Guiding Transitions: Using the LaryTube with Ring for Adhesive Success

The patient and health care teams journey post total laryngectomy.

Following a total laryngectomy, the health care team is astutely aware that pulmonary health and stomal integrity are integral to a successful recovery. Post discharge the patient is followed on an outpatient basis to address pulmonary health, communication options, emergency procedures, nutrition, swallowing, and psychosocial support by the health care team. When the patient begins outpatient rehabilitation after a laryngectomy, there is a lot to cover: learning how to use a voice prosthesis, electrolarynx training, HME compliance—the checklist is extensive. Another important element of this rehabilitation journey is finding the best stomal attachment. The purpose of a stomal attachment is to house an HME and provide a good seal for voicing with a tracheoesophageal voice prosthesis

Determining the right attachment can be challenging. Clinicians must consider several patient-specific factors, including motivation, cognition, dexterity, and stomal topography. Stoma patency is another essential consideration. Stomal stenosis—a narrowing of the stoma—is not unique to the laryngectomy population; it is also a concern in other medical contexts, such as the ostomy population.

In the context of laryngectomy, maintaining a patent stoma is vital, as narrowing can lead to complications such as difficulty breathing, mucus plugging, and challenges accessing the voice prosthesis. Risk factors for stomal stenosis include surgical technique, post-operative radiation therapy, and underlying medical conditions that influence stoma healing. Stomas with a minimum diameter of approximately 14 mm or less may be associated with adverse effects on routine stoma function (Paleri et al., 2006). For reference, typical LaryTube outer diameters include size 8 OD 12 mm, size 9 OD 13.5 mm, and size 10 OD 15 mm.

Of the different options for attachments, there are intraluminal devices like LaryTubes or LaryButtons, and peristomal options, such as baseplate adhesives. For patients, transitioning to an adhesive can offer many benefits, including improved voicing from a stronger seal, reduced coughing without a LaryTube irritating the back of the trachea, and greater comfort without visible tube ties around the neck.

For both clinicians and patients, this transition can create anxiety. Stomal narrowing is somewhat unpredictable, and it can be difficult to know which patients may experience complications.

The role of Provox Life LaryTube with Ring

This is where the LaryTube with Ring becomes a valuable tool. By combining the stability of a tube with the ability to secure into an adhesive baseplate, it offers a bridge between tube dependence and adhesive use. The Provox Life LaryTube with Ring inserts through the center of an adhesive and secures into place, allowing patients to benefit from the adhesive seal while still using a tube. This approach avoids repeatedly removing and replacing the adhesive during the transition process. For patients who require full-time stomal support due to stenosis, the LaryTube with Ring also allows continued use of baseplate adhesives without the need for visible neck ties.

Transition Process: Guiding the patient

• Preparing the skin for adhesive placement: clean peristomal area with Atos wipes, apply skin barrier.
• Educate the patient to apply and remove the adhesive and to insert and remove the LaryTube with Ring independently. Use one hand to stabilize the adhesive and the other to remove the tube.
• Instruct the patient to use a water-soluble lubricant to ease tube insertion and protect the voice prosthesis.
• Gradually extend the time each day without the LaryTube:
  - Day 1: Remove for 2–3 hours, then reinsert
  - Day 2: 4–6 hours
  - Day 3: 8–12 hours, and so on
• Ask the patient to demonstrate proper skin health practices (cleaning peristomal area, using skin barrier, etc) placing the adhesive, larytube with ring and HME to ensure adequate understanding of the process. Also ask the patient to demonstrate how to use the larytube to measure the stoma for any size changes and to monitor for stomal integrity.

Note: these instructions should be individualized as needed to meet the needs of the patient

If reinsertion becomes difficult, resume full-time tube use and return to clinic for evaluation. Encourage patients to document their wear time and any challenges they may experience. Some may eventually use the LaryTube with Ring only at night, while others may transition entirely to adhesive. If the stoma remains stable with no narrowing, the tube can eventually be discontinued.

By understanding stoma patency, patient-specific factors, and products like the LaryTube with Ring, clinicians can provide a predictable, confident pathway from tube dependence to adhesive use, improving patient comfort, voice quality, and independence.

References:
V. Paleri, R. G. Wight, S. Owen, A. Hurren, and F. W. Stafford, “Defining the Stenotic Post-Laryngectomy Tracheostoma and Its Impact on the Quality of Life in Laryngectomees: Development and Validation of a Stoma Function Questionnaire,” Clinical Otolaryngology 31, no. 5 (2006): 418–424.