Having a Laryngectomy

Before you leave hospital you will be taught by the nurses how to take care for your laryngectomy (stoma). You will go home when you are confident and feel ready. Most people are surprised how easily they learn to look after their airway. Also the care needed is safe, simple and does not take too much time.

Cleaning your stoma

• Do not allow any secretions to build up around your stoma area or down the airway.
• Check for secretions in and around the stoma at least 3 times daily -morning, midday and before going to bed.
• You may wear a stoma tube or stud so you will need to remove it and replace it with a clean one when you clean your stoma.

How to clean your stoma

• You will need a free standing table mirror, a good light (pen torch), gauze swabs and some cleaning solution (freshly boiled and cooled water or saline solution).
• Once the tube is removed clean around the stoma with gauze dampened in the cleaning solution wiping away any secretions. You may need to do this on the inside of your stoma also.
• Moisten any dried secretions with damp gauze and gently remove using angled forceps. You may need a relative, friend or District Nurse to help you. Using a pen torch check that the inside of your stoma is clear.
• When your stoma is clean reinsert a clean tube or stud.
• Occasionally the skin around the stoma may become sore. Vaseline, Ugmentin Merck, E45 cream or Cavilon can be used to protect the skin.

Report any changes in your stoma such as size, redness, swelling or sores to your G.P. or nurse.

Preventing mucous build-up inside your stoma

• You will be able to feel, when you breathe in and out, whether your airway is clear. By placing your hand near your stoma you will feel a good volume of warm as you breathe out.
• You will have chest secretions to cough up and clear away from your stoma area. The amount of secretions can vary from person to person.
• Hold some clean tissue or gauze near to your stoma, take some deep breathes and cough any secretions to the top of your airway and then wipe away.
• Try to look inside your stoma with a pen torch and a mirror to ensure that there is no build-up of mucus. If this is difficult then a relative or your district nurse may help you.
• If you allow mucus to build up in your stoma this may alter your breathing.
• You will need to clean your stoma at regular intervals morning, midday and night.
• Keeping your mucous thin will help make it easier to cough up and should help reduce build-up.

How to keep your mucous thin

• You should wear a stoma protector or filter system which will heat and moisten your mucous, helping to keep it thin. While you are in hospital your nurses will discuss this with you and show you how to use them.
• Drinking plenty of water will help to keep the body tissues moist, which will help to keep the secretions in your chest thin and make it easier to cough up.
• You may have a nebuliser and if you use sterile water or saline it may help to loosen the mucous to enable you to cough it up.
• Practice deep breathing exercises regularly throughout the day.
• You may need to continue using suction for a little while if you find it difficult to clear your airway. This equipment will be ordered for you before you leave hospital. The nursing staff will teach you and your relatives how to do this.
• Breathing in steam from a bowl of hot water may be helpful if your mucus is becoming thick and difficult to cough up.

Remember that your mucus may change according to the time of year. Your mucus may also become thicker during a cold or flu so you may need to take steps to ensure that you are able to clear your airway.

Things to remember about your laryngectomy stoma – safety needs

• You should wear a stoma protector or filter system which will heat and moisten your mucous, helping to keep it thin. While you are in hospital your nurses will discuss this with you and show you how to use them.
• Remember that during the Summer time there are more flies, wasps, blossom leaves and dust in the air which may present a hazard to the unprotected stoma.
• Never cut -up small pieces of gauze to clean around the stoma as fragments may fall into the stoma.
• Do not use cotton wool as small fibres may be inhaled causing irritation in the airway which is often difficult to relieve. Be careful when using cotton buds around the stoma and make sure they are moistened first so that small fibres are not inhaled.
• You need to take care not to get water into your stoma as it will go straight into your lungs. Take care when bathing and you may wish to ask a relative or friend to help you wash your hair.
• You can use a plastic shower shield to protect your stoma when showering and shaving etc. These are not available on prescription but can be obtained from your delivery company.
• Do not go swimming unless you have the correct breathing equipment and have had lessons in how to use it.- your local laryngectomy support group may run these.
• Take care not to spray aerosols such as polish, perfume etc too near the stoma area as this may irritate your airway causing coughing.
• During hot weather take care to protect your skin from harmful effects of the sun - a sun burnt stoma is very painful!
• While on the beach take care not to get sand in the stoma. Remember that it gets windy on the beach so protect that stoma!

It would also be useful for your friends/relatives etc to be aware of how to carry out mouth to stoma resuscitation in case of emergency. Most people find that once they return home with a few adaptations they are soon able to settle back independently life and living.