Advancing Independence: Earlier Adhesive Adoption After Laryngectomy

Whether you're new to working with patients after total laryngectomy or have years of experience, one thing is clear: There’s no one-size-fits-all approach. Every patient’s recovery is unique, and clinical practices vary significantly depending on training, setting, and resources. One area that continues to lack consistency is the transition from using a laryngectomy tube to wearing an adhesive baseplate. Common questions arise: When is the best time to make this transition? What does the process look like? Who leads it—and why is it important? The answers differ widely across clinics.

Joshua Teitcher MS-HSM, MS, CCC-SLP
Senior Speech-Language Pathologist at Rush University Medical Center

To explore this topic from a clinician’s perspective, we spoke with Joshua Teitcher, MS-HSM, MS, CCC-SLP, a Senior Speech-Language Pathologist at Rush University Medical Center, who manages a high volume of laryngectomy patients. Joshua has developed a post-operative adhesive pathway that promotes earlier transition and consistent follow-up, offering a structured yet flexible model. His approach demonstrates how patients can be safely and effectively guided toward adhesive use earlier in recovery—resulting in improved outcomes and higher satisfaction. Among the key benefits, Joshua notes improved voicing from a better seal, reduced coughing without a laryngectomy tube irritating the back of the trachea and greater comfort without visible ties or straps around the neck.

Many clinicians hesitate to introduce early post-op adhesives, often due to concerns about healing and surgeon clearance. At Rush, however, the SLP team typically begins adhesive fitting by the second post-op visit, around four to five weeks after surgery.

“We’re usually not fitting adhesives at the first post-op visit,” Teitcher explains. “But by the second visit, if the staples are out and the suture lines are flat, we’re ready to begin.” Transitioning at this stage allows patients to experience the improved voicing that comes with a secure adhesive seal. “Once they feel how much easier it is to talk with an adhesive, it opens the door to greater independence.”

Rather than abruptly removing the laryngectomy tube from their routine, Teitcher takes a gradual approach. Patients are encouraged to wear the adhesive for a few hours each day, slowly increasing wear time while removing the laryngectomy tube. They are advised to monitor for any signs of stoma narrowing or discomfort and may be asked to measure the stoma to track for stenosis.

“We always tell patients—don’t throw your tube away,” he adds. “Keep it somewhere safe. If the stoma starts to feel snug, maybe put the tube in overnight, then go back to the adhesive in the morning.” In Joshua’s experience, this weaning model helps prevent stenosis, supports comfort, and builds confidence. Most patients, he notes, become consistent adhesive users within five visits.

Adhesive wear during radiation can be more complex as peristomal skin becomes increasingly fragile. “We often start patients on Standard adhesives, but if skin becomes irritated, we’ll switch to the Sensitive or Night adhesive,” Teitcher explains. “If irritation worsens, many patients temporarily return to the laryngectomy tube.”

Both the Provox Life Sensitive and Night adhesives are made from materials commonly used in wound care. The Sensitive adhesive is made of a hydrocolloid material, which absorbs wound fluids and provides moisture to support healing. The Night adhesive uses hydrogel to hydrate the skin and promote recovery. Depending on skin tolerance and clinical needs, both can be used during and after radiation therapy.

Because skin tolerance can change rapidly during radiation, it's important to monitor patients closely and adjust the plan as needed. If a patient transitions to a laryngectomy tube toward the end of treatment, irritation can be a concern. Joshua notes, “For some patients, the skin around their stoma is still pretty raw because they have their laryngectomy tube in and it’s rubbing on it constantly. So they’re having a hard time healing from that. I have conversations about going back to the Sensitive adhesive at that point to help promote their skin healing.”

With so much for patients to manage—stoma care, adhesives, laryngectomy tube maintenance, radiation side effects—education must be clear and manageable. Teitcher follows a “keep it simple” philosophy. “I start as simple as possible, and as we need to get fancier, we get fancier,” he explains. He emphasizes repetition and hands-on learning, using simple tools like Atos handouts and CareTips sheets to reinforce each step.

At the first clinic visit, Teitcher usually applies the adhesive himself. Soon after, the goal is for the patient, or if necessary, the caregiver to take over. He walks them through the process—cleaning the skin, applying Skin Barrier and Skin Tac if needed, warming the adhesive, and securing it—always adapting based on the patient’s skin tolerance.

Ultimately, Teitcher stresses patience and flexibility. “It’s a lot of trial and error in the beginning,” he says. “But once their stoma topography settles down, things get easier. They’ll find their groove and what works for them.”

For clinicians unsure about starting adhesives early, he offers this advice: “You’re the expert in this space. If the staples are out and the skin is healing, try the adhesive—even for 30 minutes in clinic. It can change the whole rehab process.”

“As soon as their staples are out, that’s a sign the surgeon says it’s healing,” he continues. “It’s OK to try the adhesive to show the patient what talking is going to be like. The adhesive itself isn’t going to open anything.” On working with surgeons, he adds, “We (SLPs) have a hard time talking to surgeons for some reason. Don’t. You’re much more of an expert in this than they are. They don’t know anything about the products. Most will say, ‘If you think it looks good, then sure.’”

While hands-free speech is often seen as the ultimate goal in rehabilitation, Teitcher sees it differently, “We use it as a tool, not a finish line.” Once a patient has established a consistent routine, a good fit, and a strong seal, he introduces a hands-free device. “As soon as they tell me they’re independent putting the adhesive on and talking well with it all day, then I’ll introduce a hands-free device.” Because it places more demand on the seal, the team trials devices in the clinic to find the right membrane strength and ensure success. “It’s all about giving the patient choices,” he says.

The team at Rush established guidelines for best practice demonstrating that earlier adhesive adoption is not only safe, but also effective. Patients voice sooner, gain independence faster, and experience better skin outcomes when adhesives are introduced thoughtfully and supported through consistent follow-up.

Ultimately, it’s about meeting patients where they are—and giving them the tools to move forward with confidence.

Acknowledgment
Special thanks to Joshua Teitcher, MS-HSM, MS, CCC-SLP, for generously sharing his time, clinical expertise, and thoughtful insights. His patient-centered approach and commitment to advancing laryngectomy care continue to inspire and elevate best practices across the field.