Objectives: To investigate the use of tracheostoma humidification by people with total laryngectomy (PTL) in the UK and explore influencing factors. Design: National cross-sectional survey and case note review. Setting: 26 UK National Health Service (NHS) centres providing care to PTL. Participants: PTL reviewed by speech and language therapy (SLT) between March and September 2020. Methods: Secondary analysis of data collected during a national multi-centre audit of PTL completed in response to the Covid-19 pandemic. Data were collected on type of humidification used by PTL and demographic information. Type of humidification was dichotomised as ‘HME’ (closed-system heat moisture exchanger) or ‘non-HME’ (alternative stoma cover or no stoma cover). Univariable analysis was performed to determine the association with several potential explanatory variables including gender, age, living circumstances, distance from treatment centre, communication method and time elapsed since laryngectomy. A backwards selection procedure was used to determine the final model for multiple regression analysis. Results: Data were obtained from 1216 PTL from 26 centres across the UK; information on type of tracheostoma humidification used was available for 1097 PTL. Most PTL (69%) used an HME. Following multiple regression analysis, time elapsed since laryngectomy (p=<0.001), living circumstances (p=0.002) and communication method (p=<0.001) were statistically significant factors in HME use. Conclusion: In the UK, most PTL follow recommendations to use a closed-system HME, though there is marked variability across centres. HME use is influenced by time elapsed since laryngectomy, living circumstances and communication method.