Adhesive baseplates can support rehabilitation and quality of life goals, including improved HME performance, voice quality, and comfort. However, practice patterns in the US and globally vary widely regarding how and when to transition patients from intraluminal attachments, such as Provox Life LaryTube, to peristomal attachments, like Provox Life adhesives. While early HME adoption is associated with improved pulmonary outcomes and stronger long-term HME adherence,1–3 there is less standardization regarding when to introduce adhesives postoperatively. These variations often leave clinicians balancing competing priorities—maintaining airway support while advancing rehabilitation.
Navigating Stomal Patency During Adhesive Introduction
A common barrier to adhesive use is surgeon preference for LaryTube use to maintain stomal patency. While many patients do not experience issues with stomal patency, others may stenose when intraluminal attachments are not present. Stomal patency and stability can be influenced by several factors, including a patient’s history of radiation, individual healing patterns, postoperative complications, and variations in surgical technique. Close monitoring and collaboration between the SLP, ENT, and patient is necessary to ensure early identification and treatment of stomal stenosis when present.
In cases where stomal stenosis is a concern but the patient is ready to transition to an adhesive, a LaryTube with Ring may be used in combination with an adhesive to provide stomal support while allowing access to adhesive-related benefits. When appropriate, this attachment combination may also facilitate a gradual transition to full-time adhesive use by allowing the patient to remove the LaryTube for prescribed intervals while maintaining continuous HME use via adhesives. In cases of severe or refractory stomal stenosis, collaboration with the surgeon is crucial as medical/surgical intervention may be warranted.
Individualizing Adhesive Selection
Another challenge clinicians frequently report is uncertainty about selecting the most appropriate adhesive type or size, particularly early in the postoperative period when stomal contours and skin conditions are still evolving. This can make the fitting process feel complex and, at times, daunting for both clinicians and patients.
Access to a variety of adhesive options can support a more individualized approach. The Provox Life Adhesive Collection gives clinicians and patients the option to trial different adhesive types and sizes. This flexibility can help identify the most suitable options based on patient anatomy, skin sensitivity, and daily wear needs without requiring an immediate commitment to a single adhesive type. Clinicians may find it beneficial to have the Adhesive Collection in clinic to use as a tool for conducting initial fittings, while patients may find it helpful to continue trialing at home to determine which adhesives best fit their lifestyle. For patients requiring additional guidance between sessions, the Adhesive Collection Log and informational booklet can help them track their experience and ensure proper usage of each adhesive type.
Support Available
Ultimately, there is no one-size-fits-all solution. Each patient is unique in their clinical presentation, rehabilitation pathway, lifestyle, and goals. Incorporating adhesives—whether as part of a full transition or in combination with Provox Life LaryTube—can help introduce functional and comfort-related benefits earlier in the patient journey.
If you have a patient in mind, but are unsure where to start, connect with your Atos Medical Clinical Educator or reach out via Spot-on-Support (SOS) for guidance.
References
1. Ebersole, B., Moran, K., Gou, J., Ridge, J., Schiech, L., Liu, J. C., & Lango, M. (2020). Heat and moisture exchanger cassettes: Results of a quality/safety initiative to reduce postoperative mucus plugging after total laryngectomy. Head & Neck, 42(9), 2453–2459. https://doi.org/10.1002/hed.26267
2. Foreman, A., De Santis, R. J., Sultanov, F., Enepekides, D. J., & Higgins, K. M. (2016). Heat and moisture exchanger use reduces in-hospital complications following total laryngectomy: A case-control study. Journal of Otolaryngology - Head & Neck Surgery, 45(1), 40.
3. Otaki, K., Takahashi, T., Ohshima, S., Takahashi, Y., Tanaka, R., Saijo, K., Omata, J., Yokoyama, Y., Shodo, R., Ueki, Y., Yamazaki, K., & Horii, A. (2026). Early initiation and structured education promote long-term heat and moisture exchanger use after total laryngectomy. The Laryngoscope, 136(3), 1403–1408. https://doi.org/10.1002/lary.70191