The relationship between tracheostomy and swallowing dysfunction has been long recognized. Often this dysfunction is manifested by aspiration, for which a number of etiologic factors may be responsible. Disruption of glottic closure has been previously demonstrated in association with the presence of an indwelling tracheostomy tube. The plugging or removal of the tracheostomy tube, or the use of an expiratory air valve, has been demonstrated to decrease aspiration and improve swallowing function. Measurement of subglottic pressure through an indwelling tracheostomy tube during swallowing demonstrated pressure peaks occurring concomitant with swallowing and laryngeal elevation. This presentation will review the evidence supporting the role of subglottic pressure rise in swallowing efficiency. Current investigational activity will be reviewed, and new areas for study will be suggested.

This study demonstrates that a Passy-Muir speaking valve facilitated swallow and reduced aspiration in patients with a tracheostomy and known aspiration.

LTS is an effective surgical procedure that results in the elimination of intractable aspiration. Most of these patients have major neurologic impairment due to progressive neurologic disease or devastating injury secondary to stroke, trauma, or surgery. The procedure can be performed in ill, debilitated patients and is well tolerated, even with local anesthesia. Few patients lose communicative speech, and some patients gain the ability to swallow following the procedure. LTS should be considered in the management of patients with intractable aspiration before performance of a tracheotomy because the procedure is technically easier to perform at this time and may reduce the risk of a wound-healing complication. Postoperative nursing care is decreased, and most patients can be discharged or transferred to a chronic-care facility within 2 to 3 weeks following the procedure.

No abstract