The site was created by Itzhak Brook MD a physician and a laryngectomee. It contains discussions of informative topics related to head and neck cancer and life as a laryngectomee. It also contains Dr. Brook's books, manuscripts and videos about his personal experience as a patient with throat cancer.
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.
and Moisture Exchanger (HME) filter serve as stoma covers and create a tight
seal around the stoma. In addition to filtering dust and other larger airborne
particles, HMEs preserve some of the moisture and heat inside the respiratory
tract and prevent their loss, and adds resistance to the airflow. HME filters
assist in restoring the temperature, moisture and cleanliness of the inhaled
air to the same condition as before laryngectomy.
is very important that laryngectoees wear an HME. In the United States the
filters are available through Atos Medical and InHealth Technologies. The HME
filter can be attached by using an intraluminal device inserted into the
trachea or stoma, that includes laryngectomy or tracheostomy tubes, Barton Mayo
ButtonTM and/or Lary ButtonTM. The filter can also be inserted into a housing
or a base plate attached to the skin around the stoma.
foam media captures the warm, moistened, and humidified air upon exhalation. It
is can be impregnated with chlorhexidine (anti-bacterial agent), sodium
chloride (NaCl), calcium chloride salts (traps moisture), activated charcoal
(absorbs volatile fumes), and is disposable after 24 hours of use.
cassettes are designed to be removed and replaced on a daily basis. The foam
media in the cassettes are treated with agents that have antimicrobial
properties and help to retain moisture in the lungs. They should not be washed
and reused because these agents lose their effectiveness over time or when
rinsed by water or other cleaning agents.
filter’s advantages also include: increasing the moisture within the lungs
(subsequently leads to less mucus production), decreasing the viscosity of the
airway secretions, decreasing risk of mucus plugs, and re-instating the normal
airway resistance to the inhaled air which preserves the lung capacity.
addition, the HME filters reduce the inhalation of bacteria, viruses, dust and
pollen. Inhaling less pollen can reduce the airway irritation during high
allergens season. Wearing HME may reduce the risk of getting viral and
bacterial infection, especially in crowded or closed places.
new HME filter that is combined with an electrostatic filter is designed to
filter potential respiratory pathogens (Provox Micron TM, Atos Medical). This
HME most closely resemble the normal nasal properties, as it does not only
conditions, but also filters the inhaled air, and also filters the exhaled air.
The electrostatic filter eliminates transfer of particulate material and
airborne organisms from and to the laryngectomized patient (99%
Bacterial and Viral Filtration Efficiency).
is important to realize that simple stoma covers, such as a laryngofoam TM
filter, ascot, bandana, etc., do not provide the same benefits to an
laryngectomee as a HME filter.
prosthesis (below) and HMEs (above) produced by Atos (Provox) (left) and InHealth (Right)
effect of an HME on breathing as a laryngectomee
compromises the respiratory system by allowing the inhaled air to bypass the
nose and upper airways which normally provide humidification, filtration and
warmth. It also reduces the resistance and the effort needed for inhalation by
removing air resistance and shortening the distance the air travels to their
lung. This means that laryngectomees do
not have to work as hard to get air past the upper part of the system (nose,
nasal passages, and throat), and their lungs do not have to inflate as much as
they did before unless the person works to retain their capacity through
exercise and other methods. An HME increases the resistance to inhaled air and
therefore increases inhalation efforts, thus preserving previous lung capacity.
needing extra air (i.e., running, biking) the HME can be temporarily removed
and the stoma can be covered by cloth. There are less restrictive HMEs that
offer less resistance to air passage and allow greater air flow (i.e., AtosMedical's XtraFlow). These type of HME can be used when exercising and when
adapting to the breathing resistance after having been without an HME for a
an HME base plate (housing)
key to prolonging the use of an HME's base plate is not only properly gluing it
in place, but also removing the old adhesives and glue from the skin, cleaning
the area around the stoma and applying new layers of adhesive and glue.
some individuals the shape of the neck around the stoma makes it difficult to
fit a housing or a base plate. There are several types of housing; and a speech
and language pathologist (SLP) can assist in selecting the best one. Finding
the best HME housing may take trial and error. Over time, as the post-surgical
swelling subsides and the area around the stoma reshapes itself, the type and
size of the housing may change.
buildup of mucus at the bottom of the base plate can weaken the adhesion of the
base plate and eventually cause the base plate seal to break leading to air
leak. The accumulation of mucus in the space behind the base plate can be
minimized by placing the base plate (housing) as down as possible attaining the
maximum distance between the stoma and bottom part of the seal. This allows the
mucus a longer way to travel before getting to the bottom, which would then
give more time to remove the mucus before it caused the base plate to fail.
