FAQ18: Smelling Again after a Laryngectomy.

by Pat Sanders


What happens when you don't pay attention?

One morning recently, I took my yogurt out of the refrigerator, stuck a piece of bread in the toaster oven, flipped the dial to toast and turned the timer on. I then took my coffee and headed for my computer to check my e-mail before having breakfast. I got caught up with some interesting reading so was lost in thought, when I looked up and saw my house was filling with smoke. I ran for the kitchen and got the charred toast out of the toaster oven probably just before it might have burst into flames. After I opened doors and windows and turned on exhaust fans, I looked to see what I had done. I had turned the dial to 'broil' instead of 'toast' and 'broil' doesn't work off of the timer. Second, I checked the smoke alarm in this part of the house because there was no warning. Something had gone wrong with it (not the battery) and it didn't work. I have since replaced this one with two new ones.

With the top half of the rooms filled with smoke, I saw it but didn't smell it until I stood up. Prior to that, I had thought I was doing pretty well with being able to detect odors. All of a sudden, it became more important for me to find out more about this sense of smell and to understand something about how it works. So I did some research on the Internet:

http://www.entnet.org/smelltaste.html

How do smell and taste work?

Smell and taste belong to our chemical sensing system (chemosensation). The complicated processes of smelling and tasting begin when molecules released by the substances around us stimulate special nerve cells in the nose, mouth, or throat. These cells transmit messages to the brain, where specific smells or tastes are identified. Olfactory (small nerve) cells are stimulated by the odors around us-the fragrance from a rose, the smell of bread baking. These nerve cells are found in a tiny patch of tissue high up in the nose, and they connect directly to the brain. Gustatory (taste nerve) cells react to food or drink mixed with saliva and are clustered in the taste buds of the mouth and throat. Many of the small bumps that can be seen on the tongue contain taste buds. These surface cells send taste information to nearby nerve fibers, which send messages to the brain. The common chemical sense, another chemosensory mechanism, contributes to our senses of smell and taste. In this system, thousands of free nerve endings-especially on the moist surfaces of the eyes, nose, mouth, and throat-identify sensations like the sting of ammonia, the coolness of menthol, and the heat of chili peppers.

Flavor

We can commonly identify four basic taste sensations: sweet, sour, bitter, salty.

Certain combinations of these tastes-along with texture, temperature, odor, and the sensations from the common chemical sense-produce a flavor. It is flavor that lets us know whether we are eating peanuts or caviar. Many flavors are recognized mainly through the sense of smell. If you hold your nose while eating chocolate, for example, you will have trouble identifying the chocolate flavor, even though you can distinguish the food's sweetness or bitterness. This is because the familiar flavor of chocolate is sensed largely by odor. So is the well-known flavor of coffee. This is why a person who wishes to fully savor a delicious flavor (e.g., an expert chef testing his own creation) will exhale through his nose after each swallow.

Taste and smell cells are the only cells in the nervous system that are replaced when they become old or damaged. Scientists are examining this phenomenon while studying ways to replace other damaged nerve cells.

Back to Laryngectomees

I have often wondered why some laryngectomees seem to retain a better sense of smell and taste than others. This is important not just for food and drink but because smell and taste can warn us about fire, poisonous fumes, and spoiled food. Perhaps some have already had damaged or diminished abilities because of age, medication, dental problems, polyps in the sinus cavities, or prolonged exposure to some chemicals. Smoking had already messed up our sense of taste and smell, so we may have gone into surgery missing a good bit of these abilities. Since quitting smoking lets you regain this, perhaps it helps a little to offset what we have lost by not breathing through our noses. Radiation therapy often causes a loss of smell and taste. There may also be something in the way we breathe or talk. I have a better sense of taste/smell since I speak with a TEP and the air that I use comes back up to the mouth and nose. When I read the section above about breathing out through your nose, I was sitting here with a cup of flavored coffee, so I tried it. Took a sip, swallowed, then occluded and gently blew air out through my nostrils. YES! It works. I got a much stronger Hazelnut flavor or aroma..

The normal methods of taste and smell testing are not very useful to us, but I did write a couple of articles on taste in which I suggested you try chewing a tiny bit of dried herb to see if you could taste it. This was in reference to using herbs in cooking and which you might want to choose because they were tastier to you. You can find both of these article on the WebWhispers site under the recipe section. http://webwhispers.org/pages/recipes/recipemain.htm click on Articles.

One test for the ability to smell is to have the person being tested sniff two substances with only one nostril at a time while the other is held closed. They use clear liquids, water and the other a combination of water and butyl alcohol. If the patient cannot detect the odor, the butyl alcohol is increased and it is tried again. While that test would not help us, the idea could be used with something like a lemon peel twisted near the nostrils and slight sudden uplift of the head. The oils in the lemon peel tend to float and you will likely get a strong scent. Now, having a TEP, if I occlude with the same hand I use to twist the lemon peel and talk, the lemon is very clear to smell and seemingly to taste, Unfortunately, the same thing applies when you are peeling onions, quickly rinse your hands and occlude to speak when the telephone rings.

As the article quoted above states: salty, sweet, sour, and bitter are the accepted types of taste. Some people added savory to that list and it seems reasonable since placing a savory sauce in any of the 4 major categories is impossible. It is something you smell as much as taste.

Going centuries back, some scholars had broken odors down into many different classifications. Plato divided smell qualities into pleasant and unpleasant; Aristotle classified odors into 7 different classes. In the 16th century, Linnaeus delineated 7 types of smells: aromatic, fragrant, alliaceous (garlic), ambrosial (musky), hircine (goaty), repulsive, and nauseous. Some of these, we may be grateful to avoid Others later added ethereal (fruity) and empyreumatic (roasted coffee) to the list making 9 types.

Not much attention has been paid to research on smell and taste disorders because the loss or diminishing of these senses is not considered life threatening, even though it is known to take away some of the enjoyment of pleasurable pastimes. For us, infections, inflammations, oral yeast, dental problems and any vitamin deficiency should be treated to improve the ability to smell and taste that we have left. Patients are often advised that chewing food well increases taste release from the food and increases saliva production to further distribute the chemicals. Switching foods during the meal hot to cold, crisp to soft, or sweet to sour, can improve detection of the tastes.

And, we should remember that these losses can be secondarily life threatening in the event of eating spoiled food or smelling dangerous fumes or even burning your toast.