[Physical and psychosocial sequelae of total larynx extirpation and the use of a heat and moisture exchanger].

The incidence and severity of respiratory symptoms after total laryngectomy and their influence on everyday life were studied in 59 patients. Almost all patients (98%) have daily complaints of excessive sputum production and 64% of coughing. More than half the patients (57%) use forced expectoration more than 5 times a day in order to clear the airways and 37% have to clean the stoma more than 5 times a day. Respiratory problems appear to impair the quality of the voice, social contacts and psychological wellbeing and are associated with increased fatigue and sleep problems. In a prospective study the effect of a heat and moisture exchanger (HME) was measured in 42 patients. The frequency of sputum production, forced expectoration to clear the airways and stoma cleaning diminished significantly. As a result, feelings of fatigue decreased and social contacts improved. Respiratory problems after total laryngectomy deserve more attention. Treatment with an HME can in selected cases improve several other physical and psychosocial problems associated with this operation.