Breathing and stoma care
Your nose used to warm, moisten and clean every breath. Now a small device called an HME does that job for you.
Why your nose mattered
Your nose, mouth and throat make up your upper airway. Your nose in particular warms, moistens and filters the air before it reaches your lungs. Your lungs need clean, warm, moist air to work well.
After a laryngectomy, air goes straight into your windpipe through the stoma. It arrives cold, dry and unfiltered. This can affect how well your lungs work and lead to more mucus, more coughing and sometimes mucus plugs.
How an HME works
An HME, or heat and moisture exchanger, is a small cassette that sits over your stoma. Inside is a foam core treated with a special salt solution. Many people call it their “new nose”.
- When you breathe out, heat and moisture from your breath are caught in the foam.
- When you breathe in, that heat and moisture are added back to the air before it reaches your lungs.
- It adds a little resistance to each breath, which helps your lungs work well.
- It keeps larger particles out, such as insects or crumbs while you eat.
Most people who wear an HME day and night have fewer problems with coughing and mucus.
Choosing an HME for the moment
HMEs come in different designs. Some give more moisture, some make breathing easier, and some filter the air. Many people use more than one kind through the day.
| When you are… | Look for an HME that… |
|---|---|
| Relaxing at home, reading or watching TV | Gives the most moisture while keeping breathing comfortable |
| Out and about, walking, shopping or at work | Makes breathing easier, still gives good moisture, and has a low, discreet shape |
| Exercising, cycling, running or at the gym | Has very low breathing resistance, and openings that stop it blocking when you breathe hard |
| Sleeping | Gives excellent moisture in a soft, comfortable design, to reduce coughing at night |
| In crowds, travelling or visiting a clinic, and in cold and flu season | Also filters bacteria, viruses, dust and pollen. These are called HMEFs |
| Speaking hands-free | Works with a hands-free speaking valve |
A filter HME protects both you and the people around you, but no filter can promise complete protection from germs.
Coughing with an HME
When you feel a cough coming, take off your HME and cover your stoma with a lint-free tissue or handkerchief, just as you used to cover your mouth. If there is no time, take the HME off after coughing and wipe the stoma area clean. If mucus gets into the HME, put on a fresh one.
Never wash or rinse an HME. Water washes out the salt solution in the foam, and the HME stops working properly.
Attaching your HME
The HME clicks into a holder that stays over your stoma. There are two main kinds of holder.
Adhesives
An adhesive is a thin, flexible patch that sticks to the skin around your stoma, with a ring in the middle for the HME. It is the most common way to attach an HME and often the most comfortable.
Everyone’s needs are different. Some people have a flat stoma, others a deep one. Some live in hot weather and sweat a lot, others have dry skin in a cold climate. Some speak all day or speak hands-free and need a stronger hold. So adhesives come in several types:
- Everyday adhesive
- Soft, flexible and low-profile, for a strong seal in daily use. Usually comes in round and oval shapes.
- Sensitive adhesive
- Made from a gentle hydrocolloid material, for sensitive skin.
- Stability adhesive
- Firmer, with stiffening bars that support a deep stoma. Good if you speak a lot by covering your stoma, or speak hands-free.
- Night adhesive
- A soft hydrogel that soothes and cools the skin, letting it rest while you sleep.
Putting on an adhesive takes practice. At first you may need to change it more often. Once you get the hang of it, the seal lasts longer. Aim for one adhesive that holds well all day, from morning to evening. A good seal also gives you a stronger voice if you use a voice prosthesis.
Tubes and buttons
For some people the stoma shrinks or needs extra support. A laryngectomy tube (a soft silicone tube) or a stoma button (a short silicone button) sits inside the stoma to keep it open, and the HME fits on the end.
- A tube can be used straight after surgery and longer term if you need support. Some types have small holes (fenestrations) and some have a ring that attaches to an adhesive.
- A button is shorter, and its rounded lip often holds it in place by itself.
- Holding it in place. A neck band, tube holder or clip keeps a tube or button from slipping out, for example when you cough.
- Clean and disinfect it at least once a day, following the instructions that come with it.
Your clinician will tell you whether you need a tube or button, which one suits you, and whether to wear it at night.
If you have a voice prosthesis, take care when putting in a tube. The end of the tube can catch on the prosthesis and knock it out of place.
Your daily routine
Changing your adhesive and HME at the start and end of each day keeps the seal strong, your lungs healthy and your skin in good condition.
In the morning
- Remove. Hold the adhesive with one hand and lift the HME off by one edge, like opening a door. If you wore a night adhesive, wet it with water and gently peel it away. For other adhesives, use an adhesive remover wipe.
- Clean. Clean the skin around your stoma with a cleaning wipe, or mild soap and water, to remove oil and leftover adhesive. Let your skin dry.
- Prepare. Apply a skin barrier to the clean, dry skin around your stoma and let it dry for 1 to 2 minutes. It leaves a thin protective layer and helps the adhesive stick. If you need extra hold, you can add a medical skin adhesive now and let it dry for about 4 minutes. Then peel the backing off your adhesive.
- Apply. Line up the bottom of the adhesive ring with the lower edge of your stoma. Smooth it on from the centre outwards, pressing it into any creases and hollows around the stoma. Click your HME into place and listen for the click.
Warm it first. Hold the adhesive between your hands for a moment before putting it on. A warm adhesive sticks better.
At night
- Remove. Lift off the HME as in the morning. Soak the top of the adhesive with adhesive remover, work the remover under the edge, and gently push the adhesive off your skin. Keep remover out of your stoma.
- Clean. Clean the skin with a cleaning wipe, or mild soap and water.
- Prepare. Let your skin dry completely. Do not use a skin barrier, cream or alcohol wipe before a night adhesive. Remove the centre strip of the backing.
- Apply. Line up the bottom of the ring with the lower edge of your stoma. Press the centre into your skin first, then peel off the side backing and press the whole adhesive down. Click in a fresh night HME.
Night adhesives need clean, bare skin. Whenever you use one, day or night, avoid skin barrier, cream, oily soap or alcohol wipes just before. Anything that leaves a film on the skin can stop it sticking.
If you wear a tube or button, you can still follow a night routine. Switching to a fresh night HME before bed can mean less coughing and a more restful night.
Always read the instructions that come with your products.
Looking after your skin
Your skin is your body’s largest organ. It helps control your temperature and protects you. After a laryngectomy, the skin around your neck is exposed in a new way and can become sensitive. Good habits help prevent irritation and help adhesives stick better.
- Take adhesives off gently. Soak the adhesive with adhesive remover, wipe along the edge, and ease it off. Never pull it off hard, as this can damage your skin.
- Clean between adhesives. Wash away oil, dirt and leftover glue each time, with mild soap and water or a cleaning wipe.
- Use a skin barrier under everyday adhesives, but never under a night adhesive.
- Give irritated skin a rest at night with a soothing night adhesive, rather than going without an HME.