Rehabilitation after nasal cavity and paranasal sinus cancer treatment

Rehabilitation is an important part of returning to the activities of daily living after nasal cavity and paranasal sinus cancer treatment. Recovery is different for each person, depending on the stage of the cancer, the tissues removed during surgery, the type of treatment and many other factors. A person with nasal cavity and paranasal sinus cancer may be concerned about the following:

• physiotherapy
• speech therapy and swallowing problems
• loss of the sense of smell
• vision changes
• changes to hearing
• living with a facial prosthesis
• changes to how you look

Physiotherapy helps maintain or restore muscle strength and mobility. It can help you recover from treatments for cancer in the nasal cavity or paranasal sinuses.

Mouth-opening exercises should be done during and after radiation therapy. These exercises help strengthen the muscles used to open the mouth. Doing these exercises helps to prevent trismus, which is difficulty opening the jaw.

A neck dissection removes nearly all of the lymph nodes from one side of the neck, as well as muscles, nerves and veins, causing the shoulder on the side of the surgery to be lower than the other shoulder. This can lead to less mobility and more pain if you don't start physiotherapy as soon as possible after surgery. Strengthening exercises for shoulder and neck muscles can help make up for the loss of muscles from the surgery.

Both surgery and radiation therapy for nasal cavity and paranasal sinus cancer can make swallowing difficult. They can also lead to speech problems. Speech therapy can help you speak and swallow after these treatments.

A speech therapist (also called a speech language pathologist, or SLP) can help you manage speech and swallowing problems. You may see a speech therapist before you start treatment if your doctor thinks your treatment may cause problems with speaking or swallowing. Surgery to remove part or all of the upper jaw (the maxilla) on one side of the head may cause food and liquids to go inside the nose when you eat and drink. A speech therapist can suggest ways to help you swallow more easily, such as changes to your posture, controlling the amount of food you swallow at one time and exercises.

You may have a special x-ray test (called a swallowing assessment) to see what happens when you swallow. This will help the speech therapist suggest ways to make swallowing safer and easier for you.

Find out more about speech problems and swallowing problems.

Depending on the type of treatment for nasal cavity and paranasal sinus cancer, you may lose your sense of smell (called anosmia). This may be temporary or permanent.

The cells responsible for the sense of smell (called olfactory cells) are located in the mucous lining of the nasal cavity. Tumours can block air flow over the lining so that these cells can't sense a smell as they normally would. Some types of surgery remove this lining, along with the olfactory cells. Other surgeries may damage the nerves responsible for smells (called olfactory nerves). Radiation therapy can also directly damage the olfactory cells and nerves.

If you have anosmia, you will need to learn ways to cope without your sense of smell. Be careful at home and work in case there is a fire, chemical spill or another harmful situation. Make sure your smoke detectors at home are working and read labels on bottles of chemicals carefully as they may need to be used outside or in a well-ventilated area.

Nasal cavity and paranasal sinus cancer that spreads to the eye or the bone and tissue around the eye (called the orbit) can cause vision changes. Some changes to vision are minor. In some cases, doctors need to remove an eye to treat the cancer. Changes to how you see may also be caused by radiation therapy affecting the optic nerve in the eye.

Loss of vision in one eye may make it hard to judge how far an object is away from you. You may bump into things on the side of the body where vision is affected. Your healthcare team may suggest exercises to help you judge distance better. You may also have problems driving at night. It will take time to adjust to changes to your vision. Get regular eye exams to check your vision.

Find out more about vision changes.

Radiation therapy and surgery for nasal cavity and paranasal sinus cancer may affect hearing. Hearing loss because of tissue swelling after surgery is usually temporary. Hearing loss after radiation therapy may be permanent.

Coping with hearing loss can be difficult. Having a conversation with someone in person or over the phone may be very hard. You may also get tired of asking people to repeat themselves. It's important to tell people that you have trouble hearing and ask them to speak louder. You may also find it helpful to turn down a TV or radio to lower background noise when you're having a conversation.

If your hearing changes, your doctor will refer you to a hearing specialist (called an audiologist). They will assess how much hearing loss you have and can provide hearing devices and suggest ways to help you cope.

Sometimes doctors have to remove large amounts of bone and tissue during surgery to treat cancer in the nasal cavity or paranasal sinuses. Advances in plastic and reconstructive surgery allow skin and bone grafts or tissue flaps to repair most of the changes that surgery causes to your face.

If reconstructive surgery can't provide good results, or if reconstruction isn't an option, you may need a facial prosthesis.

Prostheses are fitted by a specialist who is trained to make replacements for structures of the head and neck, including the nose, mouth or eye. Each prosthesis is designed and custom fit for each person who will be using it. The following are different types of prostheses used in nasal cavity and paranasal sinus cancer:

• artificial eye
• nose prosthesis
• dentures or other types of artificial teeth, including dental implants

Your healthcare team will give you detailed instructions on how to use and care for your prosthesis.