"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, instructive manual and a slide presentation how to ventilate laryngectomees and neck breathers (free).

To obtain suggestions for laryngectomees how to cope with COVID-19 pandemic click the Laryngectomee Newsletter link.

Wednesday, August 16, 2023

Fatal Tracheoesophageal Puncture Leakage Associated With Lenvatinib.

Fatal tracheoesophageal puncture leakage associated with Lenvatinib treatment was reported by Salvatori S. and Tanvetyanon  T.  from Moffitt Cancer Center and Research Institute, Tampa, FL. The report was published in Cureus [15(8): e43490]. 

Tracheoesophageal puncture (TEP) is a voice restorative is often used in laryngectomees. Though generally safe, TEP may develop leakage. Lenvatinib is a tyrosine kinase inhibitor (TKI) with anti-tumoral activity against head and neck malignancies. TKIs, including lenvatinib, have been associated with organ perforation or fistula formation. The authors described a patient with adenoid cystic carcinoma of the larynx who had a TEP for several years. After approximately two weeks of treatment with lenvatinib, the patient developed a leakage of TEP. Despite several interventions, the patient died three months afterward due to a retropharyngeal abscess secondary to Fusobacterium nucleatum infection.

To the authors’ knowledge, this is the first report of fatal lenvatinib-associated TEP leakage. They urge clinicians to be cognizant of the potentially rapid development of this complication when prescribing TKI for patients with TEP.


Leakage through voice prosthesis barrel (central leakage):

Wednesday, July 12, 2023

Quality of sexual life after total laryngectomy for cancer.

 Babin and colleagues from the Department of Otolaryngology of the University of Caen France, reviewed 24 studies that evaluated sexual life after total laryngectomy (TL) for cancer. The main endpoint was the impact of impairment of quality of sexual life after TL. The secondary endpoints were the type of sexual impairment, associated variables and their treatment.

 The study population consisted of 1511 TL patients aged 21 to 90 years, with a male/female sex ratio of 7.5/1. Impaired quality of sexual life was reported by 47% of patients on average. Erectile and ejaculatory function and ejaculatory behavior of male patients decreased after TL. Other impairments comprised decreases in libido, frequency of sexual intercourse and satisfaction. Tracheostomy, advanced disease stage, young age and associated depression were factors for impairment. In all, 23% of patients reported lack of postoperative support in this area.

The authors concluded that laryngectomy impacted both patients and partners, negative effects being reported in more than 30% of cases. The physical transformation has aesthetic and emotional impact, inhibiting sexuality. the quality of sexual life is severely impacted by TL for cancer. There is patient demand for improved management of sexuality.

Monday, June 12, 2023



       The Laryngectomee Guide. Paperback and Kindle at http://goo.gl/z8RxEt   Free download at https://www.entnet.org/laryngectomee-guide/  (helpful for new patients)

The Laryngectomee Guide is available (Free eBooks) in 24 languages. https://dribrook.blogspot.com/2018/08/the-laryngectomee-guide-is-available-in.html


       The Laryngectomee Guide Expanded Edition, 5TH  edition., Paperback and Kindle at https://www.amazon.com/dp/B0BBJPY5P2  Free download at https://bit.ly/3QGTqNa

(Recommended for seasoned patients)


      The “Laryngectomee Guide for COVID-19 Pandemic” provides information for laryngectomee and neck breathers how to cope with the pandemic. The E books are free. Available at https://amzn.to/3i5XncR   as paperback, and at  https://bit.ly/3hZHynb   as eBook (free).


       “My Voice: A Physician’s Personal Experience with Throat Cancer.” Paperback and Kindle at http://goo.gl/j3r51V   Free download at https://dribrook.blogspot.com/p/my-voice-physicians-personal-experience.html  


        Rescue breathing of neck breathers including laryngectomees

Video:  https://www.youtube.com/watch?v=YE-n8cgl77Q  

Manual: https://bit.ly/3k1iRO5   


Friday, May 5, 2023

Pravastatin antifibrotic efficacy in reversing radiation-induced fibrosis after radiation therapy for head and neck cancer


A prospective study done by Celine Bourgier and colleagues from Université de Montpellier, France; .showed that pravastatin (a statin) is an efficient antifibrotic agent in patients with established cutaneous and subcutaneous radiation-induced fibrosis (RIF) after radiation therapy for head and neck cancer. 

The primary endpoint was reduction of RIF thickness by more than 30% at 12 months, as measured by cutaneous high-frequency ultrasonography. Secondary endpoints included RIF severity reduction, pravastatin tolerance, and quality of life. 

