title: Effects of heat and moisture exchangers on tracheal mucociliary clearance in laryngectomized patients: a multi-center case-control study.
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.
authors.affiliation: Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. c.vandenboer@amc.nl.|Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. c.vandenboer@amc.nl.
authors.forename: C
authors.initials: C
authors.lastname: van den Boer
authors.affiliation: Department of Clinical Physics and Instrumentation, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. s.muller@nki.nl.
authors.forename: S H
authors.initials: SH
authors.lastname: Muller
authors.affiliation: Department of Biometrics, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. v.vd.noort@nki.nl.
authors.forename: V
authors.initials: V
authors.lastname: van der Noort
authors.affiliation: Department of Nuclear Medicine, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. r.valdes@nki.nl.
authors.forename: R A Valdés
authors.initials: RA
authors.lastname: Olmos
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, La Sapienza Hospital, Viale del Policlinico, 155, 00161, Rome, Italy. Antonio.Minni@uniroma1.it.
authors.forename: A
authors.initials: A
authors.lastname: Minni
authors.affiliation: Department of Otorhinolaryngology and Head and Neck Surgery, Gemelli Hospital, Largo Agostino Gemelli, 8, 00168, Rome, Italy. claudioparrilla@yahoo.com.
authors.forename: C
authors.initials: C
authors.lastname: Parrilla
authors.affiliation: Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. f.hilgers@nki.nl.|Institute of Phonetic Sciences (ACLC), University of Amsterdam, Spuitstraat 210, 1012 VT, Amsterdam, The Netherlands. f.hilgers@nki.nl.
authors.forename: F J M
authors.initials: FJ
authors.lastname: Hilgers
authors.affiliation: Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute-Antoni van Leeuwenhoek, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. m.vd.brekel@nki.nl.|Institute of Phonetic Sciences (ACLC), University of Amsterdam, Spuitstraat 210, 1012 VT, Amsterdam, The Netherlands. m.vd.brekel@nki.nl.|Department of Oral-Maxillofacial Surgery, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. m.vd.brekel@nki.nl.
authors.forename: M W M
authors.initials: MW
authors.lastname: van den Brekel
authors.affiliation: Department of Otorhinolaryngology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. s.vanderbaan@amc.uva.nl.
authors.forename: S
authors.initials: S
authors.lastname: van der Baan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006358:Hot Temperature / Q000627:therapeutic use*; D006801:Humans; D006813:Humidity; D007825:Laryngectomy; D008297:Male; D008875:Middle Aged; D009079:Mucociliary Clearance
keywords: Cilia; Heat and moisture exchanger; Mucociliary clearance; Mucus; Total laryngectomy; Trachea