Introduction

Total laryngectomy results in a wide range of physical and psychosocial sequelae for the patient, including life style changes.1 The most prominent consequence of this surgical procedure is the loss of the normal voice, which nowadays often will be rehabilitated with a voice prosthesis, in our Institute, as discussed in the previous chapters, since 1988 preferably with the indwelling Provox and more recently with the second generation Provox2 prosthesis. The disconnection of the upper and lower airways also has repercussions for the conditioning - warming, humidifying and filtering - of inhaled air, which is thereby precluded. Consequently, many laryngectomized patients suffer from respiratory problems, of which involuntary coughing, excessive phlegm production, forced expectoration and dyspnea are the most pronounced complaints.2 These symptoms develop and tend to increase during the first 6 months postoperatively, and probably well beyond that period, but later seem to stabilize. Frequently, there is an increase in respiratory symptoms during the winter. Moreover, these problems can have a serious impact on many aspects of daily life, including increased fatigue and sleeping problems, compromised voice quality, disrupted social contacts, and heightened psychological distress.2 Although these problems are more or less self evident, the awareness about them amongst medical health care providers has been relatively low in the past.

Furthermore, an objective impairment of the pulmonary function of the laryngectomized patient can be expected as well. Pulmonary function assessment should be performed with an extratracheal device (e.g. Provox HME adhesive, see figure below)3. If an intratracheal cuffed-cannula is used, the flow-volume loop suggests lower (incorrect) values (see upperfigure, inner dotted curve). It could be established that the actual measured pulmonary function values of the laryngectomized patients studied are significantly lower than the (age, sex, height and race adjusted) predicted values.4 Moreover, there seems to be an additional independent adverse effect of the laryngectomy in the older patient group. The above-mentioned differences were more pronounced in the over 65 years of age group.