This study aimed to assess individual preference, symptoms and compliance between habitual use of Provox XtraFlow and the combination of Provox XtraFlow during the day and Provox Luna during the night for heat and moisture exchanger therapy in laryngectomised patients.

This was an open, randomised, crossover trial for 25 days. After this first study period and a 5-day wash-out period, treatments were switched for another 25 days.

A total of 28 patients were enrolled. Differences were found (p = 0.009) in the incidence of dermatological problems with XtraFlow (46.4 per cent) versus Provox Luna (14.3 per cent), as well as in the need to abandon the use of adhesives (46.4 per cent vs 10.7 per cent; p = 0.003). A total of 60.7 per cent of the patients preferred the Provox Luna system as their preference for heat and moisture exchanger therapy.

The Provox Luna system is a viable additive to heat and moisture exchanger therapy, especially in the setting of compliance concerns and in patients who desire dermatological relief overnight.

Patients with laryngectomy tracheostomas are at risk of developing acute airway obstruction due to mucous crusting. Current management relies on saline nebulisers, followed by suction and manual evacuation to remove the obstruction. This paper describes the first reported case of using N-acetylcysteine nebulisers in addition to saline to adequately soften the mucous plugs in order to facilitate removal.

A 68-year-old female attended the emergency department with a partial obstruction of her laryngectomy tracheostoma as a result of mucous crusting. Saline nebulisers did not provide adequate softening to allow the obstructing mucous plugs to be removed. N-acetylcysteine nebulisers were used to further soften the mucous plugs which successfully resulted in their removal.

N-acetylcysteine nebulisers can be used to assist in the removal of mucous plugs in saline-resistant cases.