INTRODUCTION TO LARYNGECTOMY CARE?

This information was prepared by Louise Malcolm, Senior Speech Pathologist, Epworth Richmond, Speech Pathology Department.

Acknowledgement – ‘Charing Cross Hospital Surgical Voice Restoration Patient Information Package’ (2004).

  • Voice Prothesis, Catheter & DilatorLARYNGECTOMY is the surgical removal of the voice box (larynx).
  • You will now breathe through a hole in your neck called a
    tracheostoma or STOMA.
  • Your trachea (airway/windpipe) and oesophagus (food pipe) have become two separate passages.
  • Your surgeon has created a passage between these called a Tracheoesophageal Puncture or TEP (also referred to as a Tracheoesophageal Fistula or TOF).
  • Your Speech Pathologist will place a one-way VOICE PROSTHESIS through this passage.
  • This prosthesis lets airflow from your lungs into your oesophagus to produce your new VOICE.
  • This prosthesis also prevents food/fluids going from your oesophagus into your trachea – this is called aspiration.
  • You must always have a voice prosthesis (item 1) or catheter (item 2). / dilator (item 3) in the TEP so that it remains open.

Stoma & Voice Prothesis Care

  • This information, based on the booklet, takes you step-by-step through the things you need to do to look after your stoma and voice prosthesis.
  • Your speech pathologist will teach you these during your hospital stay.
  • You’ll be asked to practice them while you’re on the ward so that you feel confident and comfortable doing them by yourself at home.
  • Like anything, they can take time to learn.
  • If you have any questions, please speak to your Speech Pathologist.

For a video demonstrating Laryngectomy Care – CLICK HERE

Cleaning Your Stoma

Regularly cleaning your stoma is important to ensure your airway remains open and it’s easy to breathe.

What you will Need

  • Good light source
  • Mirror
  • Tweezers
  • Moistened cloth
  • Dry towel

Procedure

  1. Laryngectomee using tweezers to remove crusts

    Using tweezers to remove crusts

    Being careful not to cause any trauma, gently remove any mucous plugs or crusts from around or within the stoma using the TWEEZERS. You don’t need to go much deeper than the rim of the stoma.
  2. Using a MOISTENED CLOTH, making sure all the excess water has been wrung out, gently clean around the stomal skin.
  3. DRY thoroughly with a clean towel.

If necessary, you can loosen any dried mucous or crusts using a NEBULISER before you start cleaning. The nebuliser is also useful if you feel you have a lot of secretions that are difficult to clear (eg. if you’re sick, or the weather is really hot/cold, etc).

Cleaning Your Voice Prosthesis

Mucous can collect on & within the prosthesis, causing it to block. Cleaning it regularly will help keep your voice strong and consistent.

Voice prosthesis barrel

Voice prosthesis barrel

What you will Need

  • Good light source
  • Mirror
  • Tweezers
  • Moistened voice prosthesis brush

Procedure

    Laryngectomee cleaning voice prosthesis with brush

    Cleaning voice prosthesis with brush

  1. Using the TWEEZERS, gently remove any crusts of mucous from the front of the voice prosthesis. Be very careful not to dislodge it.
  2. Gently insert the moistened VOICE PROSTHESIS BRUSH into the barrel of the prosthesis.
  3. Continuing to TURN IT, slowly pull the brush out of the prosthesis.
  4. Rinse, and repeat until the brush comes out clean.

Checking for Leakage

The voice prosthesis must be checked for leakage on a daily basis to make sure fluid/food isn’t going into the lungs. Leakage can be a sign that the prosthesis needs changing.

What you will Need

  • Good light source
  • Mirror
  • Coloured liquid, eg. blue food dye, Ribena, coffee

Procedure

  1. Once you have cleaned the prosthesis, stand in the front of a MIRROR, making sure you can clearly see the prosthesis barrel.
  2. Take a sip of coloured liquid, swallow and check for any LEAKAGE
    either through the prosthesis or around it. It is important to keep watching for a few seconds, as it may take this long for the liquid to show.
  3. Repeat 3 – 5 times.
Leakage through voice prosthesis
Leakage through voice prosthesis barrell (central leakage):

What to do if only trace leakage is found through the central barrel of the Voice Prosthesis (central leakage):

  1. Clean the prosthesis again with the VOICE PROSTHESIS BRUSH. This makes sure that no food particles have lodged under the flapper.
  2. Check for leakage again with coloured liquid.
    If the leakage continues, contact your Speech Pathologist ASAP to arrange a review.
  3. If OBVIOUS/PERSISTENT leakage is seen, contact your Speech Pathologist as soon as possible to arrange a review.
Leakage around voice prosthesis
Leakage around voice prosthesis (peripheral leakage):

What to do if leakage is found around the edge of the Voice Prosthesis (peripheral leakage):

Contact your Speech Pathologist ASAP to arrange a review.

You may need to thicken your fluids in the meantime to stop the leakage whilst you wait to be seen (e.g. overnight or on the weekend).

What to do if the Voice Prosthesis Comes Out

Your TEP is not a permanent opening. It can close in as little as one hour if there is nothing in the tract.

What you will Need

  • Good light source
  • Mirror
  • Catheter
  • Tape

Procedure

  1. Stand in the front of a MIRROR, making sure you can clearly see the TEP tract on the back wall of your stoma.
  2. If possible, gently insert the CATHETER into the tract and down into the oesophagus.
  3. TIE the end in a knot and TAPE securely to your neck.
  4. Contact your speech pathologist ASAP to arrange a review.
  5. IF YOU ARE UNABLE TO INSERT THE CATHETER YOURSELF, remain strictly NIL BY MOUTH and contact your speech pathologist ASAP to arrange a review. If it’s outside of working hours, go to your nearest Emergency Department (take a copy of the booklet and your catheter with you).
TEP without a Voice Prosthesis
TEP without a Voice Prosthesis
Catheter being inserted into the TEP
Catheter being inserted into the TEP

What to do if you Lose Your Voice

Losing your voice may mean the prosthesis needs cleaning, or there is a problem with the Prosthesis/TEP.

  1. CLEAN the barrel of the prosthesis thoroughly with the brush to make sure you have no mucous plugs.
  2. Have a drink of WARM WATER.
  3. If you still have no voice, contact your Speech Pathologist ASAP to arrange a review.

PLEASE DO NOT REMOVE THE VOICE PROSTHESIS.

How to Apply an HME Baseplate & Filter

The HME (Heat Moisture Exchange) system helps keeps your lungs healthy by humidifying and filtering the air you breathe.

What you will Need

  • Good light source
  • Adhesive baseplate
  • HME filter
  • Skin Prep/Remove wipes (if required)

Procedure

  1. Applying HME baseplate and filterRemove the backing from the adhesive BASEPLATE.
  2. LINE UP the opening of the baseplate with your stoma.
  3. Being careful not to fold the edges, gently PRESS the baseplate onto your skin, smoothing out any lumps/bumps to ensure a good seal.
  4. Insert the HME FILTER into the baseplate opening – you should feel it ‘click’ into place.
  5. Depending on how much mucous you have, the baseplate will need changing every 1-2 days and the cassette daily / when soiled.

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