Head and Neck Services | Hull University Teaching Hospitals NHS Trust

This leaflet has been produced to give you general information about your voice prosthesis. Most of your questions should be answered by this leaflet. It is not intended to replace the discussion between you and your healthcare professional but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team who has been caring for you.

This information leaflet describes how to look after your stoma and voice prosthesis. It also lists some of the problems that you may experience and how to deal with them.

Stoma protection

The stoma should always be covered with a Heat and Moisture Exchange filter (HME). These can be placed in a tube, stud or baseplate. The stoma is not able to perform the four essential functions of resistance, filtering, warming and moistening of the air that you breathe. Normally this is done by breathing through your nose which is no longer used for breathing after your operation. Long term breathing with the stoma uncovered will lead to irritation of the lungs which then results in increased mucus production, coughing and chestiness. A HME cassette offers the best protection for your lungs and can reduce mucus production if worn consistently.

There is a wide range of stoma protection supplies on prescription. Your ENT Nurse Practitioner and/or Speech and Language Therapist (SLT) will be happy to advise on the products most suitable for you.

Orders are generally made through the home delivery medical supplies company. You will be able to re-order as you need to, ordering by telephone, text or online.

There are a number of items that are not currently on prescription such as decorative cravats. Please ask your ENT Nurse Practitioner and/or SLT for more details or current brochures.

Cleaning your stoma and voice prosthesis

Stoma cleaning

For stoma cleaning you will need:

Water spray bottle (with cooled, boiled water)
Tissues
Cotton buds (long stem) can be used
Long handled metal forceps
Mirror
Good light
Adhesive remover wipe (if using a baseplate)

Procedure:

Wash your hands thoroughly and remove any stoma protection (laryngectomy tube or baseplate). If removing a baseplate, wipe around your baseplate with an adhesive remover wipe.
Sit in front of the mirror with a good light shining at your stoma.
Spray directly into your stoma 2 to 3 times. Wipe away any mucus with a tissue/ cotton bud.
Ease mucus away with forceps, using a damp tissue to loosen stubborn pieces.

Check your stoma regularly throughout the day. It is recommended that you clean your stoma at least four times daily.

Voice Prosthesis cleaning

For voice prosthesis cleaning you will need:

Pipette
Voice prosthesis brushes (if advised)
Water
Plus, equipment for stoma cleaning

Procedure:

Dip cotton bud in water and remove secretions from around the voice prosthesis.
Carefully remove dry pieces of mucus from the edge of the prosthesis with forceps.
Fill approximately one third of the stem of the pipette with clean water.
Gently insert the tip of the pipette into the voice prosthesis until it fits snugly.
Briskly squeeze the bulb of the pipette to flush water through the voice prosthesis.
If water does not squirt through the voice prosthesis, it may need to be cleaned with a brush.
Place a finger on the voice prosthesis strap and insert the brush carefully.
Twist in a clockwise direction before gently removing. Repeat this until the brush comes out clean.
Pipettes and brushes can be cleaned in warm, soapy water and allowed to air dry. When you have your voice prosthesis replaced, you will need to discard your old brush. This is to prevent cross contamination.

Placing your stoma protection

You will need:

Clean Laryngectomy tube or stud and lubricant gel
New baseplate and a skin barrier wipe
Clean HME

Procedure:

If using a laryngectomy tube, place this in the stoma. Use a small amount of lubricant gel on the outside of the tube stem.
If using a HME cassette, ensure this is in place (you might feel it click into place). Regularly check the back of your HME. If you see any mucus, discard and place a new one.
If using a baseplate, warm this between your hands for at least 30 seconds to allow the glue to be more sticky. To prepare the skin around the stoma, use a skin barrier wipe. Place the round hole of the baseplate over your stoma first and take time to smooth out the baseplate edges on the skin. Place the HME cassette into the round hole of the baseplate.
If using a bib cover, spray this lightly and place over your stoma. These can be washed up to 5 times.

Problems that may occur and suggested solutions

THE VOICE PROSTHESIS MAY COME OUT ON CLEANING OR COUGHING

Place a catheter in the tract where the voice prosthesis normally sits and secure appropriately. Retain the voice prosthesis and bring it with you to your next appointment (we need to know that it is not in your chest).
Make contact via the telephone numbers given and book an appointment to have a new voice prosthesis placed.