Sixty patients were enrolled from February 2011 to April 2016. The mean interval between RIF diagnosis and pravastatin initiation was 17.1 months. Pravastatin was stopped before 11 months of treatment in 18 patients (because of grade ≥2 adverse events related to pravastatin in 8 patients [13%]). In the 40 patients in whom pravastatin efficacy was assessed by high-frequency ultrasonography at baseline and at 12 months of treatment, a reduction of RIF thickness ≥30% was observed in 15 of 42 patients (35.7%). At the 12-month clinical evaluation, RIF severity was decreased in 50% of patients (n = 21), and the patients' self-perception, mood state, and social functioning were significantly improved. Pravastatin was well tolerated.

 The authors concluded that this phase 2 prospective study supports the notion of radioinduced fibrosis reversibility. It showed that pravastatin (40 mg/d for 12 months) is an efficient antifibrotic agent in patients with grade ≥2 cutaneous and subcutaneous fibrosis after head and neck cancer radiation therapy.

Thursday, January 5, 2023

Hyperventilation in neck breathers including laryngectomees.

 Hyperventilation can occur in neck breathers including laryngectomees. Hyperventilation reduces the level of carbon dioxide in the blood. It can upset the acid-base balance in the blood making it more alkaline. The syndrome is characterized by repeated episodes of excessive ventilation in response to fear, anxiety or panic. It can also occur during an orgasm or intense sexual activity, as well as heavy physical activity.

Neck breathers are more prone to this condition because rapid breathing ventilate the lungs quicker than in non-neck breathers as the inhaled air enter the trachea through the stoma, bypassing the upper airways.

The existence of hyperventilation in laryngectomees was evaluated by Brook by sending a questioner to 256 laryngectomees. Fifty-four of the 72 individuals who return the questioner experienced one or more episodes of hyperventilation. It was associated with heavy physical activity in 28 (51%) individuals, sexual activity in 15 (38%), anxiety in 8 (15%), and intense coughing in 7 (13%). The symptoms experienced were: fast or deep breathing in all cases, shortness of breath (50 or 96%); anxiety, fear, panic, or strong feeling of dread or doom (38 or 70%); dizziness (27 or 50%); generalized weakness (16 or 30%); sweating (13 or 34%); fainting (4 or 7%); and chest pain (4 or 7%).

This small survey illustrates that laryngectomees do experience hyperventilation syndrome.

Further studies are warranted to prospectively evaluate the incidence of hyperventilation in laryngectomees and other neck breathers. Such studies may highlight the need to address, prevent and treat this condition in laryngectomees.

Monday, November 7, 2022

First total laryngectomy by Theodor Billroth 150 years ago.


On December 31, 1873, in the Vienna surgery clinic, the German surgeon Theodor Billroth managed what no previous surgeon had been able to: complete ablation of the larynx in a human being, which quickly came to be known as “total laryngectomy”, without harmful immediate consequences. Billroth dared what none before had done. He had come to the conclusion that “the only way of saving life was to remove the entire larynx.”

This first total ablation of the larynx, preceded by a tracheotomy, was one of the great surprises of 19th century surgery.

This was possible because of the prior experimental study of laryngeal ablation performed in dogs by Vincent Czerny. The French physician Henri Chouppe enthused: “when experimental studies lead to practical results, one should hasten to do It”.

    Theodor Billroth operating 

Tuesday, October 11, 2022

Comparison of anxiety and depressive of head and neck cancer patients before and during the 2019 coronavirus pandemic.


Jiani Liu and colleagues from  Sun Yat-sen University, Zhuhai, China,  studied the effect of the COVID-19 pandemic on the anxiety and depressive symptoms of cancer patients before and during the 2019 coronavirus pandemic.

A total of 526 head and neck cancer patients were included in the final analysis; 27% of cases experienced anxiety and depression before the pandemic and 50 % during the COVID-19 pandemic. (P=0.018).

The present study demonstrates the significant impact of COVID-19 on the psychological states of cancer patients. This findings indicating the need for appropriate changes in treatment decisions, enhanced psychotherapy, and interventions to reduce the incidence of anxiety, depression, and even suicide during the pandemic.

Tuesday, August 23, 2022

"The 5th Edition of the Laryngectomee Guide Expanded Edition is available.

The 5th Edition of the Laryngectomee Guide Expanded Edition is available now. The 325 pages Expanded Guide is an updated and revised edition of the original Laryngectomee Guide. It is three time larger than the original Guide and also contains information how laryngectomees can protect themselves from COVID-19. It provides information that can assist laryngectomees and their caregivers with medical, dental and psychological issues. It contains information about side effects of radiation and chemotherapy; methods of speaking; airway, stoma, and voice prosthesis care; eating and swallowing; medical, dental and psychological concerns.

