Quick answer
After a total laryngectomy you breathe through a stoma in the front of your neck, not your mouth or nose. Australian resuscitation guidance is explicit: mouth to stoma rescue breathing should be used for a person who has had a laryngectomy. A bystander who does not see the stoma — or does not know what it means — will breathe into a mouth that no longer leads to the lungs. A laryngectomy medical ID says “neck breather” before anyone starts.
Most first aid assumes the airway starts at the mouth. For a person who has had a total laryngectomy, it does not. The voice box has gone, the windpipe opens directly at the front of the neck, and everything a rescuer has been taught about tilting the head and breathing into the mouth has to be redirected a few centimetres lower. People who live this way often call themselves neck breathers. This guide explains what changes in an emergency, what responders need to know, and what a laryngectomy medical ID should say.
What a laryngectomy changes
According to healthdirect, a laryngectomy is an operation that removes all or part of the larynx, or voice box. The surgeon creates a new airway opening in the lower neck, called a tracheostoma or stoma, by sewing the top of the windpipe to the skin. Head and Neck Cancer Australia describes the same thing: after a total laryngectomy, the stoma is the hole you breathe through.
Three consequences matter in an emergency:
- The airway is at the neck. healthdirect notes that smell and taste are reduced because air no longer travels through the mouth and nose. Breaths given into the mouth do not reach the lungs.
- You cannot speak in the usual way. Many people learn to speak again with a speech valve in the stoma or other methods taught by a speech pathologist. In a crisis — pain, shock, a dislodged valve — that voice may not be available, and healthdirect suggests pen and paper, a whiteboard or a tablet as back-ups.
- The stoma can block. healthdirect lists airway obstruction among the complications, and Australian resuscitation guidance tells rescuers what to do about a blocked stoma.
Rescue breathing for a neck breather
ANZCOR Guideline 5, which sets out rescue breathing in Australia and New Zealand, includes a specific section on people with a laryngectomy:
If a person with a laryngectomy needs rescue breaths
- The stoma is easier to see with the person on their back and the head tilted back.
- If there is a tube in the stoma, leave it in place — it keeps the hole open.
- Place your mouth over the stoma and give rescue breaths as usual.
- If the chest does not rise: check the seal, check whether it is a tracheostomy (air escaping from the mouth and nose), or the stoma or tube may be blocked — use back blows and chest thrusts to try to clear it.
Call Triple Zero (000) and follow DRSABCD. Tell the operator the person breathes through their neck.
For the rest of the sequence, see our guides to DRSABCD and how to do CPR. Back blows and chest thrusts are covered in choking first aid.
Laryngectomy is not the same as a tracheostomy
Both leave an opening in the neck, and that is exactly why the difference has to be written down.
| Total laryngectomy | Tracheostomy | |
|---|---|---|
| What it is | Voice box removed; windpipe sewn to the skin of the neck | A tube placed through the neck into the windpipe; healthdirect notes it may be temporary or permanent |
| Mouth and nose | No longer connected to the lungs | Still connected, so air can escape through them |
| Rescue breaths | Into the stoma | ANZCOR notes air may escape from the mouth and nose if a rescuer treats a tracheostomy like a laryngectomy |
A rescuer cannot tell which one you have by looking. Your record can: “total laryngectomy — neck breather” or “tracheostomy”, with the details.
Who reads a laryngectomy medical ID
Australian resuscitation guidance tells responders to look. ANZCOR Guideline 2 includes, in the initial assessment of an emergency, checking for “physical (eg. alert jewellery) or electronic alert devices (eg. smartphone application) that may be relevant to assessment or management”. The people who act on it:
- A bystander who has just learned that rescue breaths go into the neck.
- A paramedic, who needs to know immediately where the airway is and whether a voice prosthesis is fitted.
- An emergency or anaesthetic team planning airway care. Our anaesthetic alert medical ID guide covers recording other airway warnings.
A scarf or stoma cover hides the stoma well, which is good for daily life and bad for a stranger in a hurry. The band is how they find out what is under it.
What a laryngectomy medical ID should say
On the band
- NECK BREATHER — TOTAL LARYNGECTOMY
- RESCUE BREATHS TO STOMA
- Your membership number, so the rest can be read
In the profile
- The operation: total or partial laryngectomy, or tracheostomy, with the date and hospital.