Because the anatomy of the stoma and the skin around it is unique for each
person, finding the best location for placing the base plate can be guided by
ones SLP or otolaryngologist.
are the suggested instructions on how to place the housing for the HME.
Throughout the process it is important to wait patiently and allow the liquid
film-forming skin protecting dressing (i.e., Skin PrepTM Smith &
Nephew, Inc. Largo Fl 33773)” and silicone skin adhesive to dry before applying
the next item or placing the housing. This takes time, but it is important to
follow these instructions:
1.Clean the old glue with an adhesive
removal wipe (e.g., Remove TM, Smith & Nephew, Inc. Largo Fl 33773).
2.Wipe off the Remove TM with an alcohol
wipe. (if you do not do this the
Remove TM will interfere with the new
3.Wipe the skin with a wet towel.
4.Wipe the skin with the wet towel with
5.Wash away the soap with a wet towel
and thoroughly dry.
6.Apply Skin PrepTM and let it dry for 2-3 minutes.
7.For extra adhesion apply silicone skin
adhesive or Skin-Tac TM wipe (Torbot, Cranston, Rhode Island 20910) and let it
dry for 3-4 minutes. (This is especially important for users of automatic
8.Attach the base plate for the HME at
the best location to allow air flow and good attachment. Attempt to place it as
down as possible attaining the maximum distance between the stoma and bottom part
of the seal.
9.When using hands free HME wait for
5-30 minutes before speaking to allow the adhesive to “set”.
SLPs recommend warming the housing prior to placement by rubbing it in the
hands, holding it under the armpit for a few minutes, or by blowing warm air on
it with a hair drier. Be careful that the adhesive does not become too hot.
Warming the adhesive is especially important when you use a hydrocolloid
adhesive since the warmth activates the glue.
of HME and its base plate (housing) on a stoma
base plates produced by Provox (Atos Medical)
hands free HME
hands free HME allows speaking without the need to manually press on the HME to
close it off thus blocking exhalation through the stoma and directing air to
the voice prosthesis. This device frees one's hand and eases vocational and
recreational possibilities. Note that when using a hands free HME more pressure
is generated when air is exhaled, thus potentially leading to a break in the
HME housing's seal. Reducing the exhalation pressure when speaking, speaking
slower and softly (almost whispering), and taking a breath after 5-7 words can
prevent a break in the seal. Supporting it with a finger before needing to
speak loud can also help. It is also important to quickly remove the device
air filter (also called cassette in Provox FreeHands HME) in the hands free
device has to be changed on a regular basis (every 24 hours or sooner if it
becomes dirty or covered with mucus). However, the HME device can be used for 6
months to a year. Proper use and cleaning can prolong its life. The hands free
device requires initial adjustments to fit the laryngectomee's breathing and
speaking abilities. Detailed instructions on how to use and care for the
devices are provided by their manufacturers.
experimented with several base plates and found the Provox XtraBase (Atos) and
InHealth Tracheostoma Valve housing to last the longest ( up to 48 hours).
key to speaking with a hands free HME is to learn how to speak without breaking
the seal. Using diaphragmatic breathing allows for more air to be exhaled, thus
reducing speaking efforts and increasing the number of words that can be
articulated with each breath. This methods prevents buildup of air pressure in
the trachea which can break the base plate's seal. It may take time and
patience to learn how to speak in such a way, and guidance by a skilled SLP can
is very important to place the HME housing according to the steps outlined in
the section on HME care (see "Placing an HME Housing" above)
including cleaning the area around the stoma with Remove TM alcohol, water and
soap, placing Skin Prep TM and finally glue (Skin Tag TM). Following these
instructions can prolong the life of the HME housing and reduce the likelihood
of an air leak through the seal.
inhalation is slightly more difficult when using a free HME as compared to a
regular HME. It is possible to allow for greater amounts of air intake by
rotating the valve counter-clockwise in both Atos FreeHands TM and InHealth
HandsFree TM devices.
the challenge of keeping the seal, many laryngectomee value the ability to
speak in a more natural way and the freedom of using both hands. Some learn
that they can keep the seal much longer when they use a voice amplifier, thus
requiring less effort and generating less air pressure.
HMEs are approved for wear 24/7 ( i.e. Atos). ). The advantage of wearing the HME 24/7 is that its beneficial effects are extended throughout the whole day.
If the seal lasts, one can
keep it overnight. If it does not it is possible to use an improvised base
plate for the night period. An Atos Xtra BasePlateTM can be trimmed by removing
the outer soft part and leaving the inner rigid part. The plate is
"sticky" and thus can cover the stoma without glue, even enabling one
to speak. It is also possible to use the HME inserted in a LaryTube overnight.
Covering ( hiding) the Stoma and HME Read at the Stoma Care section.