The E Book is free for download. 

The Guide is also available in Amazon   

Itzhak Brook MD

Thursday, April 28, 2022

Atorvastatin is associated with reduced cisplatin-induced hearing loss in head and neck cancer petients

Cisplatin is widely used to treat cancers. It is the most ototoxic drug in clinical use, resulting in permanent hearing loss in approximately 50% of treated patients. There is a major need for therapies that prevent cisplatin-induced hearing loss. Studies in mice suggest that concurrent use of statins reduces cisplatin-induced hearing loss.

Fernandez and her colleagues (from the National Institute on Deafness and Other Communication Disorders, and Johns Hopkins University, Maryland ; University of Rochester Medical Center, New York; and Medical University of South Carolina, Charleston, South Carolina; USA) retrospectively examined hearing thresholds from 277 adults treated with cisplatin for head and neck cancer. The results were published in Clinical Trial Journal of Clinical  Investigation in 2021.

Pretreatment and posttreatment audiograms were collected within 90 days of initiation and completion of cisplatin therapy. The primary outcome measure was a change in hearing as defined by the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE).

Among patients on concurrent atorvastatin, 9.7% experienced a CTCAE grade 2 or higher cisplatin-induced hearing loss compared with 29.4% in nonstatin users (P < 0.0001).

 Analysis showed that atorvastatin use was significantly associated with reduced cisplatin-induced hearing loss (P ≤ 0.01). An adjusted odds ratio (OR) analysis indicated that an atorvastatin user is 53% less likely to acquire a cisplatin-induced hearing loss than a nonstatin user (OR = 0.47; 95% CI, 0.30-0.78). Three-year survival rates were not different between atorvastatin users and nonstatin users (P > 0.05).

The data indicate that atorvastatin use is associated with reduced incidence and severity of cisplatin-induced hearing loss in adults being treated for head and neck cancer. A prospective study is currently  conducted to evaluate the efficacy of statins in preventing hearing loss by cisplatin.

Thursday, February 17, 2022

Correction of carotid artery stenosis by stent placement ameliorated paroxysmal hypertension after radiation treatment of hypopharyngeal carcinoma:


Paroxysmal hypertension can be associated with failure of the carotid artery baroreceptors due to past exposure to radiation treatment. A case report describes a patient whose repeated paroxysmal hypertensive episodes were ameliorated following placement of a carotid artery stent for the treatment of carotid artery stenosis.

The patient that was diagnosed with hypopharyngeal squamous cell carcinoma in 2006, and received 70 Gy intensity-modulated radiotherapy in 2006 and underwent a total laryngectomy in 2008. He experienced paroxysmal hypertensive episodes since 2010 that exacerbated in frequency in 2019. Eighty percent left internal carotid artery stenosis was demonstrated by ultrasound and arteriography. Angioplasty and stenting of the left carotid artery was performed. A Doppler ultrasound study performed 5 months after the stent placement did not reveal any hemodynamic stenosis in the left carotid artery. The patient experienced postprandial hypotension and had experienced only three episodes of paroxysmal hypertension in the following 24 months. He was able to abort paroxysmal hypertensive episodes by eating warm food.

This is the first report of a patient whose paroxysmal hypertensive episodes that occurred following radiation of the neck subsided after placement of a stent in a stenotic carotid artery. The exact mechanism leading to this phenomena is unknown but may be due to several factors. The reversal of the carotid artery stent and improvement in blood flow to the carotid artery baroceptors may play a role in this phenomenon. Conclusion: The ability to ameliorate paroxysmal hypertensive episodes in a patient with carotid artery stenosis by stent placement may be a promising therapeutic intervention for paroxysmal hypertension.

                  Angiogram of the left carotid artery before stenting showing 80% stenosis

                                  Angiogram of the left carotid artery after stenting, no stenosis

Saturday, January 22, 2022

Tracheitis in a laryngectomee due to Gram-negative bacteria


Laryngectomees run the risk of developing respiratory tract infections. A laryngectomee who developed trachitis is presented Brook to illustrate the risks and difficulties encountered in managing this infection in neck breather.

The patient presented with coughing of viscous green purulent sputum. He has been wearing a heat moisture exchanger filter (HME) spoke through a tracheo-esophageal voice prosthesis. The symptoms started 2 days after his voice prosthesis started to leak whenever he consumed liquids.

