Episode 51: The Care of Patients After Total Laryngectomy with Bridget Guenther MS, CCC-SLP, BCS-S
Bridget Guenther has spent her SLP career focusing on the treatment and management of head and neck cancer. As a Senior Clinical Educator for Atos Medical, Bridget provides education & trainings to SLPs and patients with total laryngectomy. Bridget joins Leigh Ann to lay a foundation on the role of the SLP in managing patients with total laryngectomy. We review SLP involvement pre-surgery, immediately post-surgery (acute care), and follow-up (outpatient). Our talk covers the need for education, counseling, and information on alaryngeal speech options for this patient population.
topics covered:
Laryngectomy framework - laying foundational knowledge
HME - heat moisture exchanger
Common misconceptions regarding total laryngectomies
SLP involvement pre & post laryngectomy
Cleaning and maintenance of the stoma site and voice prosthesis/TEP
Options for alaryngeal speech
Complications regarding TEP/voice prosthesis and swallowing
Resources mentioned in the episode:
Websites:
Dr. Itzhak Brook Blog: created by Itzhak Brook, a physician and a laryngectomee. “Dr. Brook is a Professor of Pediatrics at Georgetown University. The blog contains information about head and neck cancer, life as a laryngectomee, and manuscripts and videos about Dr. Brook's personal experience as a patient with throat cancer.”
Free e-book download of The Laryngectomee Guide book by Dr. Itzhak Brook
Atos Medical website: for SLPs to access Spot on Support (SOS), free webinars, literature, videos & tutorials and more! Check out the “professional resources” tab for information geared towards SLPs.
InHealth Technologies website: (provides Blom-Singer products) Heaps of educational information (Webinars, etc.) for the SLP.
Anatomical Illustrations:
Textbooks:
The Clinician's’ Guide to Alaryngeal Speech by Minnie Graham (ISBN-13: 978-0750698627)
Head and Neck Cancer: Treatment, Rehabilitation, and Outcomes by Elisabeth Ward and Corrina van As Brooks (ISBN-13: 978-1597565677)
Videos:
Video of Secondary Puncture (After the Total Laryngectomy is performed)
Video of Primary Puncture (Performed at time of the Total Laryngectomy)
Scientific Literature:
Barauna Neto JC et al. Comparison between primary and secondary tracheoesophageal puncture prosthesis – a systematic review. ORL J. 2017Jul 29;79(4):222-229.
Hilgers, F. J.; Aaronson, N. K.; Ackerstaff, A. H.; Schouwenburg, P. F.; van, Z. N., The influence of a heat and moisture exchanger (HME) on the respiratory symptoms after total laryngectomy. Clin. Otolaryngol. Allied Sci 1991, 16 (2), 152-156.
Icuspit, P.; Yarlagadda, B.; Garg, S.; Johnson, T.; Deschler, D., Heat and moisture exchange devices for patients undergoing total laryngectomy. ORL Head Neck Nurs 2014, 32 (1), 20-23.
Panwar A et al. Impact of Primary Tracheoesophageal Puncture on Outcomes after Total Laryngectomy. Otolaryngology Head and Neck Surgery Aug 2017.
van den Boer C, Muller SH, Vincent AD, van den Brekel MW, Hilgers FJ. Ex vivo assessment and validation of water exchange performance of 23 heat and moisture exchangers for laryngectomized patients. Respir Care. 2014 Aug;59(8):1161-71.
van den Boer C, van Harten MC, Hilgers FJ, van den Brekel MW, Retèl VP. Incidence of severe tracheobronchitis and pneumonia in laryngectomized patients: a retrospective clinical study and a European-wide survey among head and neck surgeons. Eur Arch Otorhinolaryngol. 2014 Dec;271(12):3297-303.
Zuur, J. K.; Muller, S. H.; de Jongh, F. H.; van, Z. N.; Hilgers, F. J., The physiological rationale of heat and moisture exchangers in post-laryngectomy pulmonary rehabilitation: a review. Eur. Arch. Otorhinolaryngol 2006, 263 (1), 1-8.
Peri op care:
Graboyes EM, Kallogjeri D, Zerega J, et al. Association of a Perioperative Education Program With Unplanned Readmission Following Total Laryngectomy. JAMA Otolaryngol Head Neck Surg. 2017;143(12):1200–1206.
Pre op counseling:
Shenson, J. A., Craig, J. N., & Rohde, S. L. (2017). Effect of Preoperative Counseling on Hospital Length of Stay and Readmissions after Total Laryngectomy. Otolaryngology–Head and Neck Surgery, 156(2), 289–298.
Swallow s/p total laryngectomy Comprehensive review:
Terlingen, LT, Pilz, W, Kuijer, M, Kremer, B, Baijens, LW. Diagnosis and treatment of oropharyngeal dysphagia after total laryngectomy with or without pharyngoesophageal reconstruction: Systematic review. Head & Neck. 2018; 40: 2733– 2748. https://doi.org/10.1002/hed.25508. https://onlinelibrary.wiley.com/doi/full/10.1002/hed.25508
*hitting a paywall? Can’t access the research? Try Google Scholar. Click the link in the right hand column for access to the full article, if available.
Bridget Guenther MS, CCC-SLP, BCS-S dedicated the first 13-years of her career to caring for veterans with head and neck cancer as a Board Certified Swallowing Specialist and SLP at the New Mexico Veterans Affairs Healthcare System, Department of Otolaryngology. In 2010, she earned her board certification as a specialist in swallowing and swallowing disorders. While at the Albuquerque VA Medical Center, Bridget developed a telemedicine program to provide speech pathology services to veterans in rural areas. She is an invited speaker at conferences to present in the areas of dysphagia and head and neck cancer. She also provides lectures to university programs training graduate students on swallowing and alaryngeal voice disorders in the head and neck cancer population. Bridget joined Atos Medical in 2016 and is currently a Senior Clinical Educator.
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