Cost-effectiveness analysis of using the heat and moisture exchangers compared with alternative stoma covers in laryngectomy rehabilitation: US perspective

The Benefits of Silicone Laryngectomy Tubes at the Time of Laryngectomy-A Case Series Spanning 17 Years

OBJECTIVES

Although total laryngectomy (TL) is a well-established surgical procedure with clear functional or oncologic indications, the peri- and postoperative care for those undergoing TL is variable, particularly regarding postlaryngectomy tracheostoma management. This study examined TL outcomes from a single institution with the immediate perioperative use of soft silicone laryngectomy tubes. More specifically, we explored potential complications associated with immediate perioperative use of a flexible laryngectomy tube (LaryTube and StomaSoft) and the use of heat and moisture exchange (HME) devices in association with peri- and postoperative care.

METHODS

A case series including all patients undergoing TL by one primary surgeon at a tertiary care hospital between 2006 and 2023 were assessed. Variables of interest included hospital average length of stay (LOS) in hospital, use of laryngectomy tube and an HME, primary tracheoesophageal puncture voice restoration at time of TL, discharge feeding, stoma-related complications, and overall complications.

RESULTS

Seventy-two patients were included over the study period, and all utilized a laryngectomy tube and HME in the perioperative period without complications. Fifty-six patients (77.7%) had concurrent neck dissections and nine (15%) underwent total laryngopharyngectomy. Sixty-two patients (86%) underwent TL for squamous cell carcinoma of the larynx or hypopharynx and 35 of these (56%) were salvage surgeries. Mean LOS was 8.4 (3-45) days, and 63 patients (88%) were discharged with nasal gastric tube feeding. Of the six patients (8%) who were readmitted for complications, zero (0%) were related to the laryngectomy tube or to stoma-related complications (e.g., dehiscence, infection, mucous plugging). No patient who utilized a laryngectomy tube and HME device in the perioperative period experienced stomal stenosis.

CONCLUSIONS

Laryngectomy tubes combined with an HME can be employed safely and successfully in a high percentage of laryngectomy patients placed perioperative. No instances of postlaryngectomy tracheostoma stenosis occurred in association with perioperative laryngectomy tube with HME use. These collective data support the use of a laryngectomy tube with HME in the immediate perioperative period, with low risk of complications.

Tracheotomy versus tracheostomy, the need for lexicographical clarification

In the healthcare field, the terms "traqueotomía" and "traqueostomía" are frequently used, often leading to confusion among professionals regarding the appropriate definition for each term or which one should be considered more correct in specific cases. A search was conducted for the terms "traqueotomía" and "traqueostomía" in general Spanish-language dictionaries such as the Dictionary of the Royal Spanish Academy (DRAE) and the Historical Dictionary of the Spanish Language of the Royal Spanish Academy (DHLE), as well as for the English terms "tracheotomy" and "tracheostomy" in English general dictionaries like the Oxford Dictionary, the Cambridge Dictionary, and the Collins English Dictionary. Additionally, searches were performed in medical dictionaries in both Spanish, specifically the Dictionary of Medical Terms of the National Academy of Medicine (DTM), and English, including the Farlex Dictionary. The terms were also explored using the Google search engine. Definitions were analyzed from both lexicographical and etymological perspectives. Definitions found in general dictionaries, in both Spanish and English, were found to be imprecise, limited, and ambiguous, as they mixed outdated indications with criteria that deviated from etymology. In contrast, definitions in medical dictionaries in both languages were more aligned with etymology. "Traqueotomía" strictly identifies the surgical procedure of creating an opening in the anterior face of the trachea. "Traqueostomía" identifies the creation of an opening that connects the trachea to the exterior, involving a modification of the upper airway by providing an additional entry for the respiratory pathway. "Traqueostomía" becomes the sole means of entry to the airway in total laryngectomies. Both terms can be used synonymously when a traqueotomía culminates in a traqueostomía. However, it is not appropriate to use the term "traqueostomía" when the procedure concludes with the closure of the planes and does not result in the creation of a stoma. Traqueostomas can be qualified with adjectives indicating permanence (temporary/permanent), size (large/small), shape (round/elliptical), or depth, without being linked to any specific disease or surgical indication. Not all permanent traqueostomas are the result of total laryngectomies, and they do not necessarily have an irreversible character systematically.

Adoption and Utilization of Heat and Moisture Exchangers (HMEs) in the Tracheostomy Patient

OBJECTIVE

Management of tracheostomized patients typically involves a conventional external humidification system (CEHS). CEHS are noisy, negatively impact patient mobility, and increases costs. Additionally, they prevent phonation and the ability to cough. Alternatively, heat and moisture exchange (HME) devices have been used in laryngectomized patients. We present an institutional quality improvement project exploring the use and efficacy of an HME device following tracheostomy.