Please do not come to the hospital without first arranging an appointment as we need to allocate an appropriate amount of time to see you. Please bring your voice prosthesis changing kit with you.

THE VOICE PROSTHESIS MAY FALL DOWN YOUR WINDPIPE

If this happens do not panic. The voice prosthesis will not stop you from breathing.
Place a catheter in the tract where the voice prosthesis normally sits and secure appropriately.
Bend over with your head as low as you can manage and try to cough the voice prosthesis out. Try this up to 3 times, observing to see if the voice prosthesis has come out of the stoma (please retain if it does).
If you are unable to cough the voice prosthesis out, please make an appointment to see the ENT Nurse Practitioner or SLT.

IT MAY BE DIFFICULT TO PLACE A CATHETER

Try to place your dilator as an interim measure and tape securely to your neck. Do not eat or drink with the dilator in place.
You may wish to try placing the catheter after the dilator has been in for 5 to 10 minutes. You may eat and drink if the catheter is securely positioned.
If you are experiencing difficulty placing a dilator or catheter, please contact the ENT Nurse Practitioner or SLT during working hours or the ENT Ward outside working hours.
Please note that the tract may close quickly, so you need to act promptly.
If the tract closes fully, a further surgical procedure will be required before the voice prosthesis can be re-fitted.
Remember at all times that you must not eat or drink if the voice prosthesis has come out and you have not placed anything in the tract.

THE VOICE PROSTHESIS MAY LEAK THROUGH THE MIDDLE

Leakage through the middle of the voice prosthesis will tend to cause coughing and possibly staining on clothing. Do not ignore this as you may develop a chest infection if it continues.
Take a drink of milk or blackcurrant and look at your voice prosthesis in the mirror with a good light.
If you notice milk or blackcurrant coming through the middle of the voice prosthesis, clean it thoroughly with the pipette and/or brush. Food or phlegm may be stuck at the end of the voice prosthesis and simple cleaning will solve the problem.
Try drinking milk or blackcurrant again. If you still have leakage, the voice prosthesis may need to be changed. This can only be done within working hours currently.

THE VOICE PROSTHESIS MAY LEAK AROUND THE OUTSIDE

Leakage around the outside of the voice prosthesis will tend to cause coughing and possibly staining on clothing. Do not ignore this as you may develop a chest infection if it continues.
Take a drink of milk or blackcurrant and look at your voice prosthesis in the mirror with a good light.
If you notice milk or blackcurrant leaking around the voice prosthesis, you will need to make an appointment to see the ENT Nurse Practitioner or SLT. It will not be possible for you to solve this problem at home.

THE VOICE PROSTHESIS MAY DEVELOP CANDIDA DEPOSITS CAUSING LEAKAGE

Candida is a type of fungus which may grow in the mouth and neck. For the voice prosthesis wearer, it may adhere to the voice prosthesis, causing it to change shape and leak prematurely.
If you wear dentures, ensure that these are cleaned thoroughly and regularly with a recommended denture cleaning agent.
Natural anti-fungals that control the growth of candida are bio-yoghurts (with a live culture), Turkish or Greek yoghurt and buttermilk. One of these products each day is advised unless contra-indicated by your diet.
If candida deposits are significantly reducing the lifespan of the voice prosthesis on a regular basis, a medication may be recommended. These are available via your GP on prescription.

THE VOICE PROSTHESIS MAY DISLODGE RESULTING IN EFFORTFUL VOICE OR NO VOICE

If the voice prosthesis is protruding forward and you can still talk without effort, the prosthesis may be too long. Contact the ENT Nurse Practitioner or SLT to make an appointment for assessment.
If the voice prosthesis is protruding forward and you are finding difficulty in talking or you do not have any voice, you need to act promptly as the tract may be closing at the back. Contact the ENT Nurse Practitioner or SLT to make an appointment.
If the voice prosthesis is embedded in the tissue, it may have dislodged on cleaning. Secure with tape and contact the ENT Nurse Practitioner or SLT to make an appointment.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact:

Speech and Language Therapy department, Therapies Centre, Castle Hill Hospital, HU15 5JQ

Tel: 0148 626700 or tel: 01482 875875

Mobile/Text: tel: 07920287662

Email: hyp-tr.headandneck.huthslt@nhs.net

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact the Speech & Language Therapy Department on tel: 01482 626700.