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Starting out with a breathing stoma

Men and women discussing laryngeal cancer

This page tells you about breathing stomas. Breathing stomas are called tracheostomies or laryngectomy stomas. You can find information about

 

A quick guide to what's on this page

Starting out with a breathing stoma

A breathing stoma is a hole (opening) made in the skin in front of your neck to allow you to breathe. It is at the base of your neck. Through this hole, air enters and leaves your windpipe and lungs.

If you still have your voice box and this hole is temporary, it is called a tracheostomy. The stoma is held open by a tracheostomy tube. If you have had your whole voice box removed, you will have a permanent (laryngectomy) stoma to breathe through. You need this because the connection between your windpipe and mouth has gone.

Stoma tubes

If you've had your whole voice box removed, you will have a laryngectomy tube in your stoma at first. This keeps your new airway open. The tube can come out once your stoma heals. This may take a few weeks.

Both laryngectomy and tracheostomy tubes can have a small opening. If you've had a tracheostomy, you can put your finger over this hole so that you can speak. If you don't do this, air won't pass up into your voice box. If you have had your voice box removed, you block the hole when you want to use your speech valve.

If you have a speech valve, you may want to use a hands free tube later on. This automatically closes the stoma when you are using your speech valve. So you won't have to put your hand up to cover the hole when you want to say something.

 

CR PDF Icon You can view and print the quick guides for all the pages in the Living with laryngeal cancer section.

 

What a breathing stoma is

A stoma is a hole (opening) made in the skin in front of your neck to allow you to breathe. It is at the base of your neck. Through this hole, air enters and leaves your windpipe (trachea) and lungs.

If you still have your voice box and this hole is temporary, it is called a tracheostomy. The stoma is held open by a tracheostomy tube. You may have a temporary tracheostomy

  • After surgery to the voice box
  • After radiotherapy, if you have swelling in and around your voice box

You have the tracheostomy until the voice box heals. Then, the tracheostomy tube is taken out and the hole heals up by itself.

If you have had your whole voice box removed, you will have a permanent stoma to breathe through. Your clinical nurse specialist or your doctor may call this a tracheostomy, but the hole is a different shape if you've had your voice box completely taken out and ear, nose and throat (ENT) specialists prefer to call it a laryngectomy stoma. You need this because the connection between your windpipe and mouth has gone.

Diagram showing the position of the larynx

Diagram showing the position of the stoma after a laryngectomy

Your surgeon will make the stoma when you have your operation to remove or partly remove your voice box. Waking up to find you are breathing through a hole in your neck can be quite a shock. Even if you were expecting it, you may feel frightened and angry. Your doctor will discuss all aspects of this with you before you have your operation. It is very important that you understand what will happen to you, so feel free to ask questions. The staff looking after you will expect you to have questions and will want to reassure you as much as they can. 

There are lists of questions that you might like to ask your doctor throughout this section. 

If you've had your whole voice box removed, you will have a laryngectomy tube in your stoma at first. This keeps your new airway open. The tube can come out once your stoma heals. This may take a few weeks. Your stoma will then stay open on its own.

It is very important that you know how to change your tube and how to keep your laryngectomy tube clean. Your stoma is now your airway and you have to breathe and cough through it.

 

Stoma tubes

There are a number of different types of tubes. The type you have will depend on whether your stoma is temporary or permanent. Most tubes are plastic. Some have an inflatable sleeve around the outside, called a cuff. When the cuff is blown up, it helps to create a complete seal around your stoma. You only need this seal if you are on a breathing machine (ventilator) straight after your operation. So, if you have this type of tube, your nurse will change it a day or two after your surgery, to one without a cuff.

The plastic tubes are disposable, but you can use them for a few weeks or months before you have to throw them away. You change them frequently and clean them. This is very important. If you don't keep the tube clean, you are more likely to get an infection.

Some tubes are single. Others are double, with an outer and inner tube. These are called double cannula tubes.

Laryngectomy and tracheostomy tubes can have a small opening in the side of the tube. Tubes with a hole like this are called fenestrated tubes. Tubes without this side opening are called non fenestrated tubes.

Diagram showing a fenestrated and a non fenestrated tracheostomy tube

You can use a fenestrated tube to be able to speak. You put your finger over the hole at the end of the tube when you speak. If you have a tracheostomy, air is forced up through the side opening and through your voice box to create a voice. If you have had your voice box removed, when you put your finger over the hole at the end of the tube air is forced up through the side opening and though your speech valve. 

If you have a speech valve, you may want to use a hands free tube later on. This automatically closes the stoma when you are using your speech valve. So you won't have to put your hand up to cover the hole when you want to say something.

Not everyone needs to have a tube once the stoma has healed. Your surgeon is the best person to advise you on this. Some people are advised to wear a soft plastic stoma vent to help the stoma keep its shape and stop it from shrinking.

 

Protecting your stoma

Before your surgery, the air reaching your lungs was warmed, moistened and cleaned as it passed through your nose and upper airways. When you breathe in through your stoma, the air is drier and colder than your lungs are used to and will probably contain particles of dust. All this can irritate your lungs. The dry air can make your airways produce mucus. The mucus which can collect around your stoma and get crusty. To protect your stoma and your airways, try to avoid

  • Extreme temperatures
  • Fumes from traffic or work places
  • Smoke
  • Dust

Obviously if you live in a town or city, this is easier said than done. Fortunately, there are other ways to protect your lungs after tracheostomy. In our section about life with a breathing stoma, we have informaton about caring for your stoma, including how to moisten the air you breathe.

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Updated: 22 August 2013