Laryngectomee Stoma Care
- Stoma Care - Basics
- Stoma Care - Do's & Don'ts
- Stoma Care - Equipment
- HME (Heat/Moisture Exchange)
- Stoma Covers and Patterns
- After Care - Mucus Problems
hme (heat/moisture exchange)
EXCHANGING HEAT AND MOISTURE
Any good stoma cover or filter will act to some extent as an "artificial nose" - will warm and humidify incoming air by absorbing exhaled moisture, which the next incoming breath passes through before entering the stoma and then lungs. The difference in the devices that have been named and accepted by Medicare as "HMEs" is that they seal all around the stoma, so that ALL incoming air must pass through them - none can get in around the bottom or sides - and thus they are often more effective - but not necessarily so. For instance, a Buchanan Stoma Protector, tied snugly around the neck and tucked under the shirt collar, will do a very, very good job of heat-moisture exchanging - not as perfect and complete as an HME, but much, much better than nothing - and as much as a lot of people want or need, especially for the price. Even one of the foam filters under a cotton turtle neck or mock turtle neck will do a pretty good job, as will many of the other types/brands of stoma covers/filters.
Another thing the HMEs do is to force the lungs to work harder to breathe in and out - more like they had to when they had to bring in the air over the tissues of the nose. Again, good stoma covers/filters will do this too - but, again, not quite so completely since they don't seal around the stoma.
Total Laryngectomee Rehabilitation and HMEs
Newest Educational Material
Benefits of Using an HME - Video
A short video explaining in simple terms and graphics the use of an HME
The Use of HMEs - A Literature Review (pdf)
Videos demonstrating application, removal and use of adhesive for:
Provox®StabiliBase™ adhesive base plate
Videos demonstrating LaryTube placement and LaryClips for:
Reports from our members
Using with Lary Tube Holder
I wear a lary tube and HME held in place by a lary tube holder worn around my neck. I don't care for having to stick adhesive things to my throat. I wear this arrangement 24/7 and can
go for days with the same HME filter and no cleaning required. My mucus is minimal and I feel very secure and confident in knowing that the air I breathe is pretty much contaminate free. The tube holder and HME are both flesh colored so they don't stand out. My breathing is always good. If I have to cough, I quickly pluck the filter out of the tube and cough into a
handkerchief. I am very pleased with this arrangement and consider it far superior to any other arrangement. But, as you know, we are all different. This is what works for me.
Early Use of HME
I had my surgery in September 2008, and by November, after the first
successful placement of a prosthesis, I started experimenting with
baseplates and HMEs for use. One thing I determined early was I was not
going to use a baseplate which I had to glue on myself, so I think over a
two month period, I wore every self adhesive baseplate sold by Provox and
In Health. Early on I began leaning toward the Provox products primarily
because In Health was not promoting 24 hour use, while the Provox products
encouraged it. Also, it seemed to me the Provox baseplates were more
secure, or to put it another way, they seemed to stay on my neck longer
than the In Health products did.
By January 2009, I was using the Provox Xtrabase baseplate due to its rigid
center which accomodates stomas which were somewhat dented in, which mine
is. The Xtrabase is also the baseplate of choice if using a hands free
device, whether it be In Health's version or Provox's, as they both fit
onto all the baseplates. I never could master the use of the hands free
however, as it made my neck muscles hurt. So, even though I used a normal
HME with this baseplate, I have been quite satisfied with its service.
I usually will wear an Xtrabase baseplate for 48 hours before removing and
discarding it. Also, I am beginning my 4th year of wearing this self
adhesive baseplate, and I have never used any other chemicals to aid in
keeping it attached or in help of removing it. One baseplate will be used
for 2 showers, with the aid of the Provox shower attachment. Usually,
during the second shower, after I am completed with the shower, I will
remove the baseplate and shower attachment and clean around my stoma with
the hot spray in the shower. If you do this, you must remember to stand
back and not let any direct spray of water into your stoma...if you do
you'll know immediately. But doing this it really soothes the skin around
the stoma where the adhesive from the baseplate was. I think this is the
one primary reason I have not had any significant skin irritations since
wearing the baseplates. After getting out of the shower, I attach a new
baseplate after cleaning in and around my stoma area and then attach a new
HME, then shave, then I am ready to wear this baseplate for the next 48
Of course, during times of infections which cause mucus buildup and more
coughing, I may not be able to get 48 hours out of a baseplate, requiring
an earlier change. But looking back over the past 4 years, I can say that
I have averaged 48 hours for a baseplate.
