Help Your Patients Stop Smoking

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From a simple sore throat or laryngitis to cancers of the head and neck, including oropharyngeal, laryngeal, esophageal, and pharyngeal, smoking tobacco causes many problems for patients, and their otolaryngologists are in a good position to help them quit.

Tobacco smoking is an important risk factor for head and neck cancers, and smoking cigarettes increases the risk of head and neck cancer 15-fold, according to the American Academy of Otolaryngology-Head and Neck Surgery. Even if a patient’s internist or general practitioner has already made the recommendation to quit cigarettes or offered tips for smoking cessation, an otolaryngologist can highlight that message. He or she can also emphasize the potential harms of smoking as it pertains to the ear, nose, and throat, as well as reinforcing the systemic consequences a patient’s other physicians have discussed.

“We all have to remind our patients that they need to stop smoking instead of just taking a history and accepting tobacco use,” said Stacey Ishman, MD, MPH, associate professor of otolaryngology-head and neck surgery at the University of Cincinnati and surgical director of the university’s Upper Airway Center. Dr. Ishman co-authored a 2015 review that found that the majority of studies on secondhand smoke and sleep-disordered breathing indicated a significant association between the two (Laryngoscope. 2015;125:241-247). “The act of mentioning the need to stop smoking as a critical health priority for our patients can make a significant difference, and the more providers who highlight the need to stop smoking, the better,” she said.

Expect to Meet With Resistance

Michael Vick, MD, an otolaryngologist with Wellstar ENT in Marietta, Ga., said that, initially, he gently admonishes his patients who smoke, making sure they are aware of the risks associated with their habit. “The majority are quick to admit that they know it is harmful,” he said, “but most are surprisingly reluctant to quit.” Some of Dr. Vick’s patients say they have tried and failed at previous attempts to quit, while some have been successful at cessation but ultimately “fall off the wagon,” and approximately 2% to 3% are willing to try something to quit. The vast majority, however, are unwilling to stop.

“What is most surprising to me and many colleagues that have reported similar stories are the patients who have been cured of their cancer through surgery, chemo, radiation therapy, or both, who have had major resections including laryngectomies, but still find ways—sometimes creative ways—to continue to smoke,” he said. “It is baffling, but it just goes to show the powerful addictive effect that cigarettes have on our population.”

It’s Not Just Cancer

Rahmatullah Rahmati, MD, assistant professor of otolaryngology-head and neck surgery at New York Presbyterian/Columbia and the medical director of the Adult ENT Clinic at the New York-Presbyterian Vanderbilt Clinic, says that most of his patients with head and neck cancers are either current smokers or have a past history of smoking. He added that smokers who do not have cancer may suffer from ear pain, pressure, infections in the setting of the Eustachian tube, nasal congestion and sinusitis, hoarseness, globus sensation, increased phlegm, difficulty swallowing, and throat pain, as well as laryngopharyngeal reflux disease.