Lateral Flow Tests – A Few Questions

Are we different?
There is plenty of anecdotal evidence that a laryngectomee’s altered breathing mechanism affects the vulnerability to respiratory infections. The nose and mouth are redundant when air is taken in or exhaled; instead the neck stoma is the entry and exit point. I have not had a cold or the flu since my surgery 20 years ago, and I know of others with the same experience.

Covid Tests
To check for current infection, PCR tests were the first to be employed. The latest guidance on the NHS England website, as of December 23rd, is that samples need to be taken from both the tonsil area and the nose. The first lateral flow test kits gave the same advice.

Clinical opinion in the UK and elsewhere, including USA, was that the stoma needs to be swabbed. NALC, with the help of University College Hospital London, produced guidance recommending swabs be taken from the nose and additionally the stoma, rather than the throat. (See earlier post)

Newer Lateral Flow Tests
The test kits supplied in recent months provide different instructions. No longer are samples to be taken from the throat, only from the nose. Swabbing the tonsil area is difficult and uncomfortable, especially for schoolchildren, who needed to carry out these tests from last autumn. Making testing easier was perhaps a necessity to ensure tests were carried out as required.

Will the Newer Tests Work for Laryngectomees?
Lateral flow tests are not 100% reliable for people with a normal airway. There are many anecdotal reports from people who have tested the nose and then soon after sampled both the nose and throat with contradictory outcomes. Will only testing the nose and ignoring the stoma give less reliable results for our community, given our different breathing mechanism?

The article here illustrates some recent concerns from Prof. Jennifer Rohn (UCL)


Also some research has suggested nasal swabs are less effective for detecting infection with the Omicron variant and the rapid tests give a positive result several days later than a PCR test would do.


Priority for Early 2022

NALC will be seeking advice from our medical advisors and partners about effective Covid testing. My personal inclination, if carrying out a lateral flow test, is to continue to sample both the nose and stoma but definitive clinical guidance is needed.