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Olfactory disturbance in pediatric tracheotomy
M A Rothschild1, C M Myer, H J Duncan
1Department of Pediatric Otolaryngology, Children's Hospital Medical Center, University of Cincinnati School of Medicine, OH 45229, USA.
Insights
Tracheotomy in children can impair their sense of smell, specifically their ability to identify familiar odors. This reduction in olfactory identification may persist even after the breathing tube is removed, affecting children
Area of Science:
- Otolaryngology
- Pediatric Medicine
- Neuroscience
Background:
- Hyposmia (reduced sense of smell) is documented after laryngectomy, often linked to decreased nasal airflow.
- Children with nasal obstruction exhibit elevated olfactory detection thresholds due to reduced airflow.
- Tracheotomy in children can cause similar nasal airflow reductions, raising concerns about olfactory function.
Purpose of the Study:
- To investigate the impact of tracheotomy on olfactory identification abilities in children.
- To determine if reduced nasal airflow due to tracheotomy affects the capacity to recognize familiar odors.
- To assess potential long-term effects on olfactory function post-decannulation.
Main Methods:
- Studied children aged 4-16 years with upper airway obstruction requiring tracheotomy.
- Compared olfactory identification of familiar odorants in tracheotomy patients versus a control group.
- Ensured no participants had intrinsic mucosal or olfactory pathology.
Main Results:
- Children with tracheotomies showed significantly lower olfactory identification scores compared to controls.
- Statistical analyses (Student's t test, Wilcoxon rank sum test) confirmed this reduction.
- Age was identified as an independent prognostic variable affecting olfactory identification ability.
Conclusions:
- Tracheotomy is associated with a reduced ability in children to identify familiar odorants.
- Altered nasal airflow secondary to tracheotomy likely contributes to impaired olfactory identification.
- Early olfactory stimulation may be crucial for normal development, suggesting potential persistent deficits.
Abstract:
Several studies have described hyposmia after laryngectomy. The most common mechanism invoked is a reduction in nasal airflow, leading to elevated olfactory detection thresholds. Children with nasal obstruction have been shown to also have elevated olfactory detection thresholds linked to reduced nasal airflow. A child with a tracheotomy is in some degree similar to a laryngectomee. These patients will have variable amounts of nasal airflow reduction proportional to the degree of suprastomal obstruction. Our concern was that this alteration in nasal airflow may cause hyposmia. Furthermore, if the olfactory system requires adequate early stimulation for normal development (as is the case with vision and hearing), tracheotomy would be suspected to cause persistent hyposmia even after decannulation. Thus decreased olfactory sensitivity, delayed olfactory experience, or both could interfere with a child's ability to recognize and identify odor stimuli. We studied children aged 4 to 16 years with upper airway obstruction requiring tracheotomy and compared their abilities to identify familiar odorants with those of a large group of normal control children. None of the children had intrinsic mucosal or olfactory pathology. Statistical analysis of the early data shows a significant reduction in olfactory identification scores in the patients with tracheotomies, both by Student's t test and by the Wilcoxon rank sum test. Analysis of covariance confirmed age as an independent prognostic variable for identification ability. We therefore conclude that tracheotomy can reduce a child's ability to identify familiar odorants.