Early Initiation and Structured Education Promote Long-Term Heat and Moisture Exchanger Use After Total Laryngectomy

To evaluate the impact of heat and moisture exchanger (HME) use on respiratory complications after total laryngectomy (TL), and to identify factors associated with continued use, with a focus on initiation timing and inpatient education.

We retrospectively reviewed 118 patients who underwent TL between 2017 and 2024 at two tertiary centers. Patients were categorized by HME initiation (yes/no), timing (early ≤ 1 month postoperatively during hospitalization vs. late), and adherence (continued vs. discontinued). Respiratory infection and prolonged use of expectorants or antitussives were assessed as clinical outcomes. Logistic regression was performed to identify predictors of continued HME use.

Among 96 patients who initiated HME, 80 (83.3%) maintained long-term use. Compared to the non-use group (n = 38), continued users had significantly fewer respiratory infections (8.8% vs. 50%, p < 0.01) and less prolonged use of expectorants or antitussives (3.8% vs. 18.4%, p = 0.01). Early initiation and tracheoesophageal puncture use were both significantly associated with continued use (p = 0.02 each). Although peristomal skin complications were more common in the discontinued group, targeted skin care and individualized device selection enabled many patients to continue.

Early and sustained HME use significantly reduced respiratory morbidity following TL. Initiation during hospitalization, along with structured education on device handling, skin care, and baseplate management, played a key role in supporting adherence. These findings support standardized inpatient protocols for HME introduction.