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Effects of heat and moisture exchangers on tracheal mucociliary clearance in laryngectomized patients: a multi-center case–control study

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Abstract

After total laryngectomy, inspired air is no longer optimally conditioned by the upper airways. Impaired mucociliary clearance and histological changes of respiratory epithelium, such as loss of ciliated cells, have been described in laryngectomized patients. Heat and moisture exchangers (HMEs) are passive humidifiers that re-condition the inspired air. Aim of this study was to assess the effect of HMEs on tracheal epithelium and tracheal mucus transport velocity (TMV). Tracheal brush biopsies were collected in three groups of TLE patients: 21 long-term HME users, 10 non-HME users, and 16 non-HME users before and after 4–9 months HME use. Tracheal epithelium biopsies were assessed using a digital high-speed camera mounted onto a light microscope. TMV was determined by scintigraphy in the first two patient groups. Significantly more ciliated cells were found in HME users compared to non-HME users (p = 0.05). TMV was higher in HME users (median 2 mm/min; 0–7.9) compared to non-HME users (median 0.8 mm/min; 0–12.3), but this difference was not significant (p = 0.37). One-hour breathing without HME in long-term HME users did not measurably decrease TMV (p = 0.13). The long-term use of an HME restores/prevents the loss of tracheal ciliated cells. A significant improvement in TMV was not found. Short-term (one hour) detachment of an HME has no measurable effect on TMV.

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Acknowledgments

The authors would like to thank the patients that participated in this study. They also want to thank Bert Pool and other colleagues of the department of nuclear medicine, the Netherlands Cancer Institute, Amsterdam for their assistance and cooperation with the scintigraphy measurements. The authors also would like to thank Michiel Sinaasappel, clinical physicist of the Netherlands Cancer Institute, Amsterdam, for his contribution and assistance with the test configuration of the ciliary brush recordings including the in-house developed software. Last, but not least, the authors would like to thank Professor C. O’Callaghan and his colleague M. Chilvers of the Robert Kilpatrick Clinical Sciences Building, Leicester Royal Infirmary, Leicester, United Kingdom, for their time and sharing their knowledge and experience with the ciliated cell evaluations.

Conflict of interest

This research project was partly funded by an unrestricted research grant of Atos Medical, Sweden. Atos Medical, Sweden is the manufacturer of the HMEs used by the patients in this study, and has provided the HMEs for the Italian part of the study.

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Authors and Affiliations

  1. Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    C. van den Boer, F. J. M. Hilgers & M. W. M. van den Brekel

  2. Department of Clinical Physics and Instrumentation, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    S. H. Muller

  3. Department of Biometrics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    V. van der Noort

  4. Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands

    R. A. Valdés Olmos

  5. Department of Otorhinolaryngology and Head and Neck Surgery, La Sapienza Hospital, Viale del Policlinico, 155, 00161, Rome, Italy

    A. Minni

  6. Department of Otorhinolaryngology and Head and Neck Surgery, Gemelli Hospital, Largo Agostino Gemelli, 8, 00168, Rome, Italy

    C. Parrilla

  7. Institute of Phonetic Sciences (ACLC), University of Amsterdam, Spuitstraat 210, 1012 VT, Amsterdam, The Netherlands

    F. J. M. Hilgers & M. W. M. van den Brekel

  8. Department of Oral-Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    M. W. M. van den Brekel

  9. Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

    C. van den Boer & S. van der Baan

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  1. C. van den Boer
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  2. S. H. Muller
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  7. F. J. M. Hilgers
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Correspondence to F. J. M. Hilgers.

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van den Boer, C., Muller, S.H., van der Noort, V. et al. Effects of heat and moisture exchangers on tracheal mucociliary clearance in laryngectomized patients: a multi-center case–control study. Eur Arch Otorhinolaryngol 272, 3439–3450 (2015). https://doi.org/10.1007/s00405-014-3336-4

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  • DOI: https://doi.org/10.1007/s00405-014-3336-4

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