LARYNGECTOMY HOME CAREreturn to:Resources for Total Laryngectomy in 2015 Total Laryngectomy The University of Iowa INTRODUCTIONYour larynx or voice box is located at the upper end of the trachea (windpipe). This area of the neck may be referred to as the "Adam's apple." The larynx contains the vocal cords for speech. A total laryngectomy is an operation that removes the larynx (see Figures V.D.1.1 and V.D.1.2 below). After surgery, you will:
YOUR AIRWAY, BEFORE AND AFTER SURGERYSome other changes you may experience after your laryngectomy are:
COMMUNICATION--SPEECHA speech pathologist will talk with you about other methods of speaking. You may need to write messages until you learn a different means of speaking. HAND WASHING/CLEAN SUPPLIESBecause your hands may spread germs, you must wash your hands before and after all cares. Clean supplies must be used. HUMIDITYExtra humidity is required because the nose and mouth, which filter, warm, and moisten the air you breathe, are bypassed. The amount of moisture needed will vary. Use an ultrasonic nebulizer, or a room-size or cool-mist humidifier in your home. Drinking plenty of fluids also helps to keep your airway moist. Increased humidity will be needed during the winter months when your home becomes dry. More moisture is needed whenever secretions become thick, dry, or form mucous plugs (dry, crusted secretions). Pink or blood-tinged secretions may also indicate a lack of moisture. Putting (instilling) saline solution (a salt solution) into the trachea adds moisture and causes a cough to clear secretions from your airway. CLEANING THE HUMIDIFIERGerms will grow in a humidifier. Clean the unit to decrease the chance of respiratory infections. Refer to humidifier package insert for cleaning guidelines. Options for daily and weekly cleaning are listed below: Daily
MAKING SALINE SOLUTIONSaline solution is a salt solution that can be made by boiling water for 5 minutes, then adding 1 1/2 level teaspoons of noniodized salt per quart of water. Cool to room temperature prior to use. Because germs may grow in the solution, discard unused saline solution after 24 hours. INSTILLING SALINE SOLUTIONThe purpose of instilling saline solution into your airway is to stimulate a cough and clear secretions.
SUCTIONThe purpose of suction is to remove secretions that you cannot cough out. Suction will clear your airway and help you breathe easier.
AIRWAY CARECleaningThe skin around your stoma should be kept clean and dry. Cotton-tipped applicators (eg, Q-tips or a damp washcloth) may be used to gently remove secretions surrounding the stoma. It may help to apply a thin film of petrolatum ointment to the outer edges of your stoma to prevent crusting. CoveringCover your stoma to prevent dust, insects, or other foreign matter from entering your stoma and to moisten and warm the air you inhale. The covering will also decrease the sound of breathing from your stoma and stoma odors. Cover your stoma with an all-gauze square folded over twill tape or bias tape tied around your neck (see Figure V.D.1.5). A variety of stoma shields or covers are available. If you are interested, ask your nurse or speech pathologist for more information. You may wish to use a different style of stoma cover. Women may like to use a scarf, high-necked dress, or a turtleneck sweater. For men, a high neck T-shirt, turtleneck, or dress shirt with an ascot may be worn. Your stoma will remain open; therefore, you may not need an appliance inserted into your stoma. Over a period of time, however, the stoma may slowly decrease in size. This is called stoma stenosis. The stoma size may be maintained by the periodic or continuous use of a stoma vent or a laryngectomy tube. The stoma vent is a commonly used appliance (see Figures V.D.1.6 and V.D.1.7 below). Some people prefer to use the stoma vent at all times because it helps to keep the stoma edges clean and free of secretions. The correct size stoma vent will be selected for you.
PRECAUTIONS
EMERGENCY INFORMATION
ACTIVITYUnless there are other limiting conditions, you should be able to continue your usual activities other than those such as swimming or boating. It may not be necessary to change occupations unless the environment in which you work is very dusty or there are extreme temperatures, as you will find breathing in these conditions uncomfortable. MOUTH CAREBecause of your decreased ability to taste and smell, you will not be aware of mouth odors. Daily oral hygiene should be performed. DIETUnless you have had additional surgery or radiation therapy, your ability to eat and swallow should not be affected by your laryngectomy. If you have difficulty swallowing or eating, contact your physician. Because you are unable to hold your breath and bear down, constipation may be a problem. Include high-fiber foods (fresh fruits and vegetables, bran, whole grain bread, and cereals) in your daily diet to facilitate normal bowel movements. Exercise and increased amounts of liquids will also help. Use an over-the-counter laxative if needed. DISCHARGE INFORMATIONBefore you leave the hospital, a visiting nurse may be contacted to assist you with your home care and help you obtain supplies. Supplies may be obtained from a drug store or medical supply company. Arrangements for a suction machine, if needed, will be completed before you leave the hospital. Most patients rent the suction machine. The need to suction may decrease over time. Return the suction machine when it is no longer needed. Arrange to have a humidifier at home. The International Association of Laryngectomees (IAL) is an organization designed to benefit you and your family. It is sponsored by the American Cancer Society and is composed of many local chapters called "Lost Chord Clubs." For additional information contact: HOME SUPPLIESThe following will be sent home with you:
WARNING SIGNSPlease notify your physician if you feel you are having problems or if any of the following occur:
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