Aspiration in patients with head and neck cancer and tracheostomy

Muz, Jaroslaw; Mathog, Robert H.; Nelson, R. J.; Jones, Lynne A.

doi:10.1016/0196-0709(89)90009-4

Cited by 80 publications

(59 citation statements)

References 13 publications

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“…1,4 Two of the patients who aspirated in the present study did show elimination of aspiration on swallows with the tube digitally occluded. However, the results were somewhat equivocal, as one subject received no benefit in terms of eliminating his aspiration and another subject exhibited increased aspiration with the tube occluded.…”

Section: Discussionmentioning

confidence: 87%

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Light digital occlusion of the tracheostomy tube: A pilot study of effects on aspiration and biomechanics of the swallow

1998

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Background This study examined the effects of digital occlusion of the tracheostomy tube versus no occlusion on oropharyngeal swallowing in head and neck cancer patients. Methods Eight treated head and neck cancer patients were studied, six of whom had undergone surgical treatment for oral or laryngeal cancer and two who had undergone high‐dose chemotherapy and radiotherapy for laryngeal cancer. Videofluorographic studies of oropharyngeal swallowing were accomplished on 3‐mL boluses of liquid in seven patients and 3‐mL boluses of paste in three patients, first with the tracheostomy not occluded and then with it lightly digitally occluded by the patient. Videofluorographic studies of swallow were examined for observations of aspiration and residue. Biomechanical analysis of each liquid swallow was also completed. Results Four of the seven patients aspirated on thin liquids with the tube unoccluded. Aspiration was eliminated with the tracheostomy digitally occluded in two of these four patients. One of the patients also aspirated on paste with the tube unoccluded, and the aspiration was eliminated with the tube occluded. A third patient who aspirated on thin liquid had no change when the tube was occluded, and one patient's swallow worsened with the tube occluded on liquid. There were significant changes in five measures of swallow biomechanics on liquids with the tube occluded: (1) duration of base of tongue contact to the posterior pharyngeal wall was reduced, (2) maximal laryngeal elevation increased, (3) and (4) laryngeal and hyoid elevation at the time of initial cricopharyngeal opening increased, and (5) onset of anterior movement of the posterior pharyngeal wall relative to the onset of cricopharyngeal opening began later. Conclusions Light digital occlusion of the tracheostomy tube appears to be a safe procedure, because most biomechanics of swallow are positively affected, perhaps because of the increased resistance provided by the closed trachea. However, not all patients received benefit from tube occlusion, indicating that each patient must be evaluated individually to determine whether or not tube occlusion improves their swallow. © 1998 John Wiley & Sons, Inc. Head Neck 20: 52–57, 1998.

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Section: Discussionmentioning

confidence: 87%

“…1,2 One study used the Passey-Muir valve to occlude the tracheostomy tube during swallow 3 in dysphagic aspirating patients of various etiologies. In general, these studies have found a reduction in the frequency and amount of aspiration when the tracheostomy tube was oc-cluded digitally or with a valve.…”

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confidence: 99%

Light digital occlusion of the tracheostomy tube: A pilot study of effects on aspiration and biomechanics of the swallow

1998

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“…Some reports indicated that occluding the tracheotomy tube with a plug 27,28 or one-way speaking valve 29 -31 could decrease or, in selected cases, eliminate aspiration. It may be that subject selection bias or specific bolus consistencies (eg, liquid versus puree) affected aspiration status.…”

Section: Discussionmentioning

confidence: 98%

Presence of a tracheotomy tube and aspiration status in early, postsurgical head and neck cancer patients

et al. 2005

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Neither presence of a tracheotomy tube nor decannulation affected aspiration status in early, postsurgical head and neck cancer patients. The clinical impressions that a tracheotomy or tracheotomy tube increases aspiration risk or that decannulation results in improved swallowing function are not supported. Rather, need for a tracheotomy indicates comorbidities (eg, respiratory failure, trauma, stroke, advanced age, reduced functional reserve, and medications used to treat the critically ill) that by themselves predispose patients for dysphagia and aspiration.

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“…3 Regarding the latter, an increased rate of aspiration has been demonstrated in tracheostomized patients. [6][7][8][9][10][11][12][13] Elevation of the larynx is also affected since the cannula fixates the larynx to the skin of the neck. 14 Speaking valves (VF) for tracheostomy have minimized these procedure-associated losses.…”

Section: Introductionmentioning

confidence: 99%

Válvula fonatória brasileira para traqueotomia: padronização de pressão de diafragma

Silveira¹,

Soki²,

Chone

et al. 2009

Rev. Bras. Otorrinolaringol.

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Tracheot omy is performed in cases of upper airway obstruction or chronic pulmonary disorders. The Tracheotomy Speech Valves (TSV) improve communication and airway hygiene and humidification of tracheotomized patients. Aim: To show the low cost Brazilian TSV and its use in speech rehabilitation of tracheotomized patients, to evaluate diaphragm opening resistance and comfort to the patient. Study Design: Experimental, contemporary cohort . Materials and methods: The TSV was used in 32 patients. The valve has a diaphragm within a stainless steel body with plastic fittings. We studied the level of respiratory comfort according to the degree of valve diaphragm resistance, 40, 50 and 60 shores. Results: All the patients used the TSV coupled to the cannula in a regular basis, 26 of them did it for more than 12 hours daily and from these, 14 used it for 24h daily. The diaphragm pressure obtained was that of 40 shores for 13 patients and 50 shores for 19 patients. 60 shores was never used. Conclusion: the metal TSV helps with speech without the need for closing the cannula with one's finger, and breathing was comfortable. We achieved standard diaphragm resistance. Currently all the patients from this study use this TSV with speech and 43.75% use it full time.

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Aspiration in patients with head and neck cancer and tracheostomy

Cited by 80 publications

References 13 publications

Light digital occlusion of the tracheostomy tube: A pilot study of effects on aspiration and biomechanics of the swallow

Light digital occlusion of the tracheostomy tube: A pilot study of effects on aspiration and biomechanics of the swallow

Presence of a tracheotomy tube and aspiration status in early, postsurgical head and neck cancer patients

Válvula fonatória brasileira para traqueotomia: padronização de pressão de diafragma

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