Best Practices for the Laryngectomy Patient in the Community
Just as it is important for laryngectomy patients to take precautions
while in the clinic and hospital setting, it is vital that they protect
themselves and others in the community from COVID-19. Due to the
increased aerosolization risk, the potential to become “super
spreaders” necessitates that total laryngectomy patients always cover
their stoma in public. As previously mentioned, the best protection
against aerosolization and inhalation of viral particles in the
community is to cover the stoma with an HME that includes a bacterial
and/or viral filter. Many patients prefer to use laryngectomy tubes, but
during this pandemic an HME attached to the stoma with a baseplate
allows for a seal that will force all air through the HME, thus further
minimizing aerosolization. If the patient is unable to obtain a good
seal with the HME base plate, they can use laryngectomy tubes that
accept HME filters. At this time, we strongly recommend disposal of HMEs
after community exposure.
In addition to wearing an HME at all times, we encourage patients to
wear a surgical mask, 100% cotton turtleneck, or scarf over their stoma
to pre-filter inspired air, as these have been found to provide some
measure of aerosol and particle filtration, albeit not to the same level
as a dedicated filter as linked above.21,22 For
patients in whom an HME is not an option, we still recommend the use of
alternate coverings like a cotton turtleneck or scarf
alone.21,22 This measure still affords for alternative
methods of protection for laryngectomy patients regardless of
socioeconomic status. An N95 respirator over the stoma would likely be
of limited value as compared to those alternate options given the
inability to create an appropriate seal around the stoma. Covering the
mouth and nose are also important as these sites remain a potential
vector of viral inoculation. The landscape surrounding COVID-19 is
rapidly changing, and guidelines will continue to evolve, however, at
this time general recommendations are for laryngectomy patients to wear
a face mask in addition to an HME with viral filter and additional
stomal covering with a surgical mask or other garment.
If a laryngectomy patient develops symptoms of COVID-19 they should seek
testing, which should be both upper aerodigestive (nasopharynx) and
lower respiratory (tracheal), and if positive patients should
self-quarantine. All patients should continue to follow quarantine
recommendations as issued by their home states and national governments.