Subglottic Air Pressure: A Key Component of Swallowing Efficiency

Abstract

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.

Swallowing Evaluation in Patients with Unilateral Vocal Fold Immobility

“…Positive subglottic pressure during swallowing is required for an efficient swallow. Subglottic pressure decreases the distensible volume of the swallow and avoids dissipation of the intrabolus pressure occurring during swallows [15]. These situations, inadequate pharyngeal pressure, decrease in the subglottic air pressure, and longer pharyngeal contraction duration, should be the explanation for the longer UES transit for patients with pharyngeal innervation impairment and patients without clear innervation impairment.…”

Dysphagia and Associated Respiratory Considerations in Cervical Spinal Cord Injury

“…The causes of aspiration include abnormal anterior-superior movement of the larynx, reduced subglottic pressure, impaired laryngeal closure reflexes, and alterations of the oral, pharyngeal, and esophageal stages of swallowing. 23 Tracheostomy tube cuff should remain inflated until secretion management has been optimized and swallow evaluation by SLP suggests no risk for aspiration. There has been a common misconception that any risk of aspiration is entirely eliminated as long as a tracheostomy cuff is fully inflated; however, it has been identified in the literature that there is still risk for leakage of secretions around an inflated cuff.…”

Dysphagia and Respiratory Care in Individuals with Tetraplegia: Incidence, Associated Factors, and Preventable Complications

“…32 The causes of aspiration due to tracheostomy tube include abnormal anterior-superior movement of the larynx, reduced subglottic pressure, impaired laryngeal closure reflexes, and alterations of the oral, pharyngeal, and esophageal stages of swallowing. [32][33][34] Patients with premorbid diagnoses such as osteophytes and gastroesophageal reflux disease (GERD) may be at a higher risk for swallowing complications. Osteophytes can cause compression of the esophagus.…”