Clinical Intervention for Airway Improvement: Establishing a New Nose
Total laryngectomy results in a permanent, anatomical disconnection between the upper and lower airways, a process which directly impacts breathing in addition to other functional activities (e.g., smelling, tasting). Specifically, this includes changes in airway humidification, filtration, warming, and resistance as laryngectomees no longer have air actively passing through the nose and mouth, subsequently resulting in unconditioned airflow into the trachea and lungs. This chapter details the basic properties and benefits of heat and moisture exchange devices and explores available treatment options for airway protection and improvement following total laryngectomy. Of primary importance in this chapter is the goal of providing clinicians with a framework for assessing and managing pulmonary environments for laryngectomees as they work to establish a “new nose” for those who undergo total laryngectomy.
KeywordsHeat and moisture exchange HME Humidification Filtration Resistance Warming Airway improvement Pulmonary protection Respiratory changes Pulmonary environment Pulmonary rehabilitation Airway conditioning Quality of life
I would like to acknowledge Marlene Lesnoff, the first laryngectomee I ever met and my mother-in-law. She taught me long before I entered this profession that life does not end post-laryngectomy, but it does change in ways that many do not appreciate. Her larynx was removed but not her joy, which was evident when she used her electrolarynx to tell inquisitive children she was Darth Vader’s mother. Passing before I became a speech pathologist, it is her memory and passion that goes with me as I’ve had the privilege of helping these patients.
I am also deeply grateful for the incredible gift Marlene gave me in her daughter, who, along with my children, tolerated late nights of me with my nose buried in texts. I am forever grateful for their support, patience, and love.
- Ackerstaff, A. H., Fuller, D., Irvin, M., Maccracken, E., Gaziano, J., & Stachowiak, l. (2003). Multicenter study assessing effects of heat and moisture exchanger use on respiratory symptoms and voice quality in laryngectomized individuals. Otolaryngology and Head and Neck Surgery, 129(6), 705–712.CrossRefGoogle Scholar
- Ackerstaff, A. H., Hilgers, F. J. M., Aaronson, N. K., Balm, A. J., & van Zandwijk, N. (1993). Improvements in respiratory and psychosocial functioning following total laryngectomy by the use of a heat and moisture exchanger. Annals of Otology, Rhinology, and Laryngology, 102(11), 878–883.CrossRefGoogle Scholar
- Bailey, B. (Ed.). (1998). Head and neck surgery: otolaryngology (2nd ed.). New York: Lippincott-Raven.Google Scholar
- Doyle, P. C. (2005). Rehabilitation in head and neck cancer. In P. C. Doyle & R. L. Keith (Eds.), Rehabilitation following treatment for head and neck cancer: voice, speech, and swallowing. Austin: Pro-Ed Publishers.Google Scholar
- Hilgers, F. J. M., Aaronson, N. K., Ackerstaff, A. H., Schouwenburg, P. F., & van Zandwikj, N. (1991). The influence of a heat and moisture exchanger (HME) on the respiratory symptoms after total laryngectomy. Clinical Otolaryngology & Allied Sciences, 16(2), 152–156.Google Scholar
- Kerr, A. (Ed.). (1997). Scott-Brown’s otolaryngology (Vol. 4, 6th ed.). Oxford: Butterworth-Heinemann.Google Scholar
- Merol, J., Charpiot, A., Langagne, T., Hemar, P., Ackerstaff, A. H., & Hilgers, F. J. M. (2011). Randomized controlled trial on postoperative pulmonary humidification after total laryngectomy: external humidification versus heat and moisture exchanger. Laryngoscope, 122, 275–281.CrossRefGoogle Scholar
- Nystrand, R. (2007). Test summary Atos Medical HME Micron (Report no. AM 071024). Bio-TeQ Nystrand Consulting.Google Scholar
- Risberg-Berlin, B., Ylitano, R., & Finizia, C. (2006). Screening and rehabilitation of olfaction after total laryngectomy in Swedish patients: Results from an intervention study using Nasal Airflow-Induing Manuever. Archives of Otolaryngology-Head and Neck Surgery, 132, 301–306.CrossRefGoogle Scholar
- Scheenstra, R. J., Muller, S. H., Vincent, A., Annemieke, H., Ackerstaff, A. H., Jacobi, I., & Hilgers, F. J. M. (2010). Short-term endotracheal climate changes and clinical effects of a h and moisture exchanger with an integrated electrostatic virus and bacterial filter developed for laryngectomized individuals. Acta Oto-Laryngologica, 130, 739–746.CrossRefGoogle Scholar
- Scheenstra, R. J., Muller, S. H., Vincent, A., Sinaasappel, M., Zuur, J. K., & Hilgers, F. J. M. (2009). Endotracheal temperature and humidity measurements in laryngectomized patients: intra- and inter-patient variability. Medical & Biological Engineering & Computing, 47(7), 773–782.CrossRefGoogle Scholar
- van As, C. J., Hilgers, F. J. M., Koopmans-van Beinum, F. J., & Ackerstaff, A. H. (1998). The influence of stoma occlusion on aspects of tracheoesophageal voice. Acta Oto-Laryngologica, 118, 732–738.Google Scholar
- Van den Boer, C., Muller, S. H., Vincent, A. D., Zuchner, K., Van den Brekel, M. W. M., & Hilgers, F. J. M. (2013). A novel, simplified ex-vivo method for measuring performance of heat and moisture exchangers for postlaryngectomy pulmonary rehabilitation. Respiratory Care, 58, 1449–1458.CrossRefGoogle Scholar
- Zuur, J. K., Muller, S. H., Sinaasappel, M., Hart, G. A., Van, Z. N., & Hilgers, F. J. M. (2007). Influence of heat and moisture exchanger respiratory load on transcutaneous oxygenation in laryngectomized individuals: a randomized crossover study. Head & Neck, 29(12), 1102–1110.CrossRefGoogle Scholar