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Is there quality of life after tracheostomy?

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16/07/2020
Is there quality of life after tracheostomy?

After a tracheostomy/laryngectomy operation the patient has to get used to a completely new reality. Breathing is no longer done through the nose and mouth and thus a number of issues arise that need to be addressed.

The main ones are the following:

Difficulty communicating
Profuse mucous secretions
Respiratory system infections
Aesthetic issues

 


1. Communication difficulty

A. Tracheal tube with speaking valve

This tracheal tube is used in cases where the vocal cords are intact, to divert exhalation into the oral cavity and achieve speech. The tracheal tube can be plastic or silver, with or without a cuff.

B. Laryngophone

The laryngophone produces vibrations, which simulate the oscillations of the vocal cords. It is indicated in patients who have undergone a total laryngectomy. The quality of the voice result depends to a significant extent on the postoperative state of the patient's trachea.

C. Tracheoesophageal catheter + speaking valve

Alternatively, in the above patients, a special catheter is invasively placed, which connects the trachea to the esophagus. With the help of a speech valve placed in the mouth, the exhaled air is diverted through the esophagus into the oral cavity and speech is achieved. The tracheoesophageal catheter should be changed approximately every 6 months.

D. Esophageal speech

The third solution for total laryngectomy patients is esophageal speech. The patient is trained by a specialized speech therapist to speak after swallowing a quantity of air. It is a tiresome way of speaking and is not possible in case of infection or inflammation.

 

2. Profuse mucous secretions

Mucus hypersecretion is a normal reaction of the body, due to the bypass of the upper airway, which humidifies, warms and filters the inhaled air. The proposed solution is the use of humidification/warming filters which replace the functions of the nose (filtering, humidification and heating of the breath). For as long as the stoma is maintained, the use of a filter is necessary.

Especially in cases where the patient is bedridden, the use of a home suction device may be required to decongest the respiratory system.

 

3. Respiratory infections

Humidifying/warming filters contribute the most to limiting the risk of infections. The replacement of filters should be carried out according to the manufacturers' instructions, usually every 24 hours, in order to filter the inhaled air as well as possible.

 

4. Aesthetic issues

After the patient regains his strength and as long as the orifice remains open, the patient can use cotton or silk coverings for social intercourse. They are worn as scarves around the neck and offer an elegant effect.

 


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