Coughing up mucus through the stoma is the only means by which laryngectomees can keep their trachea and lungs clear of dust, dirt, organisms, and other contaminants that get into the airway. Whenever an urge to cough or sneeze emerges laryngectomees must quickly remove their stoma cover or Heat and Moisture Exchanger (HME) filter and use a tissue or handkerchief to cover their stoma to catch the mucus.
The best mucus consistency is clear, or almost clear, and watery. Such consistency, however, is not easy to maintain because of changes in the environment and weather. Steps can be routinely taken to maintain a healthy mucus production as shown below.
A lecture about life challenges after laryngectomy including stoma care can be viewed on YouTube.
Mucus production and increasing air humidity
Prior to becoming a laryngectomee, an individual's inhaled air is warmed to body temperature, humidified and cleansed of organisms and dust particles by the upper part of the respiratory system. Since these functions do not occur following laryngectomy, it is important to restore the lost functions previously provided by upper part of the respiratory system.
Followed laryngectomy the inhaled air does not get humidified by passing through the nose and mouth; accordingly, tracheal dryness, irritation and overproduction of mucus develops. Fortunately, the trachea becomes more tolerant to dry air over time. However, when the humidity level is too low the trachea can dry out, crack, and produce some bleeding. If the bleeding is significant or does not respond to an increase in humidity, a physician should be consulted. And if the amount or color of the mucus is concerning, one should contact a physician.
Restoring the humidification of the inhaled air reduces the overproduction of mucus to an adequate level. This will decrease the chances for coughing unexpectedly and plugging the HME filter. Increasing the home humidity to 40-50% relative humidity (not higher) can help in decreasing mucus production and keeping the stoma and trachea from drying out, cracking and bleeding. In addition to being painful, these cracks can also become pathways for infections.
There are two types of portable humidifiers - the steam and evaporative ones. A digital humidity gauge (called a hygrometer) can assist in controlling the humidity levels. Over time, as the airway adjusts, the need to always use a humidifier may decrease.
Caring for the airway and neck especially in a cold winter and a high altitude
- Coughing out or suctioning the mucus using a suction machine to clean the airway
- Avoiding exposure to cold, dry or dusty air
- Avoiding dust, irritants and allergens
- When exposed to cold air, consider covering the stoma with a jacket (by zipping it all the way) or a loose scarf and breathing into the space between the jacket and the body to warm the inhaled air.
- Preventing water from getting into the stoma when showering (see below)
Using Suction Machine for mucus plugs
A suction machine is often used by new ordered for a laryngectomee prior to leaving the hospital for use at home. It can be used to suction out mucus when one is unable to cough it out and/or to remove a mucus plug. A mucus plug can develop when the mucus become thick and sticky creating a plug that blocks part or, infrequently, even the whole airway.
The plug can cause a sudden and unexplained shortness of breath. A suction machine can be used in these circumstances to remove the plug. It should therefore be readily available to treat such an emergency. Mucus plugs may also be removed by using a saline “bullet” (0.9% sterile salt water in a plastic tube) or by squirting saline solution into the stoma. The saline can loosen the plug that can be coughed out. This condition may become a medical emergency, and if the plug is not successfully removed after several attempts dialing 911 may be life saving.
Blood in the mucus can originate from several sources. The most common is from a scratch just inside the stoma. The scratch can be caused by trauma while cleaning the stoma. The blood generally appears bright red. Another common cause of coughing blood in a laryngectomee is irritation of the trachea because of dryness which is common during the winter. It is advisable to maintain a home environment with adequate humidity levels (about 40-50%) to also help minimize drying the trachea. Inserting sterile saline into the stoma can help. (See above in the Mucus production section)
Bloody sputum can also be a symptom of pneumonia, tuberculosis, lung cancer, or other lung problem.
Persistent coughing of blood should be evaluated by medical professionals. This may be urgent if it is associated with difficulties in breathing and/or pain.
Because laryngectomees and other neck breathers no longer breathe through their nose their nasal secretions are not being dried by moving air. Consequently the secretions drip out of the nose whenever large quantities of them are produced. This is especially common when one is exposed to cold and humid air or irritating smells. Avoiding these conditions can prevent a runny nose.
Wiping the secretion is the best practical solution. Laryngectomees using a voice prosthesis may be able to blow their nose by occluding the tracheostoma and divert air through the nose.
After a laryngectomy the inhaled air bypasses the upper part of the respiratory system and enters the trachea and lungs directly through the stoma. Laryngectomees therefore lose the part of
the respiratory system that used to filter, warm and humidify the air they breathe.
The change in the way breathing is done also effects the efforts needed to breathe and potential lung functions. This requires adjustment and retraining. Breathing is actually easier for laryngectomees because there is less air flow resistance when the air bypasses the nose and mouth. Because it is easier to get air into the lungs, laryngectomees no longer need to inflate and deflate their lungs as completely as they did before. It is therefore not unusual for laryngectomees to develop reduced lung capacity and breathing capabilities.
There are several measures available to laryngectomees that can preserve and increase their lung capacity:
- The use of a HME can create resistance to air exchange. This forces the individual to fully inflate their lungs to get the needed amount of oxygen.
- Regular exercise under medical supervision and guidance. This can get the lungs to fully inflate and improve individuals' heart and breathing rates.
- Using diaphragmatic breathing. This method of breathing allows for greater utilization of the lung capacity.