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.