Most individuals experience less “colds” after laryngectomy. This is believed to be because respiratory viruses generally first infect the nose before spreading to other body sites (including the lungs). Because laryngectomees do not inhale through their noses this mode of transmission is rare.
However, all respiratory viruses (including COVID-19) can also access the body through the nose, mouth, conjunctiva and stoma (in neck breathers) after they are inhaled or introduced by a contaminated object or hand. It is therefore prudent that laryngectomees are extra vigilant in protecting themselves.
Laryngectomees may also be at risk for poor outcomes with COVID-19 due to other medical comorbidity (including chronic pulmonary disease, peripheral vascular disease, cardiac disease, cerebrovascular disease, diabetes, the underlying cancer history), and the propensity for lower lobs collapse (atelectasis) due to loss of upper airway resistance. Additionally, because many laryngectomees have a smoking history, they are also prone to acute infections due to impaired mucociliary function and mucosal irritation from cold, dry inspired air.
There have been several laryngectomees who acquired COVID-19 infection. Those who were diagnosed had a broad spectrum of symptoms from minimal to severe. There were at least 2 who also had comorbidities that died from COVID-19 infection.
There have been several laryngectomees who acquired COVID-19 infection. Those who were diagnosed had a broad spectrum of symptoms from minimal to severe. There were at least 2 who also had comorbidities that died from COVID-19 infection.
The information and knowledge about the prevention and management
of COCID-19 is growing and constantly evolving. Because the recommendations for
COVID-19 prevention and treatment may change, it is important to follow the local
health department and Center of Disease Control and Prevention updates and consulting with medical professionals. .
If someone in close contact with laryngectomee is exposed or infected with COVID-19, he/she should self-quarantine themselves and avoid any contact with the neck breather.
it is important for laryngectomees to protect themselves and others in the community from COVID-19. Due to the increased aerosolization risk from their stoma, the potential to become “super spreaders” necessitates that total laryngectomy patients always cover their stoma in public. The best protection against aerosolization and inhalation of viral particles in the community is to cover the stoma with an HME that includes a bacterial and/or viral filter. Many patients prefer to use laryngectomy tubes, but during this pandemic an HME attached to the stoma with a baseplate allows for a seal that will force all air through the HME, thus further minimizing aerosolization. If the patient is unable to obtain a good seal with the HME base plate, they can use laryngectomy tubes that accept HME filters is an option. It is strongly recommend disposal of HMEs after community exposure.
Laryngectomees can protect themselves and others by taking these steps:
• Wearing heat and moisture exchanger (HME) 24/7 especially when being around other people. HME with greater filtering ability would work better in reducing the risk of inhaling the virus ( e.g., Provox Micron TM). (picture below) Provox Micron, has an electrostatic filter and >99.9% filtration rate and it’s cover prevents direct finger contact with the stoma when speaking. Wearing it also protects other individuals when the laryngectomee is infected. It has maximal activity during the first 24 hours of use. A
Provox micron
• Wearing hands free tracheostoma valve (because it does not require touching when speaking) in those using trachea esophageal speech. Those who use a regular HME should wash their hands before touching their HME.
• Wearing a surgical mask (see pictures below), 100% cotton turtleneck, bib, or scarf
over the stoma (in addition to the HME). Tie the upper strings of the mask around neck, use additional extension string to connect the two lower mask strings together under the arms and behind the back.
• Wearing an additional surgical mask or respirator over the nose and mouth, and protective glasses or face shield (see pictures below). This can prevent the virus from entering the body through these sites or spread to other people when infected. Men should shave their facial hair prior to wearing surgical mask or respirator. If worn properly, a surgical mask can help block large-particle droplets, splashes, sprays or splatter that may contain germs (viruses and bacteria). While a surgical mask may be effective in blocking splashes and large-particle droplets, it does not filter or block very small particles in the air that may be transmitted by coughs, and sneezes. Wearing the mask on the stoma and face also serves in preventing laryngectomees from touching these locations with unclean hands.
Wearing protective glasses and surgical mask
over the stoma (in addition to the HME). Tie the upper strings of the mask around neck, use additional extension string to connect the two lower mask strings together under the arms and behind the back.
• Wearing an additional surgical mask or respirator over the nose and mouth, and protective glasses or face shield (see pictures below). This can prevent the virus from entering the body through these sites or spread to other people when infected. Men should shave their facial hair prior to wearing surgical mask or respirator. If worn properly, a surgical mask can help block large-particle droplets, splashes, sprays or splatter that may contain germs (viruses and bacteria). While a surgical mask may be effective in blocking splashes and large-particle droplets, it does not filter or block very small particles in the air that may be transmitted by coughs, and sneezes. Wearing the mask on the stoma and face also serves in preventing laryngectomees from touching these locations with unclean hands.
Wearing protective glasses and surgical mask
Wearing face shield and protective glasses
• Washing hands often with soap and water for at least 20 seconds. Use an alcohol-based hand sanitizer that contains at least 60% alcohol if soap and water are not available. This is especially important before managing the stoma, and touching the HME when speaking using tracheoesophageal speech.
• Avoiding touching the stoma, HME, eyes, nose, and mouth with unwashed hands.
• Avoiding close contact with sick people and avoid public and crowded places.
• Staying at least 6 feet from other who don't live with you.
• Cleaning and disinfecting frequently touched objects and surfaces.
Those in close contact with neck breathers can expose them to the virus when they become asymptomatic carrier or infected with COVID-19. These individuals as well as the neck breathers should observe meticulous hand hygiene and wear face masks, gloves, eye shields, and other protective items whenever they are in contact with each other.
Additional sources about protection of laryngectomees:
Oral Oncology editorial about protection of laryngectomees
Tracheotomy Education Website: Laryngectomy and Coronavirus Disease (COVID-19)
Message from the Japanese Head and Neck Support Society. (in Japanese and English)
Message from the Singapore Cancer Society
Message from Nu Voice ( University of Southern California) Los Angeles.
Additional sources about protection of laryngectomees:
Oral Oncology editorial about protection of laryngectomees
Tracheotomy Education Website: Laryngectomy and Coronavirus Disease (COVID-19)
Message from the Japanese Head and Neck Support Society. (in Japanese and English)
Message from the Singapore Cancer Society
Message from Atos in Spanish: LaringectomÃa y Total y el nuevo virus corona: Sugerencias para la protección.
Message from Nu Voice ( University of Southern California) Los Angeles.
Wearing a modified face mask over the stoma
Protection using Provox Micron, N95 face mask and protective glasses.
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