Some of the most significant advantages of wearing a baseplate and HME is
it is more sanitary. My wife says I have become somewhat "germophobic"
since my surgery, and while I don't agree totally with that assessment, I
will say how much more important it is is for laryngectomees to practice
good personal hygiene because we have lost the services of what our nose
and nasal cavity did for us, and if for no other reason that the stoma
opening goes directly to the lungs, we should be aware of what we are doing
in that area. Early on I wanted to use the HME because I was not having
good success getting a good fit when occluding over the foam covering I was
wearing, and I would catch myself sliding my thumb under the foam cover to
get a good seal on the stoma. By doing that, I just transferred anything
I had on my thumb into my lungs, which is not good. The use of the HME
eliminated that concern, and for me, made it easier to talk because when
using the HME, you will always get a 100% seal when pushing the HME down.
Another advantage is the chemical which is in the foam filter in both brand
HMEs will, for most laryngectomees, reduce the amount of mucus your body
will produce, which will then reduce the amount of coughing. The key word
in this saying is most. It worked exactly that way for me (after about 2
full months of use). However, it will not work this way for everyone. As
we have heard over and over again, and it is very true, we are all a bit
different in the amount of tissue we had removed, the amount of cancer we
had, our overall health, our ages.....I could just go on and on with
reasons why we are all different somewhat, which only means our outcomes
from using various products will almost always be somewhat different.
My biggest advantage of using a baseplate and HME is that it gave me an
extra level of protection when I am out in the public. It's an extra
expense and it creates a bit more work, but the use of these two products,
along with the silicone prosthesis, gets me closer, in my mind, back to the
feeling of being normal. My stoma is located low enough on my neck so
that when wearing a baseplate and HME they can be concealed under clothing,
which just gives me a better sense of normalcy. I can easily wear a shirt
and tie while wearing the baseplate and HME, which is just another plus for
I hope this has helped explain at least my use of the baseplates and the
HMEs, and maybe assist those who may be considering using them or wondering
what they were.
Filtering effects of HMEs - Woodwork
I was working on an old bench this morning that I am modifying to put in my kitchen. I was removing the old leather seat and back and the rock wool and straw stuffing that was used for padding. I also did some scraping and some sanding. The wood is black walnut.
I was wearing my HME filter and decided to take some comparison photos for folks to see that show the filtering that the HME provides.
One photo is of the old bench.
There are two (front & back views) showing the dirty HME beside a clean/unused HME.
One photo shows the dirty one torn apart.
My standard procedure is:
I use one of the bib type filter with open web type material and a foam filter inside. I dampen it and put it on over my HME. It catches a lot of stuff and keeps the HME a LOT cleaner.
Sometimes I take a big bandana style kerchief and fold it diagonally, dampen it, and tie it around my neck over top of the HME.
I did not do that the day I took the photos. I was just wearing the HME filter.
Bruce Buck Martin
|The Old Bench||
|Back View||Front View|
Use Clip to hold Lary Button
Alligator clip is used to hold the Lary button and is great for hands free.
When I cough the cap sometimes goes flying so I anchor it with a clip to attach it to my clothing.
(Paul Frehner 2009)
Heat/Moisture Exchange (HME) filters are a type of stoma cover which help laryngectomees partially restore functions previously performed by our noses and upper airways. They might be thought of as "artificial noses." As the name implies, an ?exchange? of heat and moisture occurs in the HME filter as a laryngectomee inhales and exhales. During exhalation, warmth and humidity are conveyed from the lungs and deposited into the filter. During inhalation, the warmth and moisture are picked back up by incoming air and returned to the lungs.
HMEs are receiving more attention in the U.S. as the results of research which has been conducted in several European countries becomes more widely known, and certainly because they are now covered by Medicare.
Before the laryngectomy, the upper half of the breathing system filtered, humidified and warmed incoming air. It also provided resistance so that the lungs fully inflated. This helped maintain lung capacity, and facilitated an efficient exchange of gasses in the lungs (oxygen added to the blood stream and carbon dioxide removed). Prior to the laryngectomy, by the time the inhaled air reached the lungs it was saturated with moisture and its temperature was close to the body temperature of 98 degrees Fahrenheit (37 Celsius). Air at 100% relative humidity and 98 degrees is ideal for oxygen/carbon dioxide gas exchange. After the laryngectomy, the incoming air was dirtier, drier and cooler.
