250 | Chapter 11 suggests a potential influence of cognitive biases like the “new is better” heuristic. The study underscores the necessity for further research and development to tackle the multifactorial challenges affecting voice prosthesis longevity. Large patient cohorts are crucial for in vivo evaluations and finding voice prostheses (VPs) with improved lifespan remains essential for enhancing patient quality of life. One valuable direction could involve focusing on patients who underwent total laryngectomy (TL) without (chemo)radiation, so you have the most homogenous sample. The challenge lies in finding VPs suitable for all patients. While fluoroplastics may offer strong resistance to bacterial colonization, their rigidity could lead to early device issues. Titanium, although promising, is quite rigid, but 3D printing could allow customized designs that match a patient’s specific stoma size. However, this approach would not be feasible in the initial months following TL due to stoma healing. An alternative could involve silicone VPs enhanced with hydrogels or coatings to reduce biofilm formation, maintaining flexibility while offering better bacterial resistance. Further research is necessary to address the remaining challenges and fully understand the multifaceted issues involved. Heat and moisture exchangers (HMEs) play a crucial role in managing the respiratory health of patients. With the removal of the larynx, the natural humidification and warming of the air are lost, often leading to significant pulmonary challenges like excessive mucus production, coughing, and crusting around the stoma. HMEs function as artificial noses, capturing the warmth and humidity from exhaled air and returning it to the inhaled air. This reduces pulmonary complications by maintaining moisture in the airway and improving mucus viscosity31. However, some patients find that the airflow resistance through certain HMEs can be too high, making breathing through the stoma difficult or uncomfortable. Selecting the appropriate HME with optimal resistance is essential for balancing effective moisture retention with patient comfort. Regular use of well-matched HMEs helps minimize stoma blockages, reduce coughing, and improve overall quality of life by ensuring that patients can breathe more comfortably and manage their airways better31. We have looked at the influence of the resistance of HMEs during Cardiopulmonary exercise testing (CPET) with gas exchange analysis (Chapter 9). We have also shown that CPET is technically feasible and safe for laryngectomy patients using HME. However, the study raises questions about the suitability of the ramp protocol used in reaching maximum exercise capacity in this population, as less than half of the participants achieved the predicted maximum levels. Reasons for early termination of CPET included exhaustion, breathlessness, and leg fatigue, suggesting that perceived exercise tolerance might be a limiting factor. Moreover, limitations in muscle strength,
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