LARYNGECTOMY FAQ'S

Why am I coughing up blood?
(by Glenn E. Peters M.D., Director, Division of Otolaryngology
Head and Neck Surgery, University of Alabama at Birmingham,
Birmingham, Alabama, USA)

"Please tell me how long it takes to stop coughing up blood from my lungs and stoma? I am so tired of this; I just need to know........."

Let's talk about your ‘air conditioning’ system. Before your laryngectomy you were breathing through your mouth and more importantly through your nose. Your inspired air was being filtered and humidified by your upper respiratory tract. Inspired air was taken from the relative humidity of your ambient air and moisturized up to 100% by the time it reached the gas exchange units in your lungs, called alveoli. At the same time, particulate matter was removed by the mucous blanket which coats the lining of the nose and throat.

After your laryngectomy, you were left without this normal filtration/humidifying system. Your lungs responded in a very normal and protective manner by producing an increased amount of mucous to filter and humidify the air that was coming in. Bloody sputum can result when you cough excessively to clear this increased amount of mucous. You also may be more susceptible to bronchitis ( an infection and inflammation of the lining tissues of the tracheo-bronchial tree) because you are breathing unfiltered, dehumidified air.

So, what to do?

1. Make sure you have had a recent chest X-Ray to rule out any significant lung pathology.

2. Make sure that your sputum is not discolored (in addition to bloody). Discolored is green or yellow. This may indicate an infection like bronchitis or pneumonia which may require antibiotics.

3. Do everything possible to increase the amount of moisture in the air you inhale. Some tricks include wearing a stoma bib, but you can also wear a scarf or a turtle neck shirt or sweater. This allows you to conserve the moisture that is LEAVING your lungs in the area around your stoma. Another thing you can do is to irrigate your stoma with CLEAN tap water or saline. Two to three cc's four times a day should help. Other tricks include wearing a soft stoma vent (see your M.D. for the proper size). A small plastic spray bottle filled with tap water can be used to create a mist to dampen your stoma bib. It becomes a portable humidifier---- MOISTURE IS THE KEY. MUCOUS RULES!

4. Lastly, be patient. Your lungs are going through some major changes. Ultimately, they will adapt to the new you. Things generally improve within 3 to 4 months after surgery.

As always, if problems persist, please see your M.D.