Laryngectomy Discharge
Date: March 2022
Review Date: March 2024
Ref: A-428
PDF: Laryngectomy Discharge final May 2022 v2.pdf [pdf] 123KB
Leaving Hospital after Total Laryngectomy
Undergoing a total laryngectomy can be a very overwhelming and challenging time. You will be given lots of information and will need to learn how to care for your stoma. Whilst you are in hospital you will have a lot of support from several healthcare professionals; however, this can make the prospect of returning home and leaving the ward a frightening and worrying experience. This leaflet aims to provide some information to support you after discharge from hospital.
Breathing
Removing the voice box will result in changes to your breathing. The surgery will involve the creation of a stoma (hole) in the front of your neck. This is where your windpipe is detached from the voice box and brought forward. This means that you will now breathe through the hole in your neck, rather than through your nose and mouth. This is a permanent change. It does not take any special techniques to breathe this way; your body will do this naturally. The main risks are activities involving water, such as bathing and swimming, as you will no longer be able to protect your airway if you go under water. Showering is fine, but deep baths are not advisable in case you slip.
You may find that you feel more short of breath or get tired more quickly when moving around or gently exercising. This is because the stoma is smaller than your nose and mouth so you may struggle to inhale the same volume of air. Monitor your stoma to ensure it is not shrinking and wear your laryngectomy tube as advised by your Speech and Language Therapist. If you continue to feel very short of breath then speak to your Ear Nose & Throat (ENT) Consultant. If you experience difficulties breathing then get emergency help, informing them that you have a stoma.
Secretions
One of the main issues that laryngectomy patients face is mucus, normal secretions from your lungs. Before surgery you would have coughed up these secretions and either swallowed them or spat them out. Now, when you cough these secretions will come out of your stoma. This can be difficult for some people to cope with and it can feel like it’s a never-ending problem. Initially after your surgery you will produce more mucus as your lungs get used to a new environment. However this should reduce with time. You will also become practised at coping with mucus and covering your stoma when you cough. The main things you can do to reduce the amount of mucus are:
• Ensure that you are wearing some kind of cover over your stoma. This will humidify and filter the air you breathe, as well as adding moisture and resistance. This keeps your lungs healthy and reduces mucus production. Your Speech and Language Therapist will advise you on the best filters and covers for you.
• Keep yourself well hydrated so that the mucus is thinner and easier to cough up.
• Try regular steam inhalations to add moisture to your lungs and help clear any mucus that has built up either during the day or overnight.
Mucus management can be frustrating and sometimes it takes trial and error to find the right products and the right routine for you. Make sure you discuss you concerns with your Speech and Language Therapist, Clinical Nurse Specialist or ENT Consultant.
Eating and Drinking
As your nose and mouth are no longer connected to your lungs there is no way for food or drink to ‘go down the wrong way’ and cause you to choke. This can occasionally mean that eating and drinking is easier for people if they were having problems with choking before their surgery. However, this is not always the case and sometimes swallowing can become more difficult. You may always need to have softer foods with plenty of moisture. You may also experience changes in taste, as you can no longer smell the foods you are eating. Discuss any changes to your swallowing with your Speech and Language Therapist.
You may have been advised not to eat and drink for a period of time if the surgical site has not yet fully healed. Follow the advice given to you carefully and use regular rinses to keep your mouth moist and comfortable.
Stoma Care
As your stoma has replaced your nose and mouth it is important to keep it clean to ensure you can breathe easily and keep your lungs healthy. It is good practice to clean the area morning and evening, although initially you may need to do this more often. Ensure that you also monitor the size of your stoma to check it is not shrinking.
Cleaning your stoma:
• Set up a light source and mirror to ensure that you can see the stoma clearly.
• Examine for any new areas of soreness, bleeding, or changes to the skin/tissue. If this does not resolve within a few weeks, then inform your Speech and Language Therapist.
• Cough gently to bring up any secretions and remove with clean tissue/gauze.
• Gently clean the skin around the stoma with damp gauze, trying to dab rather than wipe. You may need to use plastic tweezers to remove any dried secretions from the edge of the stoma.
• Gently dry the area and apply a barrier cream, such as Cavilon®.
• Replace the filter/stoma cover you have been advised to use.
Equipment and Deliveries
Having a laryngectomy will mean that you need some extra equipment to help look after your stoma. This may include items such as stoma covers/filters, cleaning swabs, gauze, laryngectomy tubes, shower covers etc. These items can be delivered to your home on a regular basis by a prescription home delivery service such as Atos Care or NWOS Homecare. Before you leave hospital your Speech and Language Therapist or Clinical Nurse Specialist will register you with a delivery company, with your permission, and arrange your first order. You will need to continue these orders when you need further supplies. The company will provide you with information on how to do this, and orders can be placed via email, online or via telephone. Ensure you place your order at least one week ahead, so you do not run out of supplies.
Contact Details
Chloe Jarvis (Macmillan Speech and Language Therapist): 01752 439826
Email address: chloe.jarvis@nhs.net
Please be aware that any contact via email carries risk of interception and/or data protection / confidentiality breaches. Whilst NHS mail addresses are secure, and patient information will never be shared without express permission, patients must be aware of the risks before providing private or confidential information via email. Please also note that this email is not accessed out of office hours or during leave.
Stephanie Murgatroyd (Macmillan Clinical Nurse Specialist): 01752 430279
If you cannot get hold of either the Speech and Language Therapist or Clinical Nurse Specialist, call the ENT Outpatient Department, explain the problem and ask them to bleep the SLT or CNS directly:
ENT Outpatients Department: 01752 433138
Emergency Situations
If you need resuscitation:
• Make sure you have some way of notifying others that you require resuscitation by stoma and not by mouth. This can be with a medic alert bracelet or wristband that informs others that you breathe via your neck. Speak to your Speech and Language Therapist about this.
If you need help in an emergency:
• Dialling 999 is still the fastest way of contacting emergency services. The operator should support you to access the help you need even if you cannot speak. Try coughing or tapping on the phone instead to let them know you are there. Dialling ‘55’ after dialling 999 will put you through to the police, who will then support you if you cannot speak.
• You can also register your mobile phone in order to use text messages to contact the emergency services. www.emergencysms.net and www.relayuk.bt.com provide you with further information regarding this.
• Speak to your local fire or police services to let them know that there is a person with a laryngectomy living at your address. They may be able to set up an alert so that they are prepared if there is an emergency.
• Make sure you take all your necessary equipment with you if you are out and about, including your dilator/catheter, plug, laryngectomy tubes/buttons and cleaning supplies. This will be useful in preventing an emergency situation if you are not at home.
Emotions
Returning to ‘normal life’ post-laryngectomy can initially seem impossible, and it takes time to adjust to the changes both physically and emotionally. Changes to your ability to communicate can seem isolating and make it difficult to express how you are feeling to others. If you are experiencing low or unpredictable moods or are struggling to come to terms with your surgery then ensure you let someone know. This is a normal part of the recovery process and there are a number of support options are available, including:
• The Mustard Tree Cancer Support Centre – Level 3, Derriford Hospital.
• The Macmillan Cancer Support website.
• The Swallows Head & Neck Cancer Support group.
• The Plymouth Laryngectomy Support Group
Speak to your Speech and Language Therapist, Clinical Nurse Specialist or Consultant for support, advice and further information.
