"My Voice"

Order a paperback or Kindle Edition or e-book of "My Voice: A Physician's Personal Experience with Throat Cancer," the complete 282 page story of Dr. Brook's diagnosis, treatment, and recovery from throat cancer.

Order a paperback or Kindle Edition or e-book of "The Laryngectomee Guide," the 170 page practical guide for laryngectomees.

Obtain and/or view a video presentation, a slide presentation and an instructive manual how to ventilate laryngectomees and neck breathers (all free). A self examination guide for detection of primary and recurrent head and neck cancer is available.

Stoma care

A stoma is an opening that connects a portion of the body cavity to the outside environment. A stoma is created after a laryngectomy to generate a new opening for the trachea in the neck, thus connecting the lungs to the outside. Caring for the stoma to insure its patency and health is crucial.


General care 

It is very important  to cover the stoma at all times in order to prevent dirt, dust, smoke,
bugs, etc., from getting into the trachea and lungs.

There are various kinds of stoma covers. The most effective ones are called Heat/Moisture Exchangers (HME) because they create a tight seal around the stoma. In addition to filtering dirt, HMEs preserve some of the moisture and heat inside the respiratory tract  and prevent the person from losing them. The HME therefore assist in restoring the  temperature, moisture and cleanliness of the inhaled air to the condition before the laryngectomy.

The stoma often shrinks during the first weeks or months after it is created. To prevent it from closing completely, a tracheostomy or laryngectomy tube is initially left in the stoma 24 hours a day. Over times this duration is gradually reduced. It is often left overnight until there is no more shrinking.

Stoma care when using a base plate or adhesive housing: The skin around the stoma can become irritated (i.e.,red, inflamed) because of repeated gluing and removal of the housing. The materials used to remove the old housing and prepare for the new one can irritate the skin. The removal of the old housing can also irritate the skin especially when it is glued.

An adhesive removal wipe containing liquid (e.g. Remove TM, Smith & Nephew, Inc. Largo Fl 33773) can assist in removing the base plate or housing. It is placed at the edge of the housing and helps the housing detach from the skin when it is lifted off. Wiping the area with Remove TM cleans the site from remnants of seal used to glue the housing. It is important to wipe off the leftover Remove TM with an alcohol wipe so that it will not irritate the skin. When a new housing is use, wiping off the Remove TM prevents it from interfering with placing glue again. 


It is generally not recommended to leave the housing on for more than 48 hours. Some individuals, however, keep the housing much longer, and replace it when it becomes loose or dirty. In some people the removal of the adhesive is more irritating than the adhesives. In the event the skin is irritated, it is better to leave the housing on only for 24 hours. If the skin is irritated, it may be advisable to give the skin a rest for a day or until the area heals and cover the stoma only with a rigid base without any glue or with a foam cover. There are special hydrocolloid adhesives that allow use on sensitive skin.


It is important to use liquid film-forming skin protecting dressing (i.e. Skin PrepTM Smith & Nephew, Inc. Largo Fl 33773) before placing the glue. 

Stoma care when using tracheostomy tube: The buildup of mucus and the rubbing of the tracheostomy tube can irritate the skin around the stoma. The skin around the stoma should be cleaned at least twice a day to prevent odor, irritation and infection. Using a hydrocolloid adhesive is often a good solution for patients with sensitive skin. 

If the area appears red, tender or smells bad, stoma cleaning should be performed more frequently. Contacting one's physician  is advisable if a rash, unusual odor, and/or yellowish-green drainage appear around the stoma. This may represent a bacterial  infection.





                                                                   Stoma





Skin irritation around the stoma

If the skin around the stoma becomes irritated and red, it is best to leave it uncovered (after cleaning it gently with  non alegenic soap and water) by a base plate and HME and not expose it to any solvents for a while ( an hour to 2 days ) so that it can heal. Sometimes individuals can develop an irritation to some of the solvents used to prepare and glue an HME base plate (housing). Avoiding these solvents and finding others that do not cause irritation is helpful.

Some individuals with sensitive skin that may prone to skin irritation may benefit from a skin friendly base plate such as OptiDerm™  (Atos Medical) which is made of a hydrocolloid material.

If signs of infection such as open ulcers and redness, are evident  topical antibiotics can be useful,  Seeking advice from one’s physician is helpful especially if the lesion does not heal. The physician can obtain a bacterial culture of the affected area that can guide the choice of antimicrobial therapy.


                                                                     
                                           





Protecting the stoma from water when showering

It is important to prevent water from entering the stoma when taking a shower. A small amount of water in the trachea generally does not cause any harm and can be rapidly coughed out. However, inhalation of a large amount of water can be dangerous.


Methods to prevent water from entering the stoma are:


  • Covering the stoma with the palm and not inhaling air when water is directed at the vicinity of the stoma.

  • Wearing a bib with the plastic side out.






