The physiological rationale of heat and moisture exchangers in post-laryngectomy pulmonary rehabilitation: a review

  • J. K. Zuur
  • S. H. Muller
  • F. H. C. de Jongh
  • N. van Zandwijk
  • F. J. M. Hilgers
Head and Neck Oncology


Total laryngectomy results in a permanent disconnection of the upper and lower airways and inevitably leads to chronic pulmonary complaints like frequent involuntary coughing, increased sputum production and repeated daily forced expectoration to clean the airway. Heat and moisture exchangers (HMEs), applied in an attempt to compensate for the lost functions of the upper respiratory tract, have been found to diminish these symptoms and improve the quality of life significantly. An HME has three physical properties that might be responsible for these improvements. First, its heat and moisture exchanging capacity improves intra-airway preservation of heat and water. Since the condensation and evaporation of moisture are accompanied by the release and uptake of thermal energy, these parameters are inseparable. Secondly, the HME’s resistance may reduce dynamic airway compression, thereby improving ventilation. Thirdly, to some extent, an HME might filter out particles, thereby cleaning inspiratory breathing air. This article summarizes our present knowledge of changes in respiratory physiology after total laryngectomy and the influence of the HME by reviewing the physiological impact of these three physical properties separately for in vitro and in vivo data.


Laryngectomy Respiratory physiology Respiratory function tests Heat and moisture exchanger Review 



The authors would like to acknowledge Annemieke Ackerstaff, Carel Roos, Michiel Sinaasappel and Niesje Verhey for their contribution within their area’s of expertise. Furthermore, we are greatly indebted to the Michel Keijzer Foundation, under the auspices of the Dutch Laryngectomee Society (NSVG), for their financial support of the pulmonary rehabilitation project.


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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • J. K. Zuur
    • 1
  • S. H. Muller
    • 2
  • F. H. C. de Jongh
    • 3
  • N. van Zandwijk
    • 4
  • F. J. M. Hilgers
    • 1
    • 5
    • 6
    • 7
  1. 1.Department of Head and Neck Oncology and SurgeryThe Netherlands Cancer Institute/Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  2. 2.Department of Nuclear Medicine and RadiologyThe Netherlands Cancer Institute/Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  3. 3.Department of NeonatologyAcademic Medical CenterAmsterdamThe Netherlands
  4. 4.Department of PulmonologyThe Netherlands Cancer Institute/Antoni van Leeuwenhoek HospitalAmsterdamThe Netherlands
  5. 5.Institute of Phonetic Sciences (ACLC)University of AmsterdamAmsterdamThe Netherlands
  6. 6.Department of OtorhinolaryngologyAcademic Medical CenterAmsterdamThe Netherlands
  7. 7.Plesmanlaan 121AmsterdamThe Netherlands

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