Sputum culture grew heavy growth of Klebseilla oxytoca, and Moraxella catararhalis, and medium growth of Stenothrophomonas (Xanthohmonas) maltophilia. The patient recovered after he was treated with oral levofloxacin  for 5 days. Humidification of the trachea and the airway was maintained by repeated insertions of 3-5 cc respiratory saline into the stoma at least once every two hours; and by breathing humidified air. The leaking voice prosthesis was replaced enabling the patient to consume adequate amount of fluids.

This is the first report of bacterial tracheitis due to multiple Gram-negative aerobic and facultative bacteria in a laryngectomee. The etiology of tracheitis in this patient is most likely due to aspiration of oral flora that contained these organisms through the leaking voice prosthesis (, or their acquisition through the stoma. A change in the consistency and color of the sputum was most likely due to the tracheal inflammation caused by these organisms. Obtaining a bacterial culture enabled their recovery and adequate elimination. 

Laryngectomees are at risk of aspirating liquids containing bacteria. When unclean liquids get into the lower respiratory tract, they can sometimes cause infection. Developing aspiration pneumonia depends on how much liquid is inhaled and how much is coughed out, as well as on the individuals' immune system.

This report highlights the importance of obtaining bacterial cultures and antimicrobial susceptibility that enabled eliminating the pathogens and restoring adequate mucus production. Treatment with a short course of antimicrobial as well as maintaining adequate hydration and respiratory tract humidification can restore the adequacy of the mucus.

Wednesday, December 15, 2021

Getting infected with both COVID-19 and influenza viruses


Co-infection of COVID-19 with other respiratory pathogens which may complicate the diagnosis, treatment, and prognosis of COVID-19 emerge new concern. Eleven prevalence studies with total of 3,070 patients with COVID-19, and 79 patients with concurrent COVID-19 and influenza were evaluated by Dadashi et al from Department of Microbiology, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran .The overlap of COVID-19 and influenza, as two epidemics at the same time can occur in the cold months of the year. The prevalence of influenza infection was 0.8% in patients with confirmed COVID-19. The frequency of influenza virus co-infection among patients with COVID-19 was 4.5% in Asia and 0.4% in the America. 

This information highlights the importance of getting properly vaccinated for both COVID-19 and influenza and practicing safe prevention (wearing masks and maintaining distance) as advised by the local health authorities. Neck breathers including laryngectomee should practice extra vigilance to avoid respiratory infections.

Tuesday, October 19, 2021

Discordant in Detection of COVID-19 in the Nasopharynx Versus Trachea for Patients With Tracheostomies

Patients with tracheostomies have an anatomically altered connection between their upper and lower airways that could impact SARS-CoV-2 testing. Smith and colleagues from the University of Michigan retrospectively compared the detection of SARS-CoV-2 in hospitalized patients with COVID-19 and tracheostomies.

The authors employed SARS-CoV-2 RNA nucleic acid amplification test (NAAT) in 45 newly  tracheotomized patients in nasopharyngeal (NP) and tracheal (TR) samples taken within a 48-hour period.

Thirty-two (71.1%) of the 45 patients had entirely concordant results after tracheostomy. However, 13 (28.9%) patients had at least one set of discordant results, the majority of which were NP negative and TR positive.

The authors concluded that patients with tracheostomies may have a higher false-negative rate if only one site is assessed for SARS-CoV-2. They recommend analyzing samples from both the nasopharynx and trachea for these patients until more prospective data exist.

Monday, October 4, 2021

Quality of Life, Dysphagia, Voice Problems, Depression, and Anxiety After Total Laryngectomy

 Wulff and colleagues of the Department of Otorhinolaryngology and Maxillofacial Surgery, Zealand University Hospital, Køge, Denmark,  determine the  health-related quality of life , including voice problems, dysphagia, depression, and anxiety after total laryngectomy, and investigate the associations between health-related quality of life  and the late effects. Included were 172 participants having undergone a laryngectomy 1.6 to 18.1 years ago for laryngeal/hypopharyngeal cancer.  

Participants scored worse than normative reference populations on all scales/items except one. Moderate/severe dysphagia was present in 46%, moderate/severe voice problems in 57%, depression in 16%, and anxiety in 20%. Decreasing age, increasing numbers of comorbidities, increasing voice problems, increasing dysphagia, and increasing depression symptoms, were associated with a lowered  summary score.

The authors concluded that a substantial proportion of participants experienced clinically significant late effects and increasing levels of these were associated with a lowered health-related quality of life.

Tuesday, September 7, 2021

Risk of aspiration when Provox Life FreeHands Flexivoice HME is not inserted correctly

 I would like to highlight a potentially serious problem that occurred to me when I used  the new Life HME filter. I placed it INCORRECTLY with the side with only 2 bars facing the stoma (see pictures) and it got separated and fell into the trachea after several minutes. Fortunately, I was able to cough it out.

