"Attachment of the Adjustable Tracheostoma Valve and Housing
from the View of a Laryngectomee"
by Richard Crum
The following is a description of how I have learned to wear the housing and the valve
on a daily basis. Let me first say that I am a laryngectomee, not a doctor or a speech
pathologist, and this is not to be medical advice. I have been using the Tracheostoma
valve for 6 1/2 years. In that time, I have had many failures, but over the years I have
developed the ability to keep a Tracheostoma Valve on all day without the seal failing. I
will attempt to tell you how I do this and why it works well for me.
One thing need to be said before we get into the discussion of how to maintain a seal.
My definition of success is if you can put on the housing in the morning and take it off
at night. I know several people that wear the same housing for up to seven days without
breaking a seal. I personally prefer to remove the housing each evening. This is a
personal preference and if after you have mastered keeping a seal and you want to leave it
in longer, then that is up to you.
The first thing that must be understood is some of the history connected with having a
Tracheostoma Valve in the first place. When the TEP(or Tracheoesophageal Puncture) method
was first developed, the concern was with producing voice with lung air. After this was
achieved, attention as given to how the patient could speak hands-free (without using your
thumb). There was existing technology available with colostomy patients. They used a
housing around the colostomy to hold a bag. This same technology was adapted to work with
the stoma in your neck. The plastic housing that holds the Tracheostoma valve in place, as
well as the glue and the tape disc, was developed for the colostomy and is used today for
that purpose.
Why do we break seals? There are two basic reasons for breaking a seal. I will discuss
the most obvious one first. Before you had your laryngectomy, the trachea that went from
your lungs to your mouth and nose was a closed tube. This tube was kept moist all the
time. After you laryngectomy, this tube was cut and brought out your neck to form a stoma.
Now this tube, if left unfiltered, becomes dry. So the trachea sends a message to your
brain that it needs moisture and the brain sends a message back to produce more moisture.
This results in more phlegm and you begin to cough. The use of the HumidiFilter® will
help you reduce the amount of dryness in the trachea and, in turn, reduce the amount of
coughing. As you cough up this phlegm, it gets between your skin and the housing and
erodes the glue and weakens the seal. If you cough a great deal and do not get the phlegm
out of the housing, this will result in breaking a seal. It is my experience from talking
to many laryngectomees that this is the reason for breaking a seal about 20% of the time.
Using a HumidiFilter® system will help cut down on the excess mucus that your body is
producing. The reason is this: the HumidiFilter® works as your nose and mouth once did
(before the laryngectomy). It has three functions: to warm, humidify, and filter the air
going into your trachea and lungs (just like your nose used to do). Once you restore that
function by using a HumidiFilter® , your trachea will stop producing large amounts of
mucous to liberate it and eventually the excess mucous production that you are
experiencing will reduce.
Remember, if you need to cough, you must remove the Tracheostoma valve before you
cough. Practice popping the Tracheostoma valve out by grabbing it by the sides, and not
the handle, and rolling it out. Then clean the stoma with a tissue to keep the mucous from
deteriorating the glue and wearing down the sea.
The main reason for breaking a seal is a little more complicated and more difficult to
correct. Imagine, if you can, that you could get inside your stoma. You have attached your
housing and have the Tracheostoma valve in place. You force air from your lungs up into
the stoma. Once this air is in the stoma, there is only one place it can go: through the
prosthesis and into the esophagus to produce voice. All of the air that is in the stoma
must either go immediately into the prosthesis or sit waiting for its turn. This waiting
air cannot back into your lungs because you are keeping pressure to hold it in your stoma
and it cannot go into the esophagus all at once because only so much air can get in that
little prosthesis at one time. This waiting air will then push against the housing and if
too much pressure is being applied from the lungs, it will continue to push against the
housing and break it loose from you neck and create a leak. This is called "Back
Pressure". I have found that this is the reason for failure about 80% of the time.
Your job, if you want to be able to maintain a seal for a full day, is to learn to
master the technique of not having too much "back pressure" in the stoma area.
In trying to describe to others how this is done, I have used the analogy of riding a
bicycle. Most of us, when we were children, learned to ride a bicycle, and yet very few of
us can describe to someone else how we keep our balance. Even if you have not been on a
bicycle for several years, you will be able to get on one and keep your balance. Learning
to control the amount of air pressure in the stoma is a lot like keeping your balance on a
bike. When you feel that you are exerting too much force you must ease up on the pressure
in your stoma. As you learn to reduce this air pressure, you will find that you will be
able to maintain a seal longer and longer. You will also come to realize what it feels
like when you are using too much air pressure and what happens when you use too much
pressure.
In the beginning, you will need to be sure that you are putting the housing in
correctly. One way to learn is to find a speech pathologist that understands the correct
way to apply the housing and the Tracheostoma valve. If a speech pathologist is not
available, try to find another laryngectomee with the TEP that will help you get started.
I will briefly outline the correct way to apply a housing, but there is nothing like
hands-on experience.
In applying the housing, it is necessary to clean the skin around the stoma. All of us
have a thin layer of oil that coats the skin and this must be cleaned to provide a clean
and dry base for the adhesive. I clean my skin with an alcohol pad. These can be found in
any drug store and are not very expensive. You could also soak a gauze pad with alcohol.
Care should be taken not to get alcohol in the stoma. After the skin is clean and dry, I
use a skin preperation. This serves as a thin, protective skin barrier that helps reduce
any irritation caused by adhesives. I personally like Shield Skin® (by Mentor Urology)
but any good skin prep will work. This should be applied around the stoma and let dry. In
the beginning, you will need to apply a liquid silicone adhesive (also called a glue).
This comes in a bottle with a brush and you should paint a light coat of the glue around
the stoma. This should cover all of the area where the plastic housing will be. Be very
careful not to touch this area or couch once the glue has been applied, as this will
lessen the chances for a good seal. After this had dried, you are ready to apply the
housing. A double-sided adhesive tape disc is applied to the plastic housing and this is
then applied to the neck. Some people also use adhesive foam discs. The hole in the
housing should match up with your stoma. The housing should be firmly attached to the skin
and pressure should be applies to make sure all air bubbles are worked out of the glue. If
you decide to use the adhesive foam discs, you might want to first layer the housing with
an adhesive tape disc and then put an adhesive foam disc over that so that when you are
eventually pulling everything off the housing, it will be easier to remove. Read the
information found in the instruction manual that came with your original Tracheostoma
valve kit.
As you learn to control the amount of air pressure in the stoma area, you can start to
use less and less of the liquid silicone adhesive. I have not used any glue for the last
year and I can maintain a seal for a complete day. It has been my experience that the more
failures I had, the more I learned. It is important not to give up. I have seen folks that
when it did not work on the first try, they gave up and said it was not for them. The
advantages to being able to speak hands-free far outweigh the problems with learning to
make the system work. Good luck and if I can be of any further help, please feel free to
call me. My toll free number is 1-800-893-9074. I live in southern Indiana and I am in the
Eastern time zone.
Richard Crum, INHEALTH Consultant
4701 Hamburg Pike
Jeffersonville, IN 47130
toll free: (800) 893-9074
fax: (812) 282-0800
e-mail: richcrum@aol.com Website:
http://www.inhealth.com/crumart.htm
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