The use of tracheostoma humidification by people with total laryngectomy in England and Wales: A cross-sectional survey

BACKGROUND: People with total laryngectomy (PTL) are advised to use a tracheostoma cover to protect their altered airway and optimise pulmonary health. Despite evidence for efficacy, variable adherence rates are reported. OBJECTIVE: To investigate the use of tracheostoma humidification by PTL in England and Wales and explore influencing factors. METHODS: A national multi-centre audit of PTL was completed in response to the Covid-19 pandemic over a six-month period (March to September 2020). This paper reports secondary analysis of data collected on type of humidification used by PTL. Type of humidification was dichotomised as ‘HME’ (closed-system heat moisture exchanger) or ‘non-HME’ (alternative stoma cover or no stoma cover). Univariable analysis was performed to determine the association with several potential explanatory variables including gender, age, living circumstances, distance from treatment centre, communication method and time elapsed since laryngectomy. A backwards selection procedure was used to determine the final model for multiple regression analysis. RESULTS: Data were obtained from 1216 PTL from 26 centres; information on type of tracheostoma humidification used was available for 1097 PTL. Most PTL (69%) used an HME. Following multiple regression analysis, time elapsed since laryngectomy (p = <0.001), living circumstances (p = 0.002) and communication method (p = <0.001) were statistically significant factors in HME use. CONCLUSIONS: In England and Wales most PTL use a closed-system HME, though there is marked variability across centres. HME use is influenced by time elapsed since laryngectomy, living circumstances and communication method.