Make sure that you attach the HME correctly with the side that has 3 bars (shaped like z) facing your stoma (see picture). If one has questions they  should contact their  SLP or Atos representative.

Filter side that should NOT face the stoma

Filter side that should 
face the stoma 

Correct way to insert HME to the FreeHands Flexivoice 

Thursday, August 12, 2021

Hospitalization and mortality among 1216 people with total laryngectomy in the UK during the COVID-19 pandemic


People with total laryngectomy (PTL) have an altered anatomy for breathing and speaking. The presence of a neck stoma poses an additional virus entry point aside from the nose, mouth and conjunctiva. This could increase the susceptibility to COVID-19 for PTL.

Govender and colleagues from the University College Hospital in London performed a national audit to provide data on shielding, hospital admissions and mortality for patients with total laryngectomy in the UK over the pandemic. Data were obtained from 1216 PTL from 26 centers across the UK. A total of 24 (2% of total sample) tested positive for COVID-19. Eight of the 24 PTL that were hospitalized with COVID -19 died within 28 days. During the data collection time frame, 12% had a hospital admission (n = 151) with a median length of stay of 1 day (1–133 days). A total of 20 of these admissions (13%) had tested positive for COVID-19 with a median length of stay of 26 days. The overall mortality was 4% (41 patients), with eight deaths occurring within 28 days of testing positive for COVID-19.

Although the overall mortality in PTL over the first lockdown did not appear to be higher than the “best case” estimates from previous years one in three PTL who acquired COVID-19 and were admitted to hospital, died within 28 days of testing positive. 

Greater testing in the community is necessary to understand the prevalence of COVID-19 in PTL and if this group is indeed more susceptible. The potential for nasopharyngeal and tracheal aspirates to show differing results when testing for COVID-19 in neck-breathers requires further investigation.

Thursday, April 15, 2021

Dr Brook interview “Physician’s personal challenges as a head and neck cancer patient and laryngectomee”. Brazilian Academy of speech and Voice. 2021

Dr Brook interview by Dr. Rui Imamura and Dr. Adriana Hachiya about “Physician’s personal challenges as a head and neck cancer patient and laryngectomee”. Brazilian Academy of speech and Voice. 2021 Voice Campaign.  San Paulo, Brazil. April 13, 2021. 

Issues discussed:

  • Should doctors adopt a paternalistic stance, suggesting the best treatment for the patient or just expose the options and leave it to the patient to decide?
  • Is it better that the physicians express a more optimistic or more pessimistic attitude regarding the prognosis?
  • What advice would you give to a doctor who needs to give the news of advanced cancer to a patient?
  • What were the main challenges you faced after laryngectomy?
  • What touched you (in a good or a bad way) in these interactions between the doctors who treated you?

Link to the 14 minutes interview: https://youtu.be/ofaJ7XjhZ9k

Tuesday, March 23, 2021

Safety of celebrating the spring holidays with family and Friends for head and neck cancer patients.


The upcoming spring holidays (Easter, Passover and Ramadan) creates challenges for those who are looking forward to celebrating them in person with friends and family. The availability of vaccination against the virus made it easier to resume the tradition of in person celebration although the risk of acquiring the infection can be high in some situations.

Vigilance and mitigating the risk of acquiring COVID-19 infection are especially important for Individuals with cancer including of the head and neck, who are at greater risk of suffering from a serious and life threatening COVD -19 infection.

Celebrating the holidays in close settings can be risky because of the difficulty of maintain social distance, and adequate ventilation. Mask wearing is impractical while eating and drinking.

The Center of Disease Control’s Interim Public Health Recommendations for Fully Vaccinated provide useful guidelines that can help plan a safe Seder and avoid risky scenarios that would allow the COVID-19 virus to spread. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html

For the purposes of the CDC’s recommendations people are considered fully vaccinated for COVID-19 more than 2 weeks after they have received the second dose in a 2-dose series (Pfizer-BioNTech or Moderna), or  more than 2 weeks after they have received a single-dose vaccine (Johnson and Johnson/Janssen ).

Interpretation of the CDC recommendations to the spring holidays scenario for fully vaccinated people are:

             It is permissible for fully vaccinated people to celebrate indoor with other fully vaccinated people or unvaccinated people from a single household who are at low risk for severe COVID-19 disease without wearing masks or physical distancing.

             Wearing masks, practicing physical distancing, and adhering to other prevention measures is required when celebrating with unvaccinated people who are at increased risk for severe COVID-19 disease or who have an unvaccinated household member who is at increased risk for severe COVID-19 disease

             Wearing masks, maintaining physical distance, and practicing other prevention measures are required when celebrating with unvaccinated people from multiple households

             Avoiding medium - and large-sized Seder

             Unvaccinated individuals from different households should refrain from celebrating in person.