The resistance function of the nose and upper airway might be a little more difficult to understand than dirtier, drier and cooler air and the problems those produce for laryngectomees.
Prior to the laryngectomy, the nose provided 80% of the resistance to breathing; with the mouth, larynx and trachea providing the rest. By providing resistance the lungs had to move air a further distance, and past curved and sticky mucus covered surfaces which resisted the air flow. This consequently made us "work" harder to breathe. We had to breathe more deeply to move the amount of air we needed. This helped maintain lung capacity (the volume of air our lungs could hold), and the efficiency of the gas exchange in the lungs where oxygen is added to the blood stream and carbon dioxide is removed. The quantity of oxygen in the blood of laryngectomees is measurably reduced if they do not compensate for the loss of resistance. And our breathing efficiency typically declines, particularly in the months immediately following the surgery.
All laryngectomees can use an HME regardless of their method of speech. There are basically two different types of HMEs, and two major ways to attach them to the stoma. One HME type is designed for TEP prosthesis speakers who cover their stomas (occlude) with a finger or thumb in order to speak. This same type filter can be used by traditional esophageal speakers or those who use ALs (artificial larynges). It consists of a housing and a filter.
A second type of HME is for TEP prosthesis speakers. It combines the HME filter with a hands-free valve. The hands-free valve closes when the TEP prosthesis user exhales, and air is redirected into the prosthesis without having to cover the stoma with a finger or thumb (hence the term ?hands-free?).
There are two basic ways to attach an HME or HME/hands-free valve combination. In one, the housing is glued to the skin around the stoma, and the HME snaps into the circular hole in middle of the housing.
Some systems have reusable housings and the user applies the glue in liquid form to the housing and then lets it dry. Other housings are pre-glued and are disposable after using them for a day or two.
In either case, the skin surface around the stoma is first cleaned in order to get good adhesion. Many use rubbing alcohol for this purpose. Some of those with sensitive skin also use a product such as ?Skin Prep? or ?Skin Shield? as a barrier between their skin and the housing glue. Several suppliers have pre-glued disposable housings which use special formula glue for those with sensitive skin.
A second method for using an HME filter is to combine it with a laryngectomee tube (vent, button). Two laryngectomee tubes/vents/buttons which are designed to accommodate an HME filter are the Lary Tube from ATOS, and the Barton-Mayo Button from Bivona and InHealth. The Trachi-Naze Plus system combines a lary tube with a finger occluded HME. Both the ATOS Provox filter cassette HME and the InHealth Blom-Singer HME fit into these tubes. (See "Hands-Free/Glue-Free" article in the October 2000 issue of the WWJ for more details about using the hands-free valve with the Lary Tube or the Barton-Mayo Button.
In addition to helping maintain the cleanliness, temperature, humidity and resistance to the air we breathe, HMEs have other benefits. In addition to mucus reduction, another of the most important of these is that many laryngectomees who speak via the TEP (tracheo-esophageal puncture) prosthesis report that their voicing is improved through the use of the finger occluded HME or the hands-free valve/HME combination. In the case of the finger occluded ones, it takes less pressure to get a good seal around the stoma to get a good and loud enough voice, and less pressure is applied to the entire area. This often results in speech being easier to produce as well as more clear to your listener.
Heat/moisture exchange filters (MHEs) need to be tried for a period of time. Using them continuously for at least one week is the minimum time they should be tried. The reason is that unless you just had your laryngectomy, you have gotten used to the lack of resistance to air moving in and out of your stoma. You may find the initial experience a little unpleasant and feel that the HME is restricting airflow. It is, but in beneficial ways. It takes time to get past this sensation and for you to adjust to it.
But in addition to this feeling, it also takes time for the HMEs to demonstrate some of their most important benefits such as reduced coughing and mucus production. And these benefits are unlikely to become obvious to you for a week, or even longer. A major mistake would be to try them for a day or less and conclude that they restrict your airflow. Research has shown that laryngectomees are more likely to stick with the use of HMEs if they are introduced right after the laryngectomy. The longer we go without using anything which provides resistance the more difficult it becomes to stick with them. We have simply gotten used to less restricted airflow and the sensation of having to work harder to get air is felt by many to be uncomfortable until they have adjusted to it.
