RCSLT Clinical Guidance for the Management of Total Laryngectomy in the Context of COVID-19
Royal College of Speech & Language Therapists. (2020).
London (United Kingdom): Royal College of Speech & Language Therapists, 1-20.
This is a guideline providing recommendations on the care of patients with total laryngectomy in the context of the COVID-19 pandemic.
Royal College of Speech & Language Therapists (United Kingdom)
<div>The following telehealth considerations for patients with total laryngectomy (PTL) in the context of the COVID-19 pandemic were provided:</div>
<ul>
<li>Video calls and pre-recorded information videos can be used to support or replace in-person pre-operative speech and language therapy counseling.</li>
<li>Calls during the inpatient stay can ease the transition from the hospital to the home and family/caregivers can familiarize themselves with changed anatomy, communication, and care needs via on-screen training.</li>
<li>Following discharge, calls from the clinician to the patient can troubleshoot and manage voice prosthesis problems remotely.</li>
<li>Training for all methods of alaryngeal speech can be delivered via telehealth.</li>
<li>"Speech and language therapy head and neck cancer services will need to consider carefully how to balance the risks of PTL in-person attendance, while still ensuring inclusivity of access to address the physical, emotional and information needs of all laryngectomy patients throughout the continuing pandemic" (p. 10).</li>
</ul>
<div>As all individuals in outpatient settings are required to wear face coverings to reduce the risk of COVID-19 transmission, patients with total laryngectomy should be advised to wear an appropriate face and stoma cover.</div>
<div>Since extensive outpatient speech and language treatment is needed for patients with total laryngectomy, special consideration for outpatient care is required during the continuation of the COVID-19 pandemic. "In line with local infection prevention and control guidelines, it is recommended that protocols are developed regarding information around screening, face coverings, cohorting, radiotherapy and risk management of [tracheoesophageal puncture] TEP and/or stoma complications" (p. 6).</div>
<div>"Where primary puncture has not been performed, [speech language therapists] SLTs will need to prepare and rehabilitate patients using non-surgical, [alaryngeal] voice restoration methods during their inpatient stay…. Clinicians are strongly encouraged to refer to manufacturers' guidelines and local infection prevention and control teams for advice on cleaning equipment" (p. 5).</div>
<div>Patients should be encouraged to cover their stoma with a laryngectomy airway protector in the context of the COVID-19 pandemic if they are unable to wear a heat moisture exchanger.</div>
<div>Speech and language services should have an agreed protocol for screening of COVID-19 symptoms prior to outpatient appointments. Protocols should also include how to proceed if a client reports symptoms of COVID-19, especially if the risk of deferring a procedure is potentially greater than the risk of proceeding with the appointment.</div>
<div>The following recommendations were provided for the management of voice prosthesis leakage during the COVID-19 pandemic:</div>
<ul>
<li>identify patients with total laryngectomy (PTL), or capable caregivers, who are able to safely learn how to change the patient's voice prosthesis independently;</li>
<li>if a voice prosthesis plug is indicated to manage leakage, then provision of resources such as visual aids may help PTL and caregivers successfully place the plug; and</li>
<li>the use of thickening powder may be appropriate in some situations to facilitate short-term management of central and/or peripheral voice prosthesis.</li>
</ul>
<div>Although primary tracheoesophageal puncture (TEP) was discouraged at the beginning of the pandemic, some centers have reinstated the practice of primary TEP using local safe practice pathways and the following risk assessment considerations:</div>
<ul>
<li>patient selection;</li>
<li>pre-operative information regarding TEP and associated risks in COVID-19;</li>
<li>intensive early voice prosthesis training before discharge; and</li>
<li>delivery of services via telehealth.</li>
</ul>
