Living with a laryngectomy stoma
It can take time to recover from surgery to the larynx. You may feel embarrassed about your stoma. This can affect your confidence, and may be upsetting. It can take time to adjust when you are learning how to speak in a different way and breathe through a stoma.
It can help to tell your family and close friends how you feel. Your cancer doctor, specialist nurse and speech and language therapist (SLT) can give you advice and support. They may put you in contact with someone in your area who has had a laryngectomy.
You may find it helpful to use our Online Community. You can share your experience, ask questions and get support online. You could also ask your specialist nurse or SLT if there are any local support groups. These can help support you and give practical advice.
Before you leave hospital, your specialist nurse or speech and language therapist (SLT) will show you how to look after the laryngectomy stoma. They will show you how to:
- clean the skin around the stoma
- cough and clear your mucus
- use a suction tube (if needed) to remove mucus.
They will tell you what to use to clean the skin around the stoma, and how often to do this.
Some people find it helps if a family member is also shown how to look after the stoma. This can give you support at home. You will also be given contact details of people you can contact if you have any problems at home. Your SLT will explain how you can get supplies for your stoma. These are usually available on prescription from your GP.
When you breathe in, air goes down into your lungs through your stoma. The air is not warmed and moistened by your mouth and nose. This means the cooler, drier air can irritate your lungs. You may produce more mucus (phlegm). You will not be able to clear the mucus by sniffing or blowing your nose. When you cough, the mucus is coughed out through your stoma, not your mouth.
It is important to keep your stoma covered with a stoma cover or filter. These are also known as heat and moisture exchangers (HMEs). You attach them over the stoma to warm and moisten the air. They help reduce the amount of mucus you produce. This can help reduce coughing and prevent chest infections. Your cancer doctor, specialist nurse or speech and language therapist (SLT) can show you how to use them.
When your throat has healed, you can start taking fluids and food in by mouth. If chewing or swallowing is difficult, your speech and language therapist (SLT) will give you advice on foods that are easy to swallow.
You may cough when you eat and drink. This can sometimes be a sign that food is going down the wrong way (into the airway).
Your SLT can show you exercises to help with swallowing and stop you coughing.
You need to stop water going into your stoma when you shower or bathe. To do this, you need to cover the stoma with an aid or shield. Your specialist nurse or speech and language therapist (SLT) can give you information about showering aids or shields and how to use them.
Your neck can sometimes feel numb after surgery. Try using an electric razor when shaving to avoid cutting yourself.
Breathing through a stoma may make you more likely to get chest infections.
Signs of an infection include:
- feeling unwell
- feeling cold, shivery, hot or sweaty
- a change in the colour of your mucus to green or dark yellow
- having a cough that does not go away
- coughing up more mucus than usual.
It is normal to cough up some mucus after a laryngectomy. You will get used to what is normal for you.
It is important to tell your cancer doctor straight away if you have any signs of an infection. You may need antibiotics.
Most people are able to speak again after a laryngectomy. But this will be in a different way to before surgery. Some people cope well with learning to speak again. For others, it can be hard and difficult to deal with. But there are other ways to communicate. The type of communication you use depends on your individual situation, the type of surgery you had and your preferences.
We have a video about speech therapy after a laryngectomy.
Ways to help you communicate include:
A voice prosthesis valve
The surgeon makes a small channel between your windpipe (trachea) and oesophagus (gullet) This is called a trache-oesophageal puncture (TOP). A small valve (voice prosthesis) is put into the channel. This connects the windpipe to the gullet.
The valve is one-way, which stops food and fluids passing into the windpipe. Air can pass from your windpipe into your gullet through the valve. This allows you to develop a new voice after your operation.
Covering your stoma with a thumb or finger and breathing out lets air pass from the lungs through the valve. This causes your throat muscles to vibrate and make a sound. As with normal speech, you shape the sound into words by moving your lips, cheeks and tongue.
It can take time to learn how to speak with a voice prosthesis. The voice can sound quite natural and you will speak with your usual accent. It is usually a lower pitch than before.
Some people may be able to use a hands-free valve. This allows them to speak without using their finger to cover the stoma. These are not suitable for everyone, but you can ask your cancer doctor or SLT about it.
Sometimes, people choose to learn a technique called oesophageal speech. You can learn this as you recover from your laryngectomy.
To do this, air is squeezed down into the oesophagus (gullet) from the mouth. As the air moves back up from the oesophagus, your throat muscles vibrate and make a sound. Movements of your lips, cheeks and tongue shape the sound into words.
Oesophageal speech has the advantage of not needing any equipment. Some people find it easy to do, but others find it more difficult. It is usually best to practise little and often.
There are different types of electronic aids available to help you produce a voice. You may be given one to use while you practise developing your new voice.
You hold them against a soft part of your neck. They make sound vibrations that you can form into speech.