Clinical Intervention for Airway Improvement: Establishing a New Nose

  • W. J. Bryan Lewis


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.


Heat 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.


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • W. J. Bryan Lewis
    • 1
    • 2
  1. 1.Department of SurgeryWalter Reed National Military Medical CenterBethesdaUSA
  2. 2.Uniformed Services University of the Health SciencesBethesdaUSA

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