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

Abstract

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.

Biomechanical Analysis of Hyoid Bone Displacement in Videofluoroscopy: A Systematic Review of Intervention Effects

“…The table divides the interventions into five groups: swallow postures, maneuvers, and rehabilitation exercises [31–33]; facilitation techniques [34]; bolus modification [35–37]; a combination of the mentioned interventions [38–41]; and other interventions [42]. …”

“…Hyoid bone excursion was not significantly influenced by DBS conditionBSuiter et al [41]18 dysphagic tracheostomy patients (14 with cuff)(variety of causes) (13♂, 5♀)RandomizationOne-way tracheostomy speaking valve, cuff inflation and deflation and bolus consistency modification Single sessionOne-cent coin on left mandible2 blinded ratersVideofluoroscopy (maximum superior and anterior hyoid excursion (mm))2 liquid barium boluses (60% w/v), 2 puree boluses (apple sauce with barium powder 4:1)Videofluoroscopy (spatial, temporal, and visuoperceptual variables)Cuff status had no effect on penetration or aspiration. One-way speaking valve placement significantly reduced scores on the penetration-aspiration scale for the liquid bolusBLogemann et al [42]8 dysphagic HNC patients with tracheostomy tube(5 oral cancer, 3 laryngeal cancer) (7♂, 1♀)Digital occlusion tracheostomySingle sessionAnterior/inferior corner C2&C4Anterior/superior aspect hyoid boneDiameter of a coinVideofluoroscopy (maximum anterior and superior hyoid hyoid excursion (mm))3-cc liquid bariumVideofluoroscopy (spatial, temporal, and visuoperceptual parameters)Light digital occlusion of the tracheostomy tube may improve the swallow biomechanically and may also eliminate aspiration. However, the results vary from individual to individual, and the effects must be assessed for each patient videofluoroscopically

G1 first group, G2 second group, JAVA Jandel Scientific, San Mateo, CA, Visuoperceptual data including only qualitative measurements of the swallowing act like the penetration-aspiration scale, FOAMS functional outcome assessment of swallowing, UES upper esophageal sphincter, CVA cerebrovascular accident, HNC head and neck cancer, w/v weight per volume, C cervical vertebrae, ICC intraclass correlation coefficient, NIH Bethesda, MD, NMES neuromuscular electrical stimulation, MASA Mann Assessment of Swallowing Ability, FOIS functional oral intake scale

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“…Logemann et al [42] examined the effect of digital occlusion of the tracheostomy in eight dysphagic subjects treated for head and neck cancer ( N  = 6 surgical treatment, N  = 2 chemoradiotherapy). Lightly digital occlusion resulted in a minor reduction of swallowing disorders.…”

“…Cuff deflation resulted in significantly increased anterior hyoid bone displacement [41]. During digital occlusion of the tracheostomy, hyoid bone elevation at the time of initial UES opening increased significantly [42]. However, maximal superior and anterior hyoid bone displacement were not significantly influenced by digital occlusion [42].…”

“…Only six studies described the blinding and reliability analysis of the raters and used more than one rater [31, 34, 36, 38–40]. Five studies did not present any information about the raters, resulting in less robust conclusions [32, 33, 35, 37, 42]. …”