Intensive Care Medicine

, Volume 38, Issue 1, pp 85–90 | Cite as

Effect of a tracheostomy speaking valve on breathing–swallowing interaction

  • Hélène Prigent
  • Michèle Lejaille
  • Nicolas Terzi
  • Djillali Annane
  • Marjorie Figere
  • David Orlikowski
  • Frédéric Lofaso



Expiratory flow towards the upper airway after swallowing serves to expel liquid or food particles misdirected towards the trachea during swallowing. However, expiration may not occur consistently after swallowing in tracheostomised patients with an open tracheostomy tube. We investigated the effect of a speaking valve (SV) on breathing–swallowing interactions and on the volume expelled through the upper airway after swallowing.


Eight tracheostomised neuromuscular patients who were able to breathe spontaneously were studied with and without an SV. Breathing–swallowing interactions were investigated by chin electromyography, cervical piezoelectric sensor, and nasal and tracheal flow recording. Three water-bolus sizes (5, 10, and 15 mL) were tested in random order.


Swallowing characteristics and breathing–swallowing synchronisation were not influenced by SV use. However, expiratory flow towards the upper airway after swallowing was negligible without the SV and was restored by adding the SV.


In tracheostomised patients, protective expiration towards the upper airway after swallowing is restored by the use of an SV.


Tracheostomy Speaking valve Deglutition Aspiration Subglottic air pressure 



The study was supported by the Association d’Entraide des Polios et Handicapés (ADEP).


  1. 1.
    Bonanno PC (1971) Swallowing dysfunction after tracheostomy. Ann Surg 174:29–33PubMedCrossRefGoogle Scholar
  2. 2.
    Feldman SA, Deal CW, Urquhart W (1966) Disturbance of swallowing after tracheostomy. Lancet 1:954–955PubMedCrossRefGoogle Scholar
  3. 3.
    Buckwalter JA, Sasaki CT (1984) Effect of tracheotomy on laryngeal function. Otolaryngol Clin North Am 17:41–48PubMedGoogle Scholar
  4. 4.
    DeVita MA, Spierer-Rundback L (1990) Swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes. Crit Care Med 18:1328–1330PubMedCrossRefGoogle Scholar
  5. 5.
    Betts RH (1965) Post-tracheostomy aspiration. N Engl J Med 273:155PubMedCrossRefGoogle Scholar
  6. 6.
    Eibling DE, Gross RD (1996) Subglottic air pressure: a key component of swallowing efficiency. Ann Otol Rhinol Laryngol 105:253–258PubMedGoogle Scholar
  7. 7.
    Suiter DM, McCullough GH, Powell PW (2003) Effects of cuff deflation and one-way tracheostomy speaking valve placement on swallow physiology. Dysphagia 18:284–292PubMedCrossRefGoogle Scholar
  8. 8.
    Gross RD, Mahlmann J, Grayhack JP (2003) Physiologic effects of open and closed tracheostomy tubes on the pharyngeal swallow. Ann Otol Rhinol Laryngol 112:143–152PubMedGoogle Scholar
  9. 9.
    Elpern EH, Borkgren Okonek M, Bacon M, Gerstung C, Skrzynski M (2000) Effect of the Passy-Muir tracheostomy speaking valve on pulmonary aspiration in adults. Heart Lung 29:287–293PubMedCrossRefGoogle Scholar
  10. 10.
    Stachler RJ, Hamlet SL, Choi J, Fleming S (1996) Scintigraphic quantification of aspiration reduction with the Passy-Muir valve. Laryngoscope 106:231–234PubMedCrossRefGoogle Scholar
  11. 11.
    Smith J, Wolkove N, Colacone A, Kreisman H (1989) Coordination of eating, drinking and breathing in adults. Chest 96:578–582PubMedCrossRefGoogle Scholar
  12. 12.
    Martin BJ, Logemann JA, Shaker R, Dodds WJ (1994) Coordination between respiration and swallowing: respiratory phase relationships and temporal integration. J Appl Physiol 76:714–723PubMedGoogle Scholar
  13. 13.
    Nishino T, Yonezawa T, Honda Y (1985) Effects of swallowing on the pattern of continuous respiration in human adults. Am Rev Respir Dis 132:1219–1222PubMedGoogle Scholar
  14. 14.
    Paydarfar D, Gilbert RJ, Poppel CS, Nassab PF (1995) Respiratory phase resetting and airflow changes induced by swallowing in humans. J Physiol 483(Pt 1):273–288PubMedGoogle Scholar
  15. 15.
    Martin-Harris B, Brodsky MB, Price CC, Michel Y, Walters B (2003) Temporal coordination of pharyngeal and laryngeal dynamics with breathing during swallowing: single liquid swallows. J Appl Physiol 94:1735–1743PubMedGoogle Scholar
  16. 16.
    Boden K, Cedborg AI, Eriksson LI, Hedstrom HW, Kuylenstierna R, Sundman E, Ekberg O (2009) Swallowing and respiratory pattern in young healthy individuals recorded with high temporal resolution. Neurogastroenterol Motil 21:1163 e1101PubMedCrossRefGoogle Scholar
  17. 17.
    Cohn MA, Rao AS, Broudy M, Birch S, Watson H, Atkins N, Davis B, Stott FD, Sackner MA (1982) The respiratory inductive plethysmograph: a new non-invasive monitor of respiration. Bull Eur Physiopathol Respir 18:643–658PubMedGoogle Scholar
  18. 18.
    Ertekin C, Pehlivan M, Aydogdu I, Ertas M, Uludag B, Celebi G, Colakoglu Z, Sagduyu A, Yuceyar N (1995) An electrophysiological investigation of deglutition in man. Muscle Nerve 18:1177–1186PubMedCrossRefGoogle Scholar
  19. 19.
    Terzi N, Orlikowski D, Aegerter P, Lejaille M, Ruquet M, Zalcman G, Fermanian C, Raphael JC, Lofaso F (2007) Breathing–swallowing interaction in neuromuscular patients: a physiological evaluation. Am J Respir Crit Care Med 175:269–276PubMedCrossRefGoogle Scholar
  20. 20.
    Hardemark Cedborg AI, Sundman E, Boden K, Hedstrom HW, Kuylenstierna R, Ekberg O, Eriksson LI (2009) Co-ordination of spontaneous swallowing with respiratory airflow and diaphragmatic and abdominal muscle activity in healthy adult humans. Exp Physiol 94:459–468PubMedCrossRefGoogle Scholar
  21. 21.
    Martin-Harris B, Brodsky MB, Michel Y, Ford CL, Walters B, Heffner J (2005) Breathing and swallowing dynamics across the adult lifespan. Arch Otolaryngol Head Neck Surg 131:762–770PubMedCrossRefGoogle Scholar
  22. 22.
    Ikari T, Sasaki CT (1980) Glottic closure reflex: control mechanisms. Ann Otol Rhinol Laryngol 89:220–224PubMedGoogle Scholar
  23. 23.
    Ertekin C, Aydogdu I, Yuceyar N, Kiylioglu N, Tarlaci S, Uludag B (2000) Pathophysiological mechanisms of oropharyngeal dysphagia in amyotrophic lateral sclerosis. Brain 123(Pt 1):125–140PubMedCrossRefGoogle Scholar
  24. 24.
    Ertekin C, Yuceyar N, Aydogdu, Karasoy H (2001) Electrophysiological evaluation of oropharyngeal swallowing in myotonic dystrophy. J Neurol Neurosurg Psychiatