Interaction of functional and participation issues on quality of life after total laryngectomy

Abstract

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

Optimizing Pulmonary Outcomes After Total Laryngectomy: Crossover Study on New Heat and Moisture Exchangers

“…[15][16][17][18][19] Despite these benefits, a large variation in adherence (35%-77%) has been reported, 18,20,21 and even in cases of full adherence (HME .20 hours per day) pulmonary issues are still present, negatively affecting daily life. 5,[9][10][11][22][23][24][25][26][27][28][29] Currently available HMEs do not yet provide levels of humidification identical to those provided by the nose, and further improvements are needed. Problems associated with available adhesives, such as skin irritation, 30,31 poor seal, and different shapes and morphologies of tracheostomas, 8,32,33 have been described as additional reasons for reduced adherence.…”

“…Despite these benefits, a large variation in adherence (35%‐77%) has been reported, 18,20,21 and even in cases of full adherence (HME >20 hours per day) pulmonary issues are still present, negatively affecting daily life 5,9‐11,22‐29 . Currently available HMEs do not yet provide levels of humidification identical to those provided by the nose, and further improvements are needed.…”

New Heat and Moisture Exchangers for Laryngectomized Patients in Germany: Mixed Methods Study on the Expected Effectiveness

“…Patient compliance to HME use is also considered an issue, and a large variation in compliance (35%-70%) has been observed [ 17 , 28 , 31 ]. Many patients experience issues related to the situational use of HMEs, such as the breathing resistance being too high during physical activity, insufficient protection against airborne particles, and pulmonary problems at night [ 32 ]. Other reasons for noncompliance are mainly linked to issues related to peristomal adhesives (ie, skin irritation, poor attachment, and poor fit to the stoma shape) [ 7 , 28 , 33 ].…”

“…In this light, new HMEs have been developed focusing on improving HME performance (ie, providing the most optimal humidification possible while keeping the breathing resistance comfortable), situational usability, and HME attachments (improved security, skin-friendliness, and fit). Improvements in these areas will most likely positively influence patients’ HME compliance, pulmonary health, and, ultimately, quality of life (QoL) [ 32 ].…”

Understanding and predicting the performance of passive heat and moisture exchangers using a numerical model

“…[1][2][3][4][5][6] Respiratory conditioning of the air by current HMEs is poor compared with the conditioning by the normal upper airway before laryngectomy. [7][8][9][10][11] As a consequence, pulmonary problems remain prominent in laryngectomized patients 12,13 and there is a need for further HME improvements. However, further improving the performance of HMEs is challenging due to its trade-off with breathing resistance and HME dimensions, influencing patient acceptance.…”