Skip to main content

Pathohistological changes of tracheal epithelium in laryngectomized patients


Total laryngectomy results in a permanent disconnection of the upper and lower airways. Thus, the upper airways are bypassed and can no longer condition, humidify, and filter the inhaled air, leading to damage of the tracheobronchial epithelium. There is little scientific information available about the effects of tracheostoma breathing and the degree of mucosal damage in laryngectomized patients. The aims of this study were to determine the histopathologic findings and investigate the potential impact of using a heat and moisture exchanger (HME) on the tracheal epithelium in long-term tracheostomy patients. Tracheal mucosal biopsies were taken from a total of 70 patients. Specimens were stained with hematoxylin and eosin and examined by a light microscope. Normal pseudostratified ciliated columnar epithelium was found in only 9 (12.9 %) cases; while, 17 (24.3 %) cases had some degree of basal cell hyperplasia. Squamous metaplasia was the most common finding (50 %). Pre-invasive lesions (mild and moderate squamous dysplasia) were found in only one patient who used an HME, and in eight (11.4 %) non-users. Although the HME cannot completely restore the physiological functions of the upper respiratory track, it delivers a better quality of air to the lower airways and has a positive effect on tracheal mucosa.

This is a preview of subscription content, access via your institution.


  1. 1.

    Pierce RJ, Worsnop CJ (1999) Upper airway function and dysfunction in respiration. Clin Exp Pharmacol Physiol 26(1):1–10. doi:10.1046/j.1440-1681.1999.02988.x

    CAS  Article  PubMed  Google Scholar 

  2. 2.

    Ackerstaff AH, Hilgers FJM, Meeuwis CA, Knegt PP, Weenink C (1999) Pulmonary function pre- and post-total laryngectomy. Clin Otolaryngol Allied Sci 24:491–494. doi:10.1046/j.1365-2273.1999.00298.x

    CAS  Article  PubMed  Google Scholar 

  3. 3.

    Bien S, Okla S, van As-Brooks CJ, Ackerstaff AH (2010) The effect of a heat and moisture exchanger (Provox HME) on pulmonary protection after total laryngectomy: a randomized controlled study. Eur Arch Otorhinolaryngol 267:429–435. doi:10.1007/s00405-009-1018-4

    PubMed Central  Article  PubMed  Google Scholar 

  4. 4.

    Sleigh MA, Blake JR, Liron N (1988) The propulsion of mucus by cilia. Am Rev Respir Dis 137(3):726–741. doi:10.1164/ajrccm/137.3.726

    CAS  Article  PubMed  Google Scholar 

  5. 5.

    Van den Boer C, van Harten C, Hilgers FJM, van den Brekel MWM, Retel VP (2014) Incidence of severe tracheobronchitis and pneumonia in laryngectomized patients: a retrospective clinical study and a European-wide survey among head and neck surgeons. Eur Arch Otorhinolaryngol. doi:10.1007/s00405-014-2927-4

    Google Scholar 

  6. 6.

    Roessler F, Grossenbacher R, Walt H (1988) Effects of tracheostomy on human tracheobronchial mucosa: a scanning electron microscopic study. Laryngoscope 98:1261–1267. doi:10.1288/00005537-198811000-00020

    CAS  Article  PubMed  Google Scholar 

  7. 7.

    Grolman W, Blom ED, Branson RD, Schouwenburg PF, Hamaker RC (1997) An efficiency comparison of four heat and moisture exchangers used in the laryngectomized patient. Laryngoscope 107:814–820. doi:10.1097/00005537-199706000-00017

    CAS  Article  PubMed  Google Scholar 

  8. 8.

    Toremalm NG (1960) Heat and moisture exchange for post-tracheotomy care. Acta Otolaryngol 52:1–12

    Article  Google Scholar 

  9. 9.

    Ackerstaff AH, Hilgers FJM, Aaronson NK, Balm AJ, Van Zandwijk N (1993) Improvements in respiratory and psychosocial functioning following total laryngectomy by use of a heat and moisture exchanger. Ann Otol Rinol Laryngol 102:878–883

    CAS  Article  Google Scholar 

  10. 10.

    Dassonville O, Merol JC, Bozec A, Swiekosz F, Santini J, Chais A, Marcy PY, Giacchero P, Chamorey E, Poissonnet G (2011) Randomised, multi-centre study of the usefulness of the heat and moisture exchanger (Provox HME(R)) in laryngectomised patients. Eur Arch Otorhinolaryngol 268:1647–1654. doi:10.1007/s00405-010-1474-x

    Article  PubMed  Google Scholar 

  11. 11.

    Knudtson KD (1960) The pathologic effects of smoking tobacco on the trachea and bronchial mucosa. Am J Clin Pathol 33:310–317

    CAS  PubMed  Google Scholar 

  12. 12.

    Auerbach O, Stout AP, Hammond EC, Garfinkle L (1961) Changes in bronchial epithelium in relation to cigarette smoking and in relation to lung cancer. N Engl J Med 265:253–267

    CAS  Article  PubMed  Google Scholar 

  13. 13.

    Bertram JF, Rogers AW (1981) Recovery of bronchial epithelium on stopping smoking. Br Med J 283:1567–1569. doi:10.1136/bmj.283.6306.1567

    CAS  Article  Google Scholar 

  14. 14.

