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

Abstract

Objective To evaluate the effects of new devices—heat and moisture exchangers (HMEs) and adhesives—on pulmonary symptoms, subject adherence, quality of life, dermatologic symptoms, and patient satisfaction after laryngectomy. Study Design Prospective crossover study. Setting Between December 2020 and April 2021, 40 patients were enrolled who had undergone laryngectomy, routinely used HMEs and adhesive, and were followed in our Department of Otolaryngology–Head and Neck Surgery. Methods Patients were allocated into group A (new products) or group B (usual care) for 6 weeks. Then the 2 groups reversed, and each patient acted as his or her own control. Patients kept a diary and cough tally sheet. At baseline and after each 6-week period, 2 questionnaires were administered: EQ-5D (European Quality of Life–5 Dimensions) and CASA-Q (Cough and Sputum Assessment Questionnaire). Results Six weeks of using new products resulted in the following effects for both groups: (1) a significant reduction in daily forced expectoration and dry coughs, (2) a significant improvement in all domains of the CASA-Q, (3) an increase in adherence to HME use, (4) a significant reduction in shortness of breath and skin irritation, and (5) significantly better scores in the anxiety/depression domain of the EQ-5D. Conclusion Achieving this reduction in patients who were already highly adherent to HME use is clinically relevant and underscores the importance of using better-performing HMEs that can compensate for the humidification deficit. Improving pulmonary symptomatology could reduce patient restrictions in daily life and avoidance of social activity, with a consequent positive effect on quality of life.

Post‐laryngectomy pulmonary and related symptom changes following adoption of an optimal day‐and‐night heat and moisture exchanger (HME) regimen

“…At the end of Phase 2 participants reported improved cough symptoms, cough impact, sputum symptoms, sputum impact, reduced involuntary coughing, reduced need to change devices due to blocking/secretions, and improved sleep. Despite different methods, and different international study populations, the current data is highly consistent with the findings of Longobardi et al 21 and supports the use of new generation HME systems to facilitate further optimization of pulmonary function for established HME users post laryngectomy.…”

“…Results of a recently published study by Longobardi et al, 21 which was still being finalized when the current study commenced, have provided initial evidence that this new range of devices has positive pulmonary and related symptom benefits for patients. Longobardi et al 21 used a randomized cross over study design in which the cohort of 40 laryngectomy patients completed 6 weeks of usual HME use and 6 weeks using the new HME range.…”

“…Results of a recently published study by Longobardi et al, 21 which was still being finalized when the current study commenced, have provided initial evidence that this new range of devices has positive pulmonary and related symptom benefits for patients. Longobardi et al 21 used a randomized cross over study design in which the cohort of 40 laryngectomy patients completed 6 weeks of usual HME use and 6 weeks using the new HME range. Results revealed increased HME adherence and a significant reduction in forced expectorations, dry coughs, improvements in both cough and sputum symptoms and impact, reduced shortness of breath, less skin irritation, as well as reduced anxiety/depression using the new device range.…”

“…The CASA‐Q was developed and validated for patients with chronic obstructive pulmonary disease (COPD) and covers four domains (cough symptom, cough impact, sputum symptom and sputum impact) scored from 0 to 100 with lower scores indicating more symptoms/higher impact. Although the CASA‐Q was not developed or validated for the laryngectomy population, its four domains assess symptoms experienced by the laryngectomy population 21 . Hence, in the absence of a validated tool for detecting pulmonary symptoms in the laryngectomy population, the CASA‐Q was used.…”

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.…”