory stridor, causing airway compromise, and sometimes even death. Laryngomalacia is the commonest congenital anomaly of the larynx, which is present after birth giving rise to inspiratory stridor. Laryngomalacia results as a collapse of supraglottic structures of the larynx. Clinical co-presentation of vallecular cyst and laryngomalacia is very rare. This is a report of two cases of 2-month-old infants who presented with the history of noisy breathing and refusal to feeds since 10-15 days. CT scan of the neck revealed a huge cyst in the vallecula compromising the airway. Microlaryngoscopic-guided aspiration and marsupilization of the cyst was done using CO ₂ laser and the release of aryepiglottic fold was done using microlaryngeal scissors. Respiratory and feeding problems dramatically improved in these patients by immediate surgical intervention.

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Background: Despite the prevalence of ultrasonography in medical practice, its use in laryngeal disorders appears underutilized. It provides a simple, easy, cheap and non-invasive method to diagnose vocal cord palsy in real time, dynamic 2 or 3-dimensional image mode. It can be an alternative diagnostic tool where flexible fibreoptic laryngoscopy is limited by an uncooperative patient, xylocaine sensitivity or where stroboscopy is not available due to cost restraints. Especially it is useful in the preoperative workup of a patient undergoing thyroid surgery. Aims: The present study evaluates the accuracy of ultrasonography in diagnosis of vocal cord palsy in 25 patients. We have used fibreoptic laryngoscopy purely as a comparative tool for purposes of this study. Materials and Methods: It was a prospective study carried out in 25 patients presenting with hoarseness. Patients underwent laryngeal ultrasound followed by flexible fibreoptic laryngoscopy. Results: We were able to accurately diagnose vocal cord palsy by ultrasound in all but two patients where the examination was limited by extensive laryngeal cartilage calcification. Discussion and Conclusion: There is every evidence to suggest that ultrasonography has a place in diagnosis of vocal cord palsies. It is easy, cheap, available, and non-invasive. It is a useful tool where fibreoptic laryngoscopy is limited by an uncooperative patient and where strobolaryngoscopy is not available. Further study and more familiarity would extend its use to other laryngeal disorders.

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Objective: Unilateral vocal cord palsy is a major cause of dysphonia. With umpteen number of causes being attributed to it and changing trends in etiology from place-to-place and over time, it is of utmost importance to arrive at a correct diagnosis to plan further management and to determine the prognosis. The aim was to evaluate the etiological profile of unilateral vocal cord palsy in our institute that is a tertiary referral center over the past 10 years. Materials and Methods: Case records of all patients diagnosed with unilateral vocal cord palsy who presented to Deenanath Mangeshkar Hospital, Pune, Maharashtra, India between 2003 and 2013 were retrospectively reviewed. The exclusion criteria included patients with laryngeal/hypopharyngeal malignancies, intubation trauma, congenital vocal cord palsy and cricoarytenoid joint ankylosis. The age, gender, laterality and etiology were the factors taken into consideration. Results: A total of 277 cases spanning over the age range of 2 months to 98 years met our inclusion criteria, out of which 179 were males, and 98 were females with a male to female ratio being 1.82:1. In terms of laterality, 182 patients had left sided, and 95 had right sided vocal cord palsy. Majority of the cases were found to be in the fourth and fifth decades. The most common etiology was idiopathic 136 (49.1%). The incidence of various other etiologies were surgical trauma 60 (21.6%), nonsurgical trauma 10 (3.7%), nonlaryngeal malignancy 36 (12.9%), central/neurological 17 (6.1%), postradiation 1 (0.3%), and other benign lesions 17 (6.1%). Among the surgical causes, the incidence of nonthyroidectomy surgeries (58.3%) was more than that of thyroidectomy (41.6%). Thyroidectomy was the single most common surgical cause for unilateral vocal cord palsy, followed by other nonthyroid neck surgeries (20%) and anterior cervical decompression (18.3%). Conclusion: The most common cause for unilateral vocal cord palsy is idiopathic. Nevertheless it is still an important sign of various underlying diseases. A thorough evaluation which must necessarily include a computerized tomographic scan from base of the skull to upper mediastinum is essential before labeling a case as idiopathic; hence, also the need for extended follow-up of the cases to avoid misdiagnosis of any underlying subclinical malignancy.

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Background: Puberphonia is inappropriate use of high-pitched voice beyond pubertal age in males. It is usually seen in the immediate post-pubescent period when the male vocal mechanism has undergone significant changes in size and function caused by hormonal changes. Voice therapy is one of the modality of management for puberphonia. Aim: To evaluate the efficacy of voice therapy provided to a group of 30 Puberphonia cases as the sole treatment approach to lower the pitch range. Setting: The study was carried out in a tertiary voice care and laryngology center. Materials and Methods: This is a prospective study of 30 cases diagnosed with Puberphonia managed with various techniques of voice therapy. The subjective assessment was done with GRBAS scale and objective assessment was done by acoustic analysis using Multi Dimensional Voice Profile. Results: All 30 patients achieved appropriate pitch range following Voice Therapy. Conclusion: This study encourages speech and language professionals to advice and use voice therapy as the foremost treatment modality for Puberphonia.

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Bilateral vocal fold immobility is characterized by narrowing of the glottic chink which could precipitate in the form of an acute airway insufficiency. The vocal cords may be immobile or fixed in the paramedian position depending upon the etiology and the time duration. The standard approach till the early part of the 19th century was to perform a tracheostomy in such patients. The glottis dilating operations which included cordectomy, arytenoidectomy were introduced in 1922 and have evolved over time. However most of the procedures being irreversible, were not the best line of management in cases with a recovering bilateral vocal fold paralysis. Suture lateralization was introduced as an alternative in the year 1978 which could be reversed if the paralysis resolved. This procedure had two main approaches 1) Endo – Extra laryngeal approach and 2) Extra- Endolaryngeal approach which have been published by different authors over the last 35 years. This current article reviews these techniques alongwith the published results.

