Objectives:  The aims of this study were to identify if: (i) size of stoma contributes to quality of life (QoL) in laryngectomees; (ii) stoma size has an impact on routine stoma care and function; and (iii) an optimal stoma size exists below which patients experience stoma problems.

Design:  Cross-sectional study of laryngectomees.

Setting:  Two tertiary care centres.

Participants:  Fifty-seven patients who had undergone total laryngectomy one to five years ago and using tracheo-oesophageal speech as their primary communication means.

Main outcomes measures:  Three main measures were studied:

1 a new study specific questionnaire designed to assess problems with function and care of the end tracheosto- ma;

2 QoL as assessed by the head and neck QoL instrument;

3 a precision custom designed sizer to measure the minimum stoma diameter.

Results:  The final study-specific questionnaire contained four items assessing different aspects of stomal function. From raw total scores an overall stomal score was generated. The stoma score was moderately correlated to emotion and speech domains in head and neck Quality of Life questionnaire, indicating that different concepts were being measured. The mean minimum stoma diameter was 15.9 ± 2.9 mm. There was a significant increase in the area under the receiver operating characteristic curve beyond a threshold value of ≥15 mm; smaller sizes were associated with a poorer stoma score (Mann–Whitney test, P < 0.001). No patient found the stoma sizer use distressing.

Conclusions:  Size of stoma significantly contributes to QoL in laryngectomees and stomas with minimum diameters of 14 mm or less are associated with adverse effects on routine stoma function. The study-specific stoma function questionnaire appears to be a useful instrument.