Faculty Collaboration Database

Light digital occlusion of the tracheostomy tube: a pilot study of effects on aspiration and biomechanics of the swallow. Head Neck 1998 Jan;20(1):52-7

Date

02/17/1998

Pubmed ID

9464952

DOI

10.1002/(sici)1097-0347(199801)20:1<52::aid-hed8>3.0.co;2-2

Scopus ID

2-s2.0-0344719965 (requires institutional sign-in at Scopus site)   54 Citations

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.

CONCLUSION: 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.

Author List

Logemann JA, Pauloski BR, Colangelo L

Author

Barbara R. Pauloski PhD, CCC-SLP Associate Professor in the Communication Sciences & Disorders department at University of Wisconsin - Milwaukee

MESH terms used to index this publication - Major topics in bold

Adult
Aged
Aged, 80 and over
Biomechanical Phenomena
Deglutition
Deglutition Disorders
Female
Humans
Inhalation
Laryngeal Neoplasms
Male
Middle Aged
Mouth Neoplasms
Pilot Projects
Tracheostomy
Treatment Outcome
Video Recording