Long-Term Use of Heat and Moisture Exchangers Among Laryngectomees: Medical, Social, and Psychological Patterns Itzhak Brook, MD, MSc; Hans Bogaardt, PhD; Corina van As-Brooks, PhD, MBA Objectives: After laryngectomy, pulmonary protection is mostly acquired by means of a heat and moisture exchanger (HME) that is placed on an airtight seal around the stoma. The effects of HMEs on the tracheal climate have been well described, and the filtration effect of an HME with an electrostatic filter has been described in vitro. The effects of HME use in patients have been documented in several trials in different countries. The follow-up time of the patients in these trials, however, is limited. Less is known about long-term use of HMEs, and studies describing long-term compliance with HME use are scarce. This study investigated the long-term use of HMEs in laryngectomees. Methods: Questionnaires were sent to 195 laryngectomees, and 75 questionnaires were returned. Results: More than 85% of the respondents used an HME, of whom 77% were compliant users (ie, use for more than 20 hours per day). The incidence of pulmonary illnesses (either before or after surgery) was about 25%. More than 90% of the respondents were heavy smokers before laryngectomy. One third of the respondents are regularly exposed to dusty environments. Compliant HME users tend to make less use of external humidifiers and vaporizers, and have better pul- monary status and lower health-care costs. Regarding quality of life, patients who use a FreeHands device tended to have more frequent social contacts (r = 0.251; p = 0.030). The prevalence of depression is high, pointing to an urgent need to recognize and treat psychiatric problems such as depression and suicidal ideation in this patient group. Conclusions: These findings have implications for any postlaryngectomy research that uses pulmonary parameters. Key Words: depression, heat and moisture exchanger, HME, laryngectomy, lung, speech. Annals of Otology, Rhinology & Laryngology 122(6):358-363. © 2013 Annals Publishing Company. All rights reserved. 358 From the Departments of Pediatrics and Medicine, Georgetown University School of Medicine, Washington, DC (Brook), the De- partment of Clinical Affairs, Atos Medical AB, Hörby, Sweden (Bogaardt, van As-Brooks), and the Institute of Health Studies, HAN University of Applied Sciences, Nijmegen (Bogaardt), and the Department of Head and Neck Oncology and Surgery, the Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam (van As-Brooks), the Netherlands. This study was supported through a grant from Atos Medical AB. Correspondence: Itzhak Brook, MD, MSc, 4431 Albemarle St NW, Washington, DC 20016. INTRODUCTION There are approximately 50,000 to 60,000 laryn- gectomees in the United States, and about 10,000 new cases of larynx cancer are reported each year. 1 Although laryngectomy is major surgery and may take a long time for complete healing, barring oth- er medical problems, almost all laryngectomees can expect to fully recover and regain the ability to speak again using an alternative speech mechanism. One of the speech methods used by laryngectomees is tracheoesophageal speech with a voice prosthesis. A small puncture is created in the tracheoesopha- geal wall connecting the trachea with the esophagus. Upon occlusion of the stoma, air is diverted from the trachea through the lumen of the voice prosthesis into the esophagus, allowing speech. Total laryngec- tomy involves a complete and permanent disconnec- tion between the upper and lower airways, eliminat- ing nasal functions such as conditioning of the in- haled air and olfaction. 2-6 Mohide et al 7 stated that laryngectomees experi- ence the physical consequences of having a stoma (frequent phlegm production from the stoma and its interference with social activities) as the most severe side effect of their surgery. The respiratory symp- toms significantly affect the quality of life of the pa- tient: correlations were found between respiratory symptoms and the perceived quality of the voice, aspects of daily life, anxiety, and depression. 8 Pulmonary protection after laryngectomy is mostly acquired by means of a heat and moisture exchanger (HME) that is placed on an airtight seal around the stoma. An HME has 3 physical proper- ties: heat and moisture exchanging capacity, adding resistance to the airflow, and filtering out particles. 9 Its basic component is usually an open cell polyure- thane foam, which acts as a condensation and ab- sorption surface. To enhance the water-retaining ca- pacity, the material is often impregnated with hygro- scopic salts such as calcium chloride. 10 The HMEs used for laryngectomees are mostly hygroscopic and might have been impregnated with a bactericide