Since the COVID-19  vaccine is not currently available to children, extra caution should be practiced when they are present. Outdoor gathering with masks or opening the windows to improve the ventilation, and distancing would be safest.

Although the available vaccines are helpful in curbing the spread of COVID-19 their efficacy against the variants of the virus in unknown. These variants seem to spread more easily and quickly than other variants, which may lead to more cases of COVID-19. It is there prudent to continue to maintain vigilance in the upcoming holiday.

Monday, January 25, 2021

Potential devastating impact of COVID-19 pandemic on the diagnosis and treatment of head and neck cancer


New data from the United Kingdom reveals potential devastating impact of COVID-19 pandemic on head and neck cancer patients. At the peak of the first lock down, there was a 59% drop in urgent referrals for people with a suspicion of head and neck cancer.

The devastating impact on projected five-year survival for people with head and neck cancer sees the pre-COVID projected 5 year survival of 47% will potentially drop to 43% of head and neck cancer patients.

This could lead to an additional 451 deaths in people with head and neck cancer in the United Kingdom.

The data from DATA-CAN (The Health Data Research Hub for Cancer) provided a valuable insight into the effects of the COVID-19 pandemic on all cancer patients and cancer services. The research found:

  • A decline in urgent referrals for cancer (70% decrease) during the initial lock down
  • A decline in chemotherapy attendances (40% decrease) during the initial lock down
  • For certain cancers, these declines had only partially recovered.

The researchers have now looked in detail at the impact on head and neck cancers and found that, at its worst, there was a drop of nearly 60% in urgent referrals for a suspicion of head and neck cancer during the first lockdown. This meant that 6 out 10 people who had symptoms potentially indicating head and neck cancer were not being referred to a specialist to investigate further.

Estimates suggest that this could have a devastating impact on five-year survival for people with head and neck cancer. Pre-COVID, around 47% of people with head and neck cancer would be projected to survive for five years or more. This figure could now drop to 43% which could potentially lead to an additional 451 deaths in people with head and neck cancer as a result of the pandemic.

Watch a video that presents the data and what can be done to mitigate the situation. 

Sunday, January 24, 2021

Laryngectomees’ challenges coping with COVID – 19 Pandemic as vaccines are available.

Laryngectomees are more susceptible to some respiratory infections because the air they inhale is not filtered by passing through their nose. Consequently, they are at an increased risk of inhaling respiratory pathogens (viruses, bacteria, and fungi) directly into their lungs.

Laryngectomees are also at high risk for poor outcomes when contracting COVID-19 because of their propensity to suffer from collapse of the lower lobs of their lungs (atelectasis). This is due to loss of upper airway resistance and impaired mucociliary functions, and mucosal irritation from cold, or dry inspired air. Further comorbidities such as advanced age, chronic disease (pulmonary, peripheral vascular, cardiac, cerebrovascular), diabetes, and past smoking, increase this risk.

Therefore, laryngectomees have to be vigilant and protect themselves from becoming infected with COVID-19. This can be done by wearing eat and mosuture exchanger (HME) with greater filtering properties ( i.e., Provox Micron TM); using 2 surgical masks (preferably N95), one over the stoma and the other over the mouth and nose; staying at least 6 feet away from others; washing hands often with soap and water for at least 20 seconds; and not touching their stoma, HME, eyes, nose, and mouth with unwashed hands.

Laryngectomees can protect themselves by receiving vaccination against COVID-19. All COVID-19 vaccines currently available in the United States have been shown to be highly effective at preventing COVID-19. Based on clinical trials, experts believe that getting a COVID-19 vaccine may also help keep one from getting seriously ill even when one get infected with COVID-19. Becoming vaccinated may also protect people around the vaccinated person, particularly those at increased risk for severe illness from COVID-19. This also contributes to the curbing of the national and world pandemic.

Among the benefits of being vaccinated is the emotional relief of gaining protection from the virus, and the ability of feel safer in face to face social interactions and when seeking medical and dental care.

Clinical trials demonstrated that the known and potential benefits of these vaccine outweigh the their side effects, and the known and potential harms of becoming infected with COVID-19. The Center for Disease Control’s (CDC) has reported that severe allergic reactions to COVID-19 vaccines are very rare and happened at a rate of 11.1 cases per million vaccinations. 