Those with breathing problems such as COPD (Chronic Obstructive Pulmonary Disease), emphysema, asthma, etc., should not try an HME without approval from your MD. But trying them has been made easy since the major HME producers will send you a free sample kit of their HMEs (but not the hands-free valve/HME combinations) upon request.
If you wish to try them, you might consider trying those which have the least resistance first, and then move to those with greater resistance. This would suggest trying the Blom-Singer (or ATOS HiFlo cassette) first, and then to the ATOS Regular cassette, and finally to the Kapitex filters. The Kapitex nighttime filter provides the greatest resistance, so it should probably be tried last after you have gotten used to the feeling of added resistance to air flow, and it should only be used during sleep.
HMEs cannot completely restore the functions of the nose and upper airway in conditioning the air we breathe to the standards we enjoyed prior to becoming laryngectomees. They can, however, make a significant different in reducing coughing and excessive mucus production, and deliver a better quality of air to our lungs than the alternative stoma covers. They can also make a noticeable improvement in voicing for many, and they can help maintain lung function. While some laryngectomees will decide that they are not worth the additional hassle of using them or their cost, every laryngectomee should at least consider giving them a fair trial.
Hints from members on wearing baseplates for HMEs
1. When I am working at a client site, I use the prep and remove wipes, but
when I am at home, I simply use the baseplate without any additional prep.
One suggestion I have for those who don't like/can't use the adhesives and
removers is to warm the baseplate's own adhesive with a hair dryer prior to
attaching to the skin. I put the baseplate on the countertop, adhesive-side up, and run a handheld blowdryer over it for 15-20 seconds. This makes the adhesive more liquidy
(if that is a word) and it adheres to the skin with much better results
than when I try to warm it up by hand as the instructions state.
When I know I am going to be speaking a lot during the upcoming day, I will
combine both the hairdryer and adhesive approaches and I get a really
durable seal. This has been helpful for those interminable status
meetings, conference calls, training sessions, etc.
Just a hint I picked up at the IAL convention a few years back.....
2. I use Provox Flexiderm bases and when I started using them I used Skin Prep and Skin Tac but soon found I was allergic to them so I use only the base and the built in adhesive. However I do not use a hands-free.
3. I used Skin Prep & Skin Tac for a couple years when applying my base plate and had problems. The base plate would last maybe two days and I also had the itchy skin rash trouble. So, I stopped using the other adhesives and now just use the base plate by itself. And, to combat the skin problems, I now apply skin oil to the area the night before putting
on a new base plate in the morning. Skin oil is used to help healing scars after an operation, so I figured I'd try it around the stoma - and it really has cured my skin rash troubles. You might think any oil would cause a problem with getting a good seal. But most of it sinks into the skin and the rest washes off easily.
Also, I was instructed by my SLP to clean the area with an alcohol swab. But, I then realized that it doesn't make any sense to put alcohol on skin that already has a rash. Now I just clean the area using a neutral pH soap that doesn't have any oils in it. I now get 4-6 days on a base plate, with no itchy rash -- and I talk a lot! Hope this helps.
4. My surgeon is great; the man undoubtedly saved my life after chemo and radiation didn't quite do the trick. So, my family, friends, and I adore him. However, my experience so far suggests that skin problems, issues with base plates, and prosthetics in general are best addressed with your SLP vs. the doctor. I'm no expert but these are my thoughts.
Generally, the aloe wipes help me with skin irritation. Occasionally, I'll get a spot that is particularly irritated. There I use neosporin (on the outside only) with pain med for an hour or two, without a base plate. This helps a bunch, especially if there is an actual break in the skin.
FREE HME SAMPLES
Just call these toll free numbers (or e-mail or write the companies) and request their free HME sample kits.
Do not know if these are still offered but, if not, they can send a catalog or literature.
Six self-adhesive baseplates (round and oval regular, FlexiDerm and OptiDerm adhesive), ten Provox HME cassettes (five normal and five HiFlow), Two Remove adhesive remover wipes, "Life as a Laryngectomee" brochure.
Atos Medical, Inc.
2202 N. Bartlett Ave.
Milwaukee, WI 53202-1009
One reusable humidifilter holder, seven foam filters, five TruSeal adhesive disposable housings, and a guide book. You get a one year membership in Medic Alert by requesting the kit.
1110 Mark Ave.
Carpinteria, CA 93013-2918
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