    Weller RW (1953) Metaplasia of bronchial epithelium; a postmortem study. Am J Clin Pathol 23:768–774

    CAS  PubMed  Google Scholar 

  15. 15.

    Salvato G (1968) Some histological changes in chronic bronchitis and asthma. Thorax 23:168–172. doi:10.1136/thx.23.2.168

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  16. 16.

    Jeffery PK (1997) Airway mucosa: secretory cells, mucus and mucin genes. Eur Respir J 10:1655–1662. doi:10.1183/09031936.97.10071655

    CAS  Article  PubMed  Google Scholar 

  17. 17.

    Keenan KD (1987) Cell injury and repair of the tracheobronchial epithelium. In: McDowell EM (ed) Lung carcinomas. Churchill-Livingstone, London, pp 74–93

    Google Scholar 

  18. 18.

    Stone HB, Coleman CN, Anscher MS, McBride WH (2003) Effects of radiation on normal tissue: consequences and mechanisms. Lancet Oncol 4:529–536. doi:10.1016/S1470-2045(03)01191-4

    CAS  Article  PubMed  Google Scholar 

  19. 19.

    Albertsson M, Baldetrop B, Hakansson CH, von Macklenburg C (1984) The effects of 10 Gy single-dose irradiation on the ciliated epithelium measured during and one-to-ten days following irradiation. Scan Electron Microsc 2:813–824

    Google Scholar 

  20. 20.

    Castro MA, Dedivitis RA, Macedo AG (2011) Evaluation of a method for assessing pulmonary function in laryngectomees. Acta Otorhinolaryngol Ital 31:243–247

    PubMed Central  CAS  PubMed  Google Scholar 

  21. 21.

    Griffith TE, Friedberg SA (1964) Histologic changes in the trachea following laryngectomy. Ann Otol Rhinol Laryngol 73:883–892

    CAS  Article  PubMed  Google Scholar 

  22. 22.

    Friedberg SA, Griffith TE, Hass GM (1965) Histologic changes in the trachea following tracheostomy. Ann Otol Rhinol Laryngol 74:785–798

    CAS  Article  PubMed  Google Scholar 

  23. 23.

    Kerr KM (2012) The classification of pre-invasive lesions. In: Cagle PT et al (eds) Molecular pathology of lung cancer. Molecular pathology, Library 6. Springer, New York, pp 35–39. doi:10.1007/978-1-4614-3197-8_5

  24. 24.

    Auerbach O, Gere GB, Forman JB, Petrick TG, Smolin HJ, Muehsam GE, Kassoundy DY, Stout AP (1957) Changes in the bronchial epithelium in relation to smoking and cancer of the lung; a report of progress. N Engl J Med 256:97–104

    CAS  Article  PubMed  Google Scholar 

  25. 25.

    Cunningham GJ, Winstanley DP (1959) Hyperplasia and metaplasia in the bronchial epithelium. Ann R Coll Surg Engl 24:323–330

    PubMed Central  CAS  PubMed  Google Scholar 

  26. 26.

    Fleskens S, Slootweg P (2009) Grading systems in head and neck dysplasia: their prognostic value, weaknesses and utility. Head Neck Oncol. doi:10.1186/1758-3284-1-11

    PubMed Central  PubMed  Google Scholar 

  27. 27.

    Dakir EH, Feigenbaum L, Linnoila RI (2008) Constitutive expression of human keratin 14 gene in mouse lung induces premalignant lesions and squamous differentiation. Carcinogenesis 7:2377–2384. doi:10.1093/carcin/bgn190

    Article  Google Scholar 

  28. 28.

    Kerr KM (2001) Pulmonary preinvasive neoplasia. J Clin Pathol 54:257–271. doi:10.1136/jcp.54.4.257

    PubMed Central  CAS  Article  PubMed  Google Scholar 

  29. 29.

    Ishizumi T, McWilliams A, MacAulay C, Gazdar A, Lam S (2010) Natural history of bronchial preinvasive lesions. Cancer Metastasis Rev 29:5–14. doi:10.1007/s10555-010-9214-7

    PubMed Central  Article  PubMed  Google Scholar 

  30. 30.

    Simo R, Bradley P, Chevalier D, Dikkers F, Eckel H, Matar N, Peretti G, Piazza C, Remacle M, Quer M (2014) European Laryngological Society: ELS recommendations for the follow-up of patients treated for laryngeal cancer. Eur Arch Otorhinolaryngol 271(9):2469–2479. doi:10.1007/s00405-014-2966-x

    Article  PubMed  Google Scholar 

  31. 31.

    Page C, Lucas-Gourdet E, Biet-Hornstein A, Strunski V (2014) Initial staging of head and neck squamous cell carcinoma. What is the place of bronchoscopy and upper GI endoscopy? Eur Arch Otorhinolaryngol. doi:10.1007/s00405-014-3019-1

Download references

Conflict of interest

The authors declare that they have no conflict of interest.

Author information



Corresponding author

Correspondence to Marinela Rosso.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Rosso, M., Prgomet, D., Marjanović, K. et al. Pathohistological changes of tracheal epithelium in laryngectomized patients. Eur Arch Otorhinolaryngol 272, 3539–3544 (2015).

Download citation


  • Laryngectomy
  • Heat and moisture exchanger
  • Pulmonary rehabilitation
  • Trachea