A. True. The cough isn't as effective following laryngectomy and secretions may be thicker due to reduced humidification. The lack of vocal cords that can close and facilitate pressure build up at the start of a clough means that the cough isn’t as 'explosive' as before. Physiotherapists have a key role.

B. False. In the first days following a laryngectomy or fashioning of a tracheo-oesophageal puncture (TEP) for vocalisation, swallowing can be difficult, and may require naso-gastric feeding tubes. Specialist input from ENT and Speech and Language Therapy teams is essential. Most patient will go on to be able to eat and drink normally.

C. True. The Valsalva manoeuvre involves expiring (forced expiration) against a closed glottis, which is no longer possible. This raises the intra-abdominal pressure and can help with opening the bowels. Most patients wil adapt but some might need laxatives or changes to their diet.

D. True. As above, bracing the abdominal muscles and lumber spine is more difficult if you can’t hold your breath and perform a Valsalva manoeuvre.

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