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Unilateral vocal cord paralysis (UVCP) in children is a rare and challenging disorder for the pediatric otolaryngologist. The overall etiology differs from that in adults, iatrogenic causes are the commonest, followed by traumatic - birth or intubation trauma and neurologic causes. Prolonged spontaneous recovery occurs in up to 50% of cases. Management strategies used for adults have evolved and been utilized in children, with increasing reports of surgical intervention over the last decade. However, number of children treated remains small with no long-term follow-up. We used the terms "vocal cord palsy," "vocal cord paresis," "vocal fold immobility" each limited by "paediatric," "children," to search Medline, Embase, PubMed, Cochrane, and CINHAL. Reference lists were crosschecked to include relevant studies. Only English language literature was searched. Studies specifically relating to unilateral vocal cord or containing relevant data were identified and analyzed. We present our review of literature on pediatric UVCP with emphasis on various interventions for management, especially the growing experience with laryngeal re-innervation.

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Various materials such as autogenous cartilage, silicone, hydroxylapatite, Gore-tex (expanded polytetrafluoroethylene), and titanium have been used for medialization laryngoplasty. We report an extrusion of Gore-tex implant after 11 months of medialization laryngoplasty. We believe tha t thought Gore-tex is a safe and easy-to-use implant for medialization laryngoplasty, the possibility of extrusion after the operation must not be ignored.

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Rhinosporidiosis is chronic granulomatous disease of likely fungal etiology which usually affects the nasal mucosa. Extranasal manifestations of rhinosporidiosis are relatively uncommon. Laryngeal and tracheobronchial tree involvement is extremely rare and only six cases have been reported till date. Here we report a case of laryngeal rhinosporidiosis, which occurred in a patient with coexisting nasal rhinosporidiosis and was successfully managed surgically.

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Background: Laryngopharyngeal reflux disease (LPRD) cases are common in clinical practice and usually neglected for want of a definitive diagnosis. Diagnosis requires a documented evidence of fall in pH levels in the laryngopharynx with dual-probe 24-hour ambulatory pH-metry. Aim: To study pH-metry findings in laryngopharyngeal reflux cases. Settings and Design: Study was done in a tertiary teaching hospital. Material and Methods: A total of 30 normal volunteers (Group A) and 65 patients (Group B) with complaints of hoarseness of voice for more than six weeks in the age group of 20 to 40 years were studied. A thorough ENT examination including fiberoptic laryngoscopy (FOL) was done on all cases. Group B was further divided into two subgroups. Subgroup B1 (n = 32) consisted of FOL positive and subgroup B2 (n = 33) comprised of FOL negative patients by reflux finding score. 24-hour ambulatory pH-metry was done for both groups. Results: Group A had no abnormal reflux patterns. In Subgroup B1, all 32 patients showed at least single laryngopharyngeal reflux episode over the 24-hour period. The most common pattern was 2 to 5 episodes occurring in 16/32 cases. Of the 32, five (15.6%) also had abnormal De Meester's score (gastroesophageal reflux disease [GERD] positive). In subgroup B2, 2 of 33 patients showed a typical LPR on 24-hour ambulatory pH-metry, despite showing LPRD negativity on FOL. None had an abnormal De Meester's score. Conclusion: LPRD may not coexist with GERD. Two to five reflux episodes pattern were found to be more common in LPR patients. Dual-sensor pH-metry is confirmatory for establishing diagnosis of LPRD.

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Early glottic carcinoma can be treated using endoscopic surgery, radiotherapy, or partial open surgery. Lesions limited to the vocal fold are normally treated with endoscopic surgery or partial open surgery, with local control results between 80% and 90%. The choice of one treatment over another should contemplate the cure rate, larynx preservation rate, post-treatment voice quality, morbidity, and treatment cost. Although both external beam radiotherapy and endoscopic carbon dioxide laser excision of early glottic cancer will affect voice quality, it is difficult to compare them. A complete voice assessment including perceptual, objective, and subjective evaluation is mandatory whenever a meaningful analysis of the pathological voice is to be accomplished. Meta-analyses of the results of voice treatments are generally limited and may even be impossible owing to the major diversity in the ways functional outcomes are assessed. The postsurgical voice outcome depends upon having a straight postoperative vocal fold for glottic closure and intact vibration from the contralateral vocal fold. Subepithelial and subligamental cordectomies are oncologically safe resections and have a quality of voice comparable to that of controls. By contrast, with wider resections (types III-V cordectomies), a concave neocord may form resulting in an aerodynamic glottic incompetence. In order to select the most appropriate treatment modality according to the patient's age, gender, compliance, and professional activity, a detailed preoperative counseling concerning vocal outcome is recommended. After phonosurgical resection, patients who have lost paraglottic musculature may benefit from medialization and augmentation procedures to re-establish glottic competence.

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Total laryngectomy (TL) results in the complete disconnection of the upper and lower respiratory tract, ceasing orthonasal airflow. Hence, olfaction and olfactory acuity are negatively impacted. Prior to the late 1990s, impaired olfaction was simply accepted as a negative consequence of TL surgery. However, a growing body of research conducted within this past decade has demonstrated that rehabilitation is possible with a simple and effective behavioral technique. The current review outlines the literature supporting the negative impact of altered olfaction on quality of life, details of known best practice methods for olfactory assessment both for research and clinical use, and outlines the evidence for interventions known to improve olfactory performance in the TL population. Intervention for olfactory impairment should be part of a holistic, evidence-based rehabilitation process for patients post-laryngectomy.

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