  • Using a commercial device that covers the stoma.


                                                     Provox (Atos Medical) ShowerAid






                                                 InHealth Stoma Shower Devices




  • Wearing one's stoma cover, he base plate or HME housing while showering may be sufficient especially if water flow is directed away from the stoma. Pausing air inhalation for a few seconds while washing the area close to the stoma is also helpful. Taking a shower at the end of the day just before removing the HME and its housing is a way to use the housing for water protection. This simple method can make taking a shower easier.

  • When washing the hair lowering the chin below the stoma by bending over.








Water and aspiration pneumonia
Aspiration pneumonia is rare in laryngectomees because they can not aspirate saliva from their mouth as their lungs are not connected to the mouth. However, aspiration pneumonia can develop when bacteria get into the lungs from the stoma's area and can not be expelled out by coughing. This can occur when the mucus is not adequately coughed out usually because it is too dry. Maintaining mucus with clear consistency,is imperative  (See Mucus and respiratory care section).

It is also very important  to cover the stoma at all times in order to prevent bacteria and viruses from getting into the trachea and lungs. Clean ones hands before touching the stoma or the Heat and Moisture Exchanger (HME) can reduce the risk of introducing bacteria and viruses to the lungs.

Laryngectomees are at risk of inhaling (aspirating) water that may not be free of bacteria.
Taking a bath is not recommended for laryngectomees because of the risk of water aspiration.  Those who take a bath should keep the water level up to their hips when seated.

Tap water contains bacteria; the number of bacteria varies, depending on the cleaning efficacy of the water treatment facilities and their source (e.g., well, lake river etc.). Pool water contains chloride that reduces, but never sterilize the water. Sea water contains numerous bacteria; their nature and concentrations varies.

When unclean water or non sterile saline gets into the lungs it can sometimes cause pneumonia. Developing aspiration pneumonia depends on how much water is inhaled and how much is coughed out , as well as on the individuals' immune system. 






Radiography of aspiration pneumonia




Preventing aspiration of tissue or paper into the stoma

One of the major causes of respiratory emergency in a neck breather is the aspiration of tissue or paper towels into the trachea. This can be very dangerous and cause asphyxiation. It usually happens after covering the stoma with a paper towel when coughing out sputum. Following the cough there is a very deep inspiration of air that can suck the paper back into the lungs. The way to prevent this is to use a cloth towel or a strong paper towel that does not break easily, even when moist. Thin tissues should be avoided.

Another way to prevent aspiration of paper tissues is to hold one's breath until one has completely finished wiping off the sputum and removed the paper tissue or paper towel from the stoma area.

Aspiration of other foreign material should also be prevented by covering the stoma at all times by an HME, foam cover, or stoma cover.

Aspiration of water into the stoma while taking a shower can be prevented by wearing a device that covers the stoma (see above). One can keep the HME on while showering and/or avoid breathing in when water is directed at the stoma’s site.

Taking a bath in a tub can be done safely  as long as the water level does not reach the stoma. The  areas above the stoma should be washed with a soapy washcloth. It is important to prevent soapy water from entering the stoma.






Covering ( hiding) the Stoma and HME

Following laryngectomy, individuals breathe through a tracheostomy site that opens through a stoma on their neck. Most place an HME or a foam filter over the stoma to filter the inhaled air and maintain warmth and humidity in the upper airway. The covered stoma site is prominent, and laryngectomees face a choice whether to cover the HME or filter with a garment, an ascot, or jewelry or to leave it uncovered.

The pros and cones of each choice:

Breathing may be easier without an additional cover which can interfere with air flow. Leaving the area exposed allows for easier access to the stoma for purpose of cleaning and maintenance and enables a rapid removal of the HME in case one needs to cough or sneeze. The urge to cough or sneeze is often very sudden and if the HME is not taken out quickly it can become clogged with mucus.

Exposing the site provides an unspoken explanation for the weak and rusty voice of many laryngectomees and encourages others to listen to them more attentively. It also makes it easier for health care providers to recognize the laryngectomees’ unique anatomy in case emergency respiratory ventilation is needed. If this condition is not rapidly recognized ventilation may be administered through the mouth or nose rather than through the stoma.

Openly displaying the covered stoma site also reveals the person’s medical history and the fact that he/she are cancer survivors who go on with their lives despite their handicap, cancer being the leading indication for a laryngectomy. Although there are many cancer survivors in the community, their identity is hidden from outward appearances.

Those who cover their stoma site with a stoma cover or cloth often do it because they do not want others to be distracted or offended by the site. They also do not want to expose anything that is disfiguring and want to be inconspicuous and appear as normal as possible. Covering the site is often more common among females who may be more concerned with their physical appearance. Some individuals feel that being a laryngectomee is only a small part of who they are as a person; and they do not want to “advertise” it.


There are advantages and repercussions to each approach and the final selection is up to the individual.




Stoma cover