METHODS

Health care professionals and stakeholders from multiple disciplines were identified: otolaryngology, nursing, administration, case management, and speech-language pathology. The focus was on an otolaryngology acute care nursing unit. Protocols for product acquisition, nursing education, care flowcharts, and discharge planning were established. Efficacy was assessed by tracking patient pulmonary status, nursing notes, and questionnaires.

RESULTS

Seventy-one tracheostomized patients were enrolled. Two patients (2.8%) were unable to tolerate the HME. There were no complications from mucous plugging or respiratory distress. Eighty-nine percent of nursing staff surveyed preferred the use of an HME device over CEHS, particularly for ease of patient mobility. Additional favorable findings were patient satisfaction, cost savings, reduced noise, communication, and ease of discharge education and planning.

DISCUSSION

Replacing CEHS with HMEs provides distinct advantages, with a positive impact on patients, family members, and health care personnel. Resistance to changing from the traditional standard of care was alleviated with education, focused training, and positive outcomes.

IMPLICATIONS FOR PRACTICE

These data indicate that an HME device is safe and offers advantages to both patients and nurses over traditional CEHS.

Post-laryngectomy pulmonary and related symptom changes following adoption of an optimal day-and-night heat and moisture exchanger (HME) regimen

BACKGROUND

This study examined post-laryngectomy pulmonary and related symptom changes following establishment of an optimal day/night regimen (all day/night wear of devices with improved humidification) using a new generation range of heat and moisture exchanger (HME) devices.

METHODS

In Phase 1 (6 weeks), 42 post-laryngectomy HME users transitioned from their usual HME regime to equivalent new device/s (i.e., "like-for-like"). In Phase 2 (6 weeks) participants used the full range of HMEs to achieve an optimal day/night regimen. Pulmonary symptoms, device use, sleep, skin integrity, quality of life and satisfaction were examined at baseline, and weeks 2 and 6 of each Phase.

RESULTS

From baseline to end of Phase 2, cough symptoms and impact significantly improved, as did sputum symptoms, sputum impact, duration and types of HMEs used, reasons for HME replacement, involuntary coughs, and sleep.

CONCLUSION

The new HME range supported improved HME use, with pulmonary and related symptom benefits.

Optimizing Pulmonary Outcomes After Total Laryngectomy: Crossover Study on New Heat and Moisture Exchangers

OBJECTIVE

To evaluate the effects of new devices-heat and moisture exchangers (HMEs) and adhesives-on pulmonary symptoms, subject adherence, quality of life, dermatologic symptoms, and patient satisfaction after laryngectomy.

STUDY DESIGN

Prospective crossover study.

SETTING

Between December 2020 and April 2021, 40 patients were enrolled who had undergone laryngectomy, routinely used HMEs and adhesive, and were followed in our Department of Otolaryngology-Head and Neck Surgery.

METHODS

Patients were allocated into group A (new products) or group B (usual care) for 6 weeks. Then the 2 groups reversed, and each patient acted as his or her own control. Patients kept a diary and cough tally sheet. At baseline and after each 6-week period, 2 questionnaires were administered: EQ-5D (European Quality of Life-5 Dimensions) and CASA-Q (Cough and Sputum Assessment Questionnaire).

RESULTS

Six weeks of using new products resulted in the following effects for both groups: (1) a significant reduction in daily forced expectoration and dry coughs, (2) a significant improvement in all domains of the CASA-Q, (3) an increase in adherence to HME use, (4) a significant reduction in shortness of breath and skin irritation, and (5) significantly better scores in the anxiety/depression domain of the EQ-5D.

CONCLUSION

Achieving this reduction in patients who were already highly adherent to HME use is clinically relevant and underscores the importance of using better-performing HMEs that can compensate for the humidification deficit. Improving pulmonary symptomatology could reduce patient restrictions in daily life and avoidance of social activity, with a consequent positive effect on quality of life.

Factors Affecting the Lifetime of Third-Generation Voice Prosthesis After Total Laryngectomy

PURPOSE

The study aimed to evaluate the impact of different variables on the longevity of Voice Prosthesis (VP) in patients after total laryngectomy.

PATIENTS AND METHODS

This retrospective cohort study is based on data about a continuous series of 328 third-generation VP, which were implanted between 2016 and 2020. Data about the VP users' age, sex, place of residence, laryngeal tumor stage, neck irradiation, VP size, and the use of Heat and Moisture Exchanger (HME) were obtained and analyzed. The effect of these variables on VP lifetime was determined.

RESULTS

The median lifetime of VPs in patients 65 years old and above was 182 days (95% CI 168-196), versus 146 days (95% CI 130-162) (P = 0.033) in patients younger than 65. Neck irradiation was associated with a longer VP median lifetime of 161 days (95% CI 142-180) compared to 126 days (95% CI 100-152) with no prior neck irradiation (P = 0.046). HME usage was associated with significantly increased longevity of VPs: 182 days (95% CI 156-208) with HME and 149 days (95% CI 132-166) without HME usage (P = 0.039).

CONCLUSION

The results of the present study suggest that neck irradiation, and routine use of use of HME are positively associated with the longevity of VPs.