Vaccination is not expected to relax the CDC recommendations for continued use of masks and social distancing. This is because vaccines are not 100% effective, their protective effect is not maximized for at least six weeks, and vaccines may keep a person from getting sick but not from transmitting the virus. Masks and HMEs reduce the spread of any mutated strain of the coronavirus, while vaccines may not be as effective in preventing the transmission of newer, more contagious strains.

It is advisable to contact one’s physicians for guidance about vaccination or if one gets ill with the Corona virus. There are currently treatments available that can be administered early in the course of the infection to mitigate the illness and prevent complications. It would be prudent to following the guidance and instruction issued by the CDC and the local government health authorities.

Wednesday, December 23, 2020

Cancer Care During the COVID 19 Pandemic


Dr Brook's Letter to the Editor  published  in the New York Times has an important message to all cancer survivors:

The prolonged COVID -19 pandemic has led to an increase in the number of patients who present with late-stage, previously undiagnosed cancers, and recurrence of a previously diagnosed malignancy.

This is probably due to the reluctance of people to seek medical care because of fear of contracting COVID -19 at medical facilities; the closing or reduction in clinical services; the requirement to obtain COVID -19 testing before some medical procedures; and the use of telemedicine without physical examination instead of an actual office visit.

It is important that people not defer their medical care during the pandemic. It is especially important that those who previously received a cancer diagnosis continue their treatment and follow-up. Those who experience new or unusual signs and symptoms that may indicate aggravation of their condition or a new ailment should seek medical care without delay.

Postponing care or ignoring symptoms may lead to complications and deterioration, making future care more difficult and leading to increased morbidity and mortality.

Friday, November 13, 2020

Clinical Practice Guidelines for diagnosis, treatment and follow-up. Guidelines by the European Head & Neck Society, European Society for Medical Oncology, and the European Society for Radiology and Oncology.

This EHNS-ESMO-ESTRO Clinical Practice Guideline provides key recommendations for managing Squamous cell carcinoma of the oral cavity, larynx, oropharynx and hypopharynx (SCCHN).


  • It covers clinical and pathological diagnosis, staging and risk assessment, treatment and follow-up.
  • Opportunities for personalized medicine in SCCHN are also discussed.
  • All recommendations were compiled by a multidisciplinary group of experts from different institutions and countries.
  • Recommendations are based on available clinical evidence and the collective expert opinion of the authors.

Click to read the original recommendations.

Thursday, October 29, 2020

Increased risk of serious illnesses including advanced stage cancer due to COVID -19 pandemic


The prolonged COVID-19 world wide pandemic led to an increase in medical problems due to other etiologies. Medical providers are facing growing number of patients with previously undiagnosed late stage cancers, and recurrence of a previously diagnosed malignancies.  This led to an increase in the number of radical surgeries including laryngectomies and increase in the death rate among patients with many types of cancer.    

This is likely due to several factors that include the reluctance of individuals to seek medical care because of fear of contracting COVID-19 at medical facilities; the closure or reduction of clinical services, the suspension of cancer screening, the deferral of routine diagnostic work, the requirement to obtain COVID-19 testing prior to some medical procedures, and the utilization of telemedine without physical examination instead of an actual office visit.

It is therefore important that individuals do not defer their medical, dental, and mental care during the COVID-19 pandemic. It is especially important that those who were previously diagnosed with an ailment including cancer continue their treatment and follow up. Those who experience new or unusual signs and symptoms that may indicate an aggravation of their condition or a new ailment should seek medical care without delay. Postponing care or ignoring symptoms may lead to complications and deterioration making future care more difficult and may lead to increase morbity and mortality.

Wednesday, October 14, 2020

Oral Intubation Attempts in Patients with a Laryngectomy: A Significant Safety Threat.

Brenner and colleagues presented national data from the American Academy of Otolaryngology–Head and Neck Surgery, the American Head and Neck Society, and the United Kingdom’s National Reporting and Learning Service. Over half of US otolaryngologist respondents reported instances of attempted oral intubations among patients with laryngectomy, with a mortality rate of 26%. UK audits similarly revealed numerous resuscitation efforts where misunderstanding of neck breather status led to harm or death. The data underscore the critical importance of staff education, patient engagement, effective signage, and systems-based best practices to reliably clarify neck breather status and provide necessary resources for safe patient airway management.

Click to read the study. 

Friday, September 11, 2020

COVID 19 infection in laryngectomees reported in Italy and Scotland


Three studies from Italy and Scotland reported seven laryngectomees who  developed COVID -19 infection. Two acquired the infection while in the hospital after undergoing laryngectomy. The infection was serious in three of them and they required intubation and intensive care admission. All the patients survived.

