How is tracheostomy-associated dysphagia treated?

Updated: Mar 20, 2020
  • Author: Nam-Jong Paik, MD, PhD; Chief Editor: Elizabeth A Moberg-Wolff, MD  more...
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Answer

A tracheostomy tube worsens dysphagia by tethering the trachea to the skin and decreasing laryngeal elevation over time. To restore glottic closure, subglottic pressures, and transglottic airflow in patients with a tracheostomy, 1-way speaking valves are used. The value of the occlusion of the tracheostomy tube may be related to the provision of a closed aerodigestive tract, which enables the patient to effectively react to aspiration.

Other important benefits include improved communication, improved olfaction, and assistance with decannulation. Restoration of glottic function can also be accomplished by downsizing the standard cuffed tracheostomy tube toward stepwise decannulation.

Patients receiving mechanical ventilation often cannot control the duration of inspiratory and expiratory airflow. Therefore, ventilator settings, such as tidal volume and flow rate, may need to be adjusted during meals. (Tidal volume may need to be increased, and flow rate may need to be reduced.) The patient may have to relearn the inspiratory and expiratory phases of the breathing cycle for optimal coordination with swallowing.


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