Background: Due to the heat and moisture exchanger's (HME) breathing resistance, laryngectomized patients cannot always use an (optimal) HME during physical exercise. We propose a novel HME cassette concept with adjustable "bypass," to provide adjustment between different breathing resistances within one device. Methods: Under standardized conditions, the resistance and humidification performance of a high resistance/high humidification HME (XM) foam in a cassette with and without bypass were compared to a lower resistance/lesser humidification HME (XF) foam in a closed cassette. Results: With a bypass in the cassette, the resistance and humidification performance of XM foam were similar to those of XF foam in the closed cassette. Compared to XM foam in the closed cassette, introducing the bypass resulted in a 40% resistance decrease, whereas humidification performance was maintained at 80% of the original value. Conclusions: This HME cassette prototype allows adjustment between substantially different resistances while maintaining appropriate humidification performances.
ObjectiveTotal laryngectomy (TL) leads to lifelong physical changes which can lead to functional and participation issues. To assess the relationship between self‐reported quality of life and functional and participation issues, a large international online questionnaire was used.MethodA questionnaire was sent out to 8119 recipients of whom 1705 (21%) responded. The questionnaire consisted of 26 questions regarding demographic information, product use of the respondents, experienced overall health and independence, and functional and participation issues. Respondents were grouped based on sex, age, time since TL, educational level, and country of residence. Questions were grouped in one measure of reported quality of life (r‐QoL) and seven issue themes (“esthetic issues,” “experienced limitations in daily activities,” “avoiding social activities,” “communication issues,” “experienced vulnerability due to environmental factors,” “pulmonary issues,” and “sleep issues”) to assess the underlying relations.ResultsThis study showed that more functional and participation issues and a lower r‐QoL are reported in the group of younger respondents (<60 years), women, and respondents who have had the TL procedure less than 2 years ago. The issue themes “experienced limitations in daily activities” and “avoiding social activities” are related to r‐QoL. Most participants report “pulmonary issues,” and these issues have a strong correlation with most other themes.ConclusionThe ability to participate in meaningful and social activities is a major factor in r‐QoL. Due to the frequency and strong correlations of pulmonary issues with other issue themes, pulmonary issues might be an underlying cause of many other issues.Level of evidence3b
Permanent hands-free speech with the use of an automatic speaking valve (ASV) is regarded as the optimal voice rehabilitation after total laryngectomy. Due to fixation problems, regular ASV use in patients with a laryngectomy is limited. We have developed an intratracheal fixation device (ITFD) composed of an intratracheal button augmented by hydrophilic foam around its shaft. This study evaluates the short-term effectiveness and experienced comfort of this ITFD during hands-free speech in 7 participants with a laryngectomy. We found that 4 of 7 participants had secure ASV fixation inside the tracheostoma during hands-free speech for at least 30 minutes with the ITFD. The ITFD’s comfort was perceived positively overall. The insertion was perceived as being mildly uncomfortable but not painful. This proof-of-concept study demonstrates the feasibility of the ITFD that might improve stomal attachment of ASVs, and it provides the basis for further development toward a prototype suitable for long-term daily use.
Due to the large variation, no 'average tracheostoma morphology', suitable for shaping a generic intratracheal fixation device, can be defined. Therefore, providing an airtight fixation in each patient would require a large range of different sizes, customization or a new approach.
ObjectiveThis study aims to assess the product performance of a new moldable peristomal adhesive with corresponding heating pad designed to facilitate and improve automatic speaking valve (ASV) fixation for hands‐free speech in laryngectomized patients.MethodsTwenty laryngectomized patients, all regular adhesive users with prior ASV experience, were included. Study‐specific questionnaires were used for data collection at baseline and after two weeks of moldable adhesive use. The primary outcome parameters were adhesive lifetime during hands‐free speech, use and duration of hands‐free speech, and patient preference. Additional outcome parameters were satisfaction, comfort, fit, and usability.ResultsThe moldable adhesive enabled ASV fixation adequate for hands‐free speech in the majority of participants. Overall, the moldable adhesive significantly increased adhesive lifetime and duration of hands‐free speech compared to participants' baseline adhesives (p < 0.05), regardless of stoma depth, skin irritation, or regular use of hands‐free speech at baseline.The participants who preferred the moldable adhesive (55% of participants) experienced a significant increase in the adhesive lifetime (median of 24 h, range 8–144 h) and improved comfort, fit, and ease of speech.ConclusionThe moldable adhesive's lifetime and functional aspects, including the ease of use and custom fit, are encouraging outcomes and enable more laryngectomized patients to use hands‐free speech more regularly.Level of Evidence4 Laryngoscope, 2023
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