A different way of breathing
A total laryngectomy will affect your lungs
Lungs are vital organs. They are responsible for ventilation, providing oxygen to your body as you breathe in, and releasing carbon dioxide as you breathe out.
Before surgery, you breathe through your nose, mouth and throat – or what’s known as the ‘upper airways.’ These upper airways (in particular the nose) condition the air you breathe by humidifying and filtering it because your lungs need conditioned air to work properly. Since a laryngectomy will disconnect your upper airways, it will affect your lung function.
After your laryngectomy, you will breathe through a stoma in your neck. This means the air you breathe in won’t be optimally humidified or heated by the time it makes it to your windpipe and lungs. This sort of ‘unconditioned air’ will be too dry and cold for your lungs, and may potentially lead to more mucus, coughing and a higher risk of airway infections.
Heat and Moisture Exchangers (HMEs) have been designed to help your lungs by conditioning the air you breathe in, partly restoring what the upper airways used to do.
Your lungs need warm and moist air
Your nose, mouth and throat serve to heat and humidify the air you breathe. After a laryngectomy, Heat and Moisture Exchangers (HMEs) will do this for you.
An HME sits over your stoma and you breathe through it. It warms up the air and makes it more moist. It does this by ‘catching’ the heat and humidity of the air as you breathe out, then passes it on to the air when you breathe in. In other words, an HME ‘conditions’ the air you breathe by keeping it at a good humidity and temperature for your lungs to function properly.
Many people find that wearing an HME all the time can help them live a better life and go back to doing many of the things they did before their surgery. This is because an HME helps them produce less mucus, cough less, feel less irritation in their windpipe, and breathe more easily.
‘Conditioned air’ vs. ‘Unconditioned air’
We all have mucus in our airways, which traps dust and germs from the air we breathe in. We also have millions of tiny hairs (or ‘cilia’) that sweep back and forth in our airways to keep this mucus, with the trapped dirt, away from our lungs, cleaning the airways.
The dryer the air is when you breathe in, the less active your cilia will be. Without an HME, the cilia start to slow down, and your mucus starts to build up.
Air is best ventilated when it is at a body temperature of 37 degrees Celsius and 100% relative humidity. If the air is cooler and the humidity drops, the cilia come to a complete standstill and this leads to more mucus, coughing and airway infections.
Keep your cilia moving
By using an HME 24 hours a day, the air you breathe in will be properly humidified and heated, so the cilia can keep up their normal activity.
Watch this video about what happens inside your lungs when you are using an HME and when you are not using an HME.
When using an HME
Without using an HME
Learn more about the different ways of breathing after laryngectomy
References
Bien, S., Okla, S., van As-Brooks, C. J., & Ackerstaff, A. H. (2010). The effect of a Heat and Moisture Exchanger (Provox HME) on pulmonary protection after total laryngectomy: a randomized controlled study. Eur. Arch. Otorhinolaryngol, 267(3), 429-435. https://doi.org/10.1007/s00405-009-1018-4 [doi] (Not in File)
Hilgers, F. J., Ackerstaff, A. H., Aaronson, N. K., Schouwenburg, P. F., & Van, Z. N. (1990). Physical and psychosocial consequences of total laryngectomy. Clin. Otolaryngol. Allied Sci, 15(5), 421-425. http://www.ncbi.nlm.nih.gov/pubmed/2282704 (Not in File)
Mercke, U. (1975). The influence of varying air humidity on mucociliary activity. Acta Otolaryngol, 79(1-2), 133-139. https://www.ncbi.nlm.nih.gov/pubmed/1146532
Toremalm, N. G., Mercke, U., & Reimer, A. (1975). The mucociliary activity of the upper respiratory tract. Rhinology, 13(3), 113-120. http://www.ncbi.nlm.nih.gov/pubmed/1224134 (Not in File)
van den Boer, C., van Harten, M. C., Hilgers, F. J., van den Brekel, M. W., & Retel, V. P. (2014). Incidence of severe tracheobronchitis and pneumonia in laryngectomized patients: a retrospective clinical study and a European-wide survey among head and neck surgeons. Eur. Arch. Otorhinolaryngol, 271(12), 3297-3303. https://doi.org/10.1007/s00405-014-2927- 4 [doi] (Not in File)
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