Respiratory rehabilitation with heat moisture exchanger after total laryngectomy: long-term evaluation

BACKGR OUND: Total laryngectomy determines important psycho-physical and social consequences on the patient’s quality of life. This is due to the functional changes resulting from the removal of the larynx, which determines the immediate loss of the phonatory and nasal function. To try to restore the loss of nasal functions, the use of heat and moisture exchanger (HME) may contribute to rehabilitation of lung function and restoration of muco-ciliary clearance. We conducted a multicentric study on laryngectomized patients in order to assess the degree of satisfaction and long-term adherence to the pulmonary rehabilitation program with HME. METHODS: This prospective study was carried out on patients submitted to total laryngectomy who have never used HME. In order to assess the degree of patient satisfaction and adaptation after using the Provox HME, we used self-assessment questionnaires, that were administered at 3 months to 6 months and 12 months. R ESULTLTS: Sixty-eight patients, 66 males and 2 females aged between 48 and 79 (mean 66.2±7.14 years) were recruited in the study. The percentage of patients, who at 12 months adhered to the respiratory rehabilitation program with HME, was 94.1%. Analyzing the answers given to the questionnaires, after 3 months, 94.1% of the patients believe that their appearance has not worsened and 91.2% of them believe that covering the stoma with HME is more hygienic. While at 3 months, 47.0% had difficulty breathing, however at 12 months only 18.8% continue to consider breathing more difficult with the HME, and 6.3% felt the need for removing the HME for episodes of difficulty breathing. Comparing the patients’ responses relating to the subjective perception of respiratory and pulmonary conditions after the use of HME 13%, 39.4%, and 83.4% of patients (at 3, 6, and 12 months respectively) gave a score of maximum satisfaction. CONCLUSIONS: The pulmonary rehabilitation with HME, in the total laryngectomized patient, should be undertaken promptly, in order to prevent the processes of alteration of the muco-ciliary clearance furthermore, in order to obtain the maximum benefit of rehabilitation with HME, constant use over time is necessary.