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.