View source for Heat and moisture exchanger after laryngectomy

{{More footnotes|date=March 2012}}
[[File:Heat and Moisture Exchanger.jpg|thumb|Heat and Moisture Exchanger (HME)]]
[[Heat and moisture exchanger]]s (HME) are used after [[laryngectomy]] to help reduce breathing restrictions and compensate nasal functions.
==Procedure==
During a total [[laryngectomy]], the entire voicebox ([[larynx]]) is removed, which leads to a permanent disconnection of the upper and lower airways and a permanent [[Tracheotomy|tracheostoma]] (a breathing hole in the neck).<ref>{{Cite web |title=Description of a Laryngectomy (Removal of the Larynx) - Eastern Virginia Medical School (EVMS), Norfolk, Hampton Roads |url=https://www.evms.edu/patient_care/specialties/ent_surgeons/services/head__neck/patient_education/description_of_a_laryngectomy_removal_of_the_larynx/ |access-date=2022-07-27 |website=www.evms.edu}}</ref>  Prior to the operation, breathing primarily occurs through the nasal airways. In the [[upper airways]], the inhaled air is warmed up or cooled down, to prepare the optimal temperature before the air reaches the lungs. After a total laryngectomy, the upper airways are bypassed and breathing in and out occurs through the tracheostoma in the neck which means that the inhaled air flows directly into the lungs. These anatomical changes lead, among others, to changes in voice production, breathing, and [[olfaction]].  The nasal functions of regulating the temperature, humidifying, and filtering of the inhaled air are lost. The lack of these functions impairs the lower airways and the activity of the cilia, which leads to pulmonary problems such as [[Tracheobronchial tree|tracheobronchial]] mucus, excessive [[sputum]] production, crusting, which can also cause fatigue and shortness of breath. To at least partially reduce these restrictions and compensate the nasal functions, an HME cassette can be attached over the tracheostoma to provide a means for conditioning, humidifying and to a certain extent filtering the inhaled air.
==Pulmonary function rehabilitation==
With the regular use of an HME cassette over a couple of weeks, the pulmonary functions can be significantly improved in the majority of patients regarding reduced sputum production, reduced forced expectoration in order to clear the airways, and thereby reduced stoma cleaning.{{Unreliable medical source|date=March 2012}}<ref>{{Unreliable medical source|date=March 2012}}  {{cite journal |vauthors=Hilgers FJ, Aaronson NK, Ackerstaff AH, Schouwenburg PF, van Zandwikj N |title=The influence of a heat and moisture exchanger (HME) on the respiratory symptoms after total laryngectomy |journal=Clin Otolaryngol Allied Sci |volume=16 |issue=2 |pages=152–6 |date=April 1991 |pmid=2070531 |doi=10.1111/j.1365-2273.1991.tb01966.x}}</ref> This is due to improved ventilation and blood oxygenation values, which leads to a better ciliary activity and thus more efficient coughing for mucus clearance from the trachea.  Studies show that with regular and enduring use of an HME cassette, pulmonary complaints decrease, regardless of country and climate.{{Unreliable medical source|date=March 2012}}<ref>{{Unreliable medical source|date=March 2012}}{{cite journal |vauthors=Herranz González-Botas J, Suárez T, García Carreira B, Martínez Morán A |title=[Experience with the HME-Provox Stomafilter in laryngectomized patients] |language=Spanish|journal=Acta Otorrinolaringol Esp |volume=52 |issue=3 |pages=221–5 |date=April 2001 |pmid=11526867 |doi=10.1016/s0001-6519(01)78201-5}}</ref><ref>{{Unreliable medical source|date=March 2012}} {{cite journal |vauthors=Ackerstaff AH, Fuller D, Irvin M, Maccracken E, Gaziano J, Stachowiak L |title=Multicenter study assessing effects of heat and moisture exchanger use on respiratory symptoms and voice quality in laryngectomized individuals |journal=Otolaryngol Head Neck Surg |volume=129 |issue=6 |pages=705–12 |date=December 2003 |pmid=14663439 |doi=10.1016/s0194-5998(03)01595-x}}</ref> These improvements can affect voice pitch, loudness and intelligibility,{{Citation needed|date=March 2012}} and on sleeping disorders and fatigue, which is often related to pulmonary problems.{{Citation needed|date=March 2012}}
==Attachment==
HME devices can be attached to the tracheostoma in two different ways: peristomally, by use of a base plate, to which the HME can be attached, and intraluminally, by putting the HME into a laryngectomy tube or a stoma button.
Adhesive baseplates come in different shapes and properties to meet the users’ differences in anatomy and skin types.
'''Peristomally through an adhesive on the neck surrounding the stoma'''
There is a variety of adhesive baseplates, that can be used to attach the HME and products that are recommended for proper application and removal of the adhesive complement the portfolio.
'''Intraluminally through a device that is inserted into the tracheostoma'''
Some laryngectomized patients require a laryngectomy tube to maintain stoma patency, especially in the early postsurgical days and during postoperative radiotherapy.<ref>{{cite book |title=Head and Neck Cancer: Treatment, Rehabilitation, and Outcomes|year=2007|publisher=Plural Publishing|location=San Diego|pages=289–311|vauthors=Ward EC, van As-Brooks CJ, Acton LM, ((Morton A-L)) |chapter=11}}</ref> A stoma button is primarily used in stomas that are shrinking.{{Citation needed|date=March 2012}} This is the preferred solution for many users, but there has to be a tight lip that holds the button in place.
==Device lifetime==
Most patients use one adhesive per day and 1-2 HME cassettes per day.{{Citation needed|date=March 2012}}
==Voice prosthesis and HME==
An individual combination of [[voice prosthesis]], HME, and attachment{{Clarify|date=March 2012}} is important for good speech and pulmonary rehabilitation.
==References==
{{reflist}}
[[Category:Prosthetics]]
[[Category:Human head and neck]]
[[Category:Larynx surgery]]
[[Category:Trachea surgery]]