The authors concluded that individuals who have undergone laryngectomy for head and neck squamous cell carcinoma are high risk for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection and may be at risk for worse outcomes of COVID-19 due to anatomical changes in their airways.

Monday, August 3, 2020

What are marijuana's effects on lung health?

The American Lung Association is concerned about the health impacts of marijuana use, especially on lung health, and caution the public against smoking marijuana because of the risks it poses to the lungs. Like tobacco smoke, marijuana smoke is an irritant to the throat and lungs and can cause a heavy cough during use. It also contains levels of volatile chemicals and tar that are similar to tobacco smoke, raising concerns about risk for cancer and lung disease. 

Marijuana smoking is associated with large airway inflammation, increased airway resistance, and lung hyperinflation, and those who smoke marijuana regularly report more symptoms of chronic bronchitis than those who do not smoke. Smoking marijuana may also reduce the respiratory system’s immune response, increasing the likelihood of the person acquiring respiratory infections, including pneumonia.

Whether smoking marijuana causes lung cancer, as cigarette smoking does, remains an open question. Marijuana smoke contains carcinogenic combustion products, including about 50% more benzoprene and 75% more benzanthracene (and more phenols, vinyl chlorides, nitrosamines, reactive oxygen species) than cigarette smoke. Because of how it is typically smoked (deeper inhale, held for longer), marijuana smoking leads to four times the deposition of tar compared to cigarette smoking.  However, well-designed population studies have failed to find an increased risk of lung cancer associated with marijuana use.

Smoking marijuana 

Tuesday, July 28, 2020

Impact of active smoking on outcomes in HPV+ oropharyngeal cancer

Researchers from Harvard Medical School, and Cleveland Clinic studied the impact of active smoking on survival in human papillomavirus - positive (HPV+) oropharyngeal squamous cell carcinoma (OPSCC) patients from 2001 to 2015.

Among the 484 evaluated patients, 94 (20%) were active smokers, 226 (47%) were former smokers, and 164 (34%) never smoked. Among active smokers, 82 patients (87%) had a ≥10 packs/year and 69 (73%) had a ≥20 pack/year smoking history. Active smoking was a significant predictor of inferior survival and progression-free survival, and ≥20 pack/yeas predicted a decreased effect-size for inferior survival and progression-free survival.

The investigators concluded that active smoking at diagnosis is the most powerful predictor of survival and progression-free survival in patients with HPV(+) OPSC .

Monday, June 29, 2020

The Effect of Laryngectomy on Couples' Sexual Functions in Men with Larynx Cancer

Dr Gür and colleagues from the Department of Otorhinolaryngology, Mersin University School of Medicine in Turkey investigated the effect of total or partial laryngectomies with or without adjuvant treatments on couples' sexual functions. 

The study included 39 male patients with laryngeal cancer and their female partners who were sexually active. Twenty-six patients underwent total laryngectomy, and 13 had partial laryngectomy.

The authors found that laryngectomies have negative impact on male erectile and ejaculatory functions, and also have negative effect on female partners' sexual functions. Presence of pre-operative erectile dysfunction and additional chemo-radiation therapy were the predictors to decrease in erectile and ejaculatory functions after surgery. The authors recommend that male patients and their female partners should be counselled about these issues before and after undergoing laryngeal surgery and adjuvant therapy. Those who experience sexual difficulties may be able to benefit from medical and psychological interventions.

Click to read about the impact of laryngectomee on sexuality and intimacy.

Wednesday, June 17, 2020

Recommendations for head and neck surgical oncology practice during the COVID-19 pandemic

The speed and scale of the global COVID-19 pandemic has resulted in unprecedented pressures on health services worldwide, requiring new methods of service delivery during the health crisis. In the setting of severe resource constraint and high risk of infection to patients and clinicians, there is an urgent need to identify consensus statements on head and neck surgical oncology practice.

An international consensus group published their recommendations for head and neck surgical oncology practice in a setting of acute severe resource constraint during the COVID-19 pandemic.

The COVID-19 pandemic created a significant  risk of contagion for anesthetists, dentists, head and neck surgeons, maxillofacial surgeons, ophthalmologists, and otolaryngologists.

A review summarizing some of the more readily available clinical protocols that can protect head and neck specialists caring for patients in an environment of a COVID-19 mediated COVID-19 pandemic was published by Kowalskiet al.   The authors recommend that for any care or intervention in the upper aerodigestive tract region, irrespective of the setting and a confirmed diagnosis (eg, rhinoscopy or flexible laryngoscopy in the outpatient setting and tracheostomy or rigid endoscopy under anesthesia), it is strongly It is recommended that all health care personnel wear personal protective equipment such as N95, gown, cap, eye protection, and gloves.