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Laryngectomized Patients (laryngectomized + patient)

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Medical Sciences	100%

Selected Abstracts

Influence of breathing resistance of heat and moisture exchangers on tracheal climate and breathing pattern in laryngectomized individuals,

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2010
Renske J. Scheenstra MD
Abstract Background. The aim of this study was to determine the influence of breathing resistance of heat and moisture exchangers (HMEs) on endotracheal climate and breathing pattern. Methods. Endotracheal temperature and humidity and tidal volumes were measured in 11 laryngectomized patients with a regularly used HME with "standard" breathing resistance (Provox Normal HME; R-HME), a low breathing-resistance HME (Provox HiFlow HME; L-HME), and without HME. Results. Both R-HME and L-HME increased end-inspiratory humidity (+5.8 and 4.7 mgH2O/L, respectively), decreased end-inspiratory temperature (,1.6 and ,1.0°C, respectively), and prolonged the exhalation breath length to approximately 0.5 seconds. The R-HME significantly enlarged tidal volumes (0.07 L; p < .05). Conclusions. Both HMEs significantly improve tracheal climate. The R-HME has better moistening properties and a small but significant positive effect on tidal volume. Therefore, if the higher resistance is tolerated, the R-HME is the preferred pulmonary rehabilitation device. The L-HME is indicated if lower breathing resistance is required. © 2009 Wiley Periodicals, Inc. Head Neck, 2010 [source]

Assessment of tracheal temperature and humidity in laryngectomized individuals and the influence of a heat and moisture exchanger on tracheal climate

HEAD & NECK: JOURNAL FOR THE SCIENCES & SPECIALTIES OF THE HEAD AND NECK, Issue 8 2008
J. Karel Zuur MD
Abstract Background The beneficial function of heat and moisture exchangers (HMEs) is undisputed, but knowledge of their effects on intra-airway temperature and humidity is scarce. The aim of this study was to evaluate the clinical applicability of a new airway climate explorer (ACE) and to assess the HME's influence on tracheal climate. Methods Intratracheal temperature and humidity were measured with and without HME in 10 laryngectomized patients. Results An HME causes the intratracheal mean humidity minima to increase with 3.2 mg H2O/L (95% CI: 1.5,4.8 mg H2O/L; p <.001), from 21.4 to 24.6 mg H2O/L, and the mean temperature minima to decrease with 1.6°C (95% CI: 0.9,2.4°C; p <.001) from 28.5°C to 26.9°C. Relative humidity values suggest that the tested HME keeps inspired air (nearly) fully saturated during the full course of inspiration. Conclusion Assessment of intratracheal temperature and humidity, and evaluation of HME effectiveness is feasible with the ACE. The tested HME significantly increases the intratracheal humidity, but decreases the intratracheal temperature. Relative humidity calculations suggest that increasing the thermal capacity of this rehabilitation device can further increase the heat and moisture exchange efficiency. © 2008 Wiley Periodicals, Inc. Head Neck, 2008 [source]

A Thin Tracheal Silicone Washer to Solve Periprosthetic Leakage in Laryngectomies: Direct Results and Long-Term Clinical Effects,

THE LARYNGOSCOPE, Issue 4 2008
Frans J. M. Hilgers MD
Abstract Objectives: Assessment of the immediate results and long-term clinical effects of a thin silicone washer placed behind the tracheal flange of voice prostheses to treat periprosthetic leakage. Patients and Methods: Three year retrospective analysis of 32 laryngectomized patients with 107 periprosthetic leakage events (PLEs). Custom-made silicone washers (outer diameter 18 mm, inner diameter 7.5 mm, thickness 0.5 mm) were placed behind the tracheal flange either in combination with prosthesis replacement or later. Results: There was immediate resolution of periprosthetic leakage in 88 PLEs (median, 38 d; mean, 53 d; range, 8,330 d) and in 6 PLEs with the washer still in situ at the date of analysis (median, 75; mean, 97 d; range, 38,240 d). There was no resolution for periprosthetic leakage in 13 PLEs. Thus, in total, 94 of 107 PLEs (88%) were successfully resolved. In 29 of 32 (91%) patients, the washer resolved the problem at least in one PLE successfully. Twelve of 32 patients, including all 3 with washer failures, also required other interventions to ultimately solve the problem. The vast majority of patients (80%) did not consider placement of the washer to be inconvenient. Conclusions: In consideration of the high success rate and limited inconvenience for patients, this simple thin silicon washer application provides a good first option for the treatment of periprosthetic leakage. [source]

Long-Term Results of Provox ActiValve, Solving the Problem of Frequent Candida- and "Underpressure"-Related Voice Prosthesis Replacements

THE LARYNGOSCOPE, Issue 2 2008
Jessica Soolsma MSc
Abstract Objectives: To assess the long-term results of the Provox ActiValve, a prosthesis for voice rehabilitation after total laryngectomy that was designed to lessen the need for frequent replacements caused by Candida and "underpressure." Patients and Methods: Retrospective assessment of device lifetime, indications for replacement, voice quality, and maintenance issues, measured by a structured trial specific questionnaire, in a cohort of 42 laryngectomized patients, experiencing a short Provox2 device lifetime (median, 21 days). Results: The median device lifetime of Provox ActiValve, replaced for leakage through the device and those still in situ at the date of data collection (N = 32), was 337 days (mean 376 days): a statistically significant 16-fold increase compared to the Provox2 prosthesis (P < .001). In 10 patients, replacement was fistula-related (median after 86 days): esophageal pouch (N = 4), fistula granulation (N = 3), extrusion of the device (N = 2), and periprosthetic leakage (N = 1). Eighty-six percent of the patients used a special lubricant to diminish "stickiness" of the valve. Provox ActiValve was preferred by 90% of the patients who completed the trial-specific questionnaire. Conclusions: For patients requiring frequent device-related replacements, Provox ActiValve, also long-term, provides a true solution and thereby is a valuable addition to prosthetic voice rehabilitation. [source]