Laryngectomy tubes

Patients will usually have a short soft tube inserted into the stoma. This tube helps to keep the stoma open and is usually worn for at least 12 hours per day, although some patients with well-established stomas can manage without a tube. This can be easily removed for cleaning. It doesn’t need to be sterile, just visibly clean.

Cleaning the stoma

Normal respiratory secretions will accumulate in and around the stoma. These would often be swallowed without thinking about it prior to the laryngectomy. These need to be routinely cleaned at least 3 times per day (morning lunch and evening).

Patients need a mirror and some tissues. Cooled boiled (or sterile) water is used when the stoma is healing, but tap water is ok when the stoma is healed and healthy.

Tilly forceps can be helpful. Any thick or dried secretions should be carefully removed. Small cut pieces of gauze or cotton wool can easily enter the windpipe and cause irritation or blockage.

Once the stoma is clean and dry, the laryngectomy tube can be reinserted.

Barrier creams such as Vaseline, E45 or Cavilon can help manage irritation around the stoma. Steroid creams are useful for granulation tissue.

Humidification

Patients should always have some form of humidification. This can be active or passive. Most passive systems trap exhaled warmth and moisture in a foam, which you then breathe back in with your next breath. Try breathing onto your hand how and see how warm and wet it gets.

Most take the form of a simple covering such as Buchanan Bib or Laryngofoam, but more elaborate systems with a baseplate and central casette are available. Some of these act in conjunction with TEP valves (explained later).

Inhaled steam, nebulisers or mist sprays can help, as can adequate hydration and mucolytics.

Showering and bathing

It is important not to get water in the stoma. Showering covers are available in various designs. Swimming is possible with specialist equipment and some support.