Post-laryngectomy videofluoroscopic assessment in relation to olfactory rehabilitation through the physiological olfactory recovery technique.

Objective: To correlate the anatomo-physiological characteristics of post-laryngectomy changes, assessed by videofluoroscopy, with the outcome and modalities of olfactory rehabilitation using the physiological olfactory recovery technique (PORT). Materials and methods: From 2019 to 2021, a prospective observational study was conducted at the Department of Otolaryngology-Head and Neck Surgery of Ospedale del Mare, Naples, Italy, on 31 patients who had undergone total laryngectomy with primary placement of a tracheo-oesophageal voice prosthesis. All patients completed a proprioceptive training programme with a speech-language pathologist and learned the PORT method. At the end of the 10-session rehabilitation protocol, all participants demonstrated significant improvement in olfactory perception, which was maintained at long-term follow-up. During subsequent application of PORT in selected patients, notable inter-patient differences emerged in both the modality and timing of response to rehabilitation. This prompted an anatomo-physiological investigation of the post-laryngectomy changes to objectify these variable outcomes. As part of an ongoing collaborative project between the Otolaryngology and Radiology Units aimed at monitoring swallowing and phonatory function in laryngectomized patients, videofluoroscopic examinations were analysed. A total of 31 videofluoroscopic studies performed between February and October 2022 were reviewed. Results: Differences in patient responses to PORT correlated with individual anatomo-physiological variations in the amount and distribution of air reaching the proximal oesophagus during phonation - defined as the phonatory air bubble (PAB) - as well as with differences in the elasticity of the anatomical district examined. Five distinct types of proximal oesophageal PABs were identified, classified according to post-surgical anatomical characteristics and functional alterations related to adjuvant therapy, particularly radiation-induced fibrosis. Conclusions: PORT is an effective olfactory rehabilitation technique for laryngectomised patients with a trachea-oesophageal voice prosthesis, including those with complex anatomo-physiological conditions. Accurate interpretation of post-laryngectomy changes is essential for evaluating treatment efficacy: 28 of the 31 patients evaluated physiologically recovered the daily olfactory sniffing manoeuvre, although with variable modalities and timing. Overall, PORT represents a widely applicable and effective method for olfactory rehabilitation in the vast majority of patients with a tracheo-oesophageal voice prosthesis after total laryngectomy.