Fistula after total laryngectomy: What helped you?

Hi @kestamey Ken, Welcome to the head and neck group although this is not really a place most folks desire to be.
I really have no information or reference for you on a fistula in that location. I also am not a fan of HBOT except in specific cases such as bone healing. But perhaps someone on this feed has experience in this situation. We can give it some time and see what pops up. I didn’t want you to feel like you were calling out into an empty canyon.

@kestamey, here is another discussion about HBOT in the group that you may be interested in:
- Anyone had Hyperbaric Oxygen Treatment after radiation?https://connect.mayoclinic.org/discussion/hyperbaric-oxygen-treatment/

I'm also bringing in @ltecato who has experience with a fistula related to nasopharynx cancer and feeding tube.

Ken, did your wife's doctor explain why surgery is not an option? Did the first set of HBOT sessions help?

I had hyperbaric oxygen treatment c. 1979 in San Antonio at a military facility (Brooke Army) because I was an Air Force dependent and I had been heavily radiated and needed to have my wisdom teeth removed. It was not very remarkable. The main thing I remember is having to wear flame-retardant coveralls and bring a paperback book to read, and of course no smoking in the chamber. It was like a simulator for a submarine training exercise, kind of like one of those tourist subs that hold a half dozen passengers. Every session was called a “dive.” We would feel a bit warm as the pressure was increasing and then slightly chilly as we were “resurfacing” IIRC.

I suspect that the hyperbaric chamber was just a new toy for the Air Force oral surgeon to play with when they decided that they wanted to use it on me. Other dentists told me that they could pull my teeth safely as long as they prescribed antibiotics afterward. But the radiation I received was supposed to put me at risk of osteoradionecrosis, so that was why the oral surgeon wanted me to take the “dives.”

The only thing I can complain about is the “pressure equalization tubes” that were placed in my eardrums using only local anesthetic. I would advise against allowing any doctor to do that. (You DO need the tubes because of air pressure changes, but don’t consent to the local anesthetic unless you can get assurances that you won’t get vertigo.) First, it hurts when you are getting the shot in your ears. Second, and even worse, is that about half an hour after the tubes go into your ears, you will be hit with the worst vertigo you have ever experienced unless maybe you have been an astronaut trainee who has ridden the “Vomit Comet.” I suddenly could not walk or even move my head without being overwhelmed by dizziness and nausea. The doctor didn’t warn me or my dad about this and it hit me when we were waiting to eat lunch at a very nice Mexican restaurant in San Antonio. I had to spend about eight hours lying in bed, unable to even lift my head. If you have to get tubes inserted, don’t let them use a local unless they can deal with the effects on your inner ear. I am not exaggerating about the effects that will ensue once the local anesthetic disables your labyrinthine nerves. You do not want to find out how bad it is. It will probably not kill you but it is a miserable experience.

I should have read the original post. It sounds like the patient has already had some hyperbaric treatments. If they have tolerated them so far, I would say that is a good sign.

I had a problem with a fistula that developed after I had a feeding tube fall out and decided not to replace it. It was a constant issue until I was able to get it surgically repaired. I have been a lot better since then. I’m very much in favor of fistula surgery.

Long hard story, my wife AND I went through total Larengectomy back in May 2025 ,all at St.Vincents in Worcester MA side note. Awesome Hospital so first 3 weeks in was Biopsy and Tracheotomy Full Blown Voice Box Cancer was diagnosed, I should say something now or would be derelict, Baystate Medical Center found this Cancer way back in November 2024 Wife went to ER with very HOARSE VOICE AND VERY PAINFUL SORE THROAT basically sent home and told to contact Primary doctor ok I have to give more information Wife was raging alcoholic to be fair Baystate Center was like Not her again! Yah past 3 years nonstop around the clock, many, many Nipps 100 proof or better falls, outbursts, walking neighborhood naked yes. Very Depressed Woman so sitting in bed with ciggs and Nipps for 3 years produced throat cancer ,they saw it on xray ,but said nothing to us Just follow up with Primary ,so being to inebriated to go to any medical appointments o I made them but come time to go ,forget about it This went on for 4 months Hospital knew she wasn't gonna see her doctor and they would have to do something , Ya they did,made appointment with ENT oncologist for October 15th 2025 ,, only thing I can think is they figure she be dead by then, Problem Solved If I didn't get on phone start making calls no one else would. I finally got her appointment with Associates in Orentology in Worcester Mass I can't say enough great things about Dr.Du she 1 in Million si now back to 3rd week in May. 3 weeks in for Biopsy and Trach healed nice sent home for few days be back June 3rd for Total Larengectomy WOW like slice someone ear to ear 4 weeks to somewhat heal , ended up with good infection but me living in room with her gave them 24/7 wound healer I changed drains more often than they would lol I took most of care since that was my job past 2-3 years Yep it's for better or worse plus I figured she definitely was my care taker for most of our 47 years So now we home with STILL good open wound , but that didn't matter, it was back to booze very fast DOORDASH will accommodate anything While im napping or out shopping she does delivery ,, o ya ,forgot,, Fistula opens up like 2nd week after Larengectomy seems wife wasn't supposed to eat normal food while healing Oppps so after HOARSE runs they close barn door ,, put in stomach feeding tube but food , booze, too drunk to take care of self AT ALL ,I was going out of my mind trying to do it all Cancer care sure but Cancer and alcoholism NOPE. I cried out to every Organization I could find Her going ( no joke) 3-4 times a week to ER for mucas Plugs,, Pneumonia , falls, and just plain I Need a Break 4 months this goes on Its funny took a really caring nurse at Baystate to see me and say wow ARE YOU OK?? I was amazed, someone asking me WOW so that's how wife spent 3 weeks in hospital while waiting for Extended Care Facility with her medical conditions u be surprised how many don't have those kinds beds of course no wer around home. Has to be Hour and 25 minutes away , but this Lanessa Extended Care Facility will transport her to all appointments Since she missed window for radiation treatments and started Speech and Swallow to get voice BUT fistula prevented both NOW Back on some sort of track ,, no drinking 3 months might have shot. HERE'S THE KICKER she don't want to go on anymore says it's too much trouble