- Any voice prosthesis or speech valve in the stoma, and that it should not be removed by untrained people.
- How you communicate: speech valve, writing, a tablet, or other methods. Ask responders to give you something to write with.
- Your head and neck cancer history and any other treatment, such as radiotherapy to the neck.
- Your ENT surgeon, speech pathologist and hospital, and your GP.
- Other conditions, medicines and allergies.
- Emergency contacts who know how you speak and breathe.
Neck breather, your stoma, how you speak — readable before the first rescue breath.
A MedibandPlus profile stores your laryngectomy details, voice prosthesis, communication method and contacts behind a membership number on a band you wear. No app, no login, from $19 a year.
Set up your profilePart of the Mediband family. Designed in Australia since 2004.
Teach the people around you
The people most likely to give you first aid are the ones you live and spend time with. Show them your stoma, explain ANZCOR’s mouth-to-stoma advice, and make sure they know where your spare supplies and your speech pathologist’s number are. If you also communicate differently in an emergency for another reason, our guide to emergency communication for deaf and hard of hearing people has practical ideas that apply here too.
Keeping it current
Update the record when your voice prosthesis is changed, after any further surgery or treatment, and whenever your communication method changes. It is the record a stranger will use to work out where your airway is — it needs to be right.
FAQs
How do you give rescue breaths to someone who has had a laryngectomy?
ANZCOR Guideline 5 says mouth to stoma should be used. With the person on their back and the head tilted, find the stoma at the front of the neck, leave any tube in place, place your mouth over the stoma and give rescue breaths. Call Triple Zero (000) and follow DRSABCD.
What is a neck breather?
A person who breathes through an opening in the front of the neck rather than the mouth and nose. After a total laryngectomy, healthdirect explains, the top of the windpipe is sewn to the skin of the neck to make a stoma, and air no longer travels through the mouth and nose.
What if the chest does not rise during mouth-to-stoma breathing?
ANZCOR lists three causes: a poor seal over the stoma, the person having a tracheostomy rather than a laryngectomy so air escapes from the mouth and nose, or a blocked stoma or tube. If it is blocked, use back blows and chest thrusts to try to clear it.
How is a laryngectomy different from a tracheostomy?
A laryngectomy removes the voice box and connects the windpipe directly to the neck, so the mouth and nose no longer lead to the lungs. A tracheostomy is a tube through the neck into the windpipe, which healthdirect notes may be temporary or permanent, and the mouth and nose usually remain connected.
Should I leave a tube in the stoma during an emergency?
Yes. ANZCOR advises that if a tube is seen in the stoma, it should always be left in place to keep the hole open for breathing and resuscitation.
How do people communicate after a laryngectomy?
healthdirect explains that you cannot speak in the usual way, that a speech pathologist helps with voice rehabilitation, for example with a speech valve in the stoma, and that pen and paper, a whiteboard or a tablet can help. Record your method so responders can use it.
What should a laryngectomy medical ID say?
On the band: “neck breather – total laryngectomy”, “rescue breaths to stoma” and a number that opens your record. In the record: the operation and date, any voice prosthesis, how you communicate, your cancer history, your ENT and speech pathology team, and your emergency contacts.
Sources
- ANZCOR Guideline 5 — Breathing — mouth-to-stoma rescue breathing and a blocked stoma.
- healthdirect — Laryngectomy — (reviewed May 2024) the operation, the stoma, communication and complications.
- healthdirect — Tracheostomy — how a tracheostomy differs.
- Head and Neck Cancer Australia — Laryngectomy — the stoma and life after surgery.
- ANZCOR Guideline 2 — Managing an Emergency — checking for alert jewellery and devices.
Disclaimer: This article is general information about recording laryngectomy details for emergencies, not medical advice, and it does not replace accredited first aid training or the advice of your ENT and speech pathology team. In an emergency, always call Triple Zero (000). For non-urgent health advice, call healthdirect on 1800 022 222 (NURSE-ON-CALL 1300 60 60 24 in Victoria, 13 HEALTH 13 43 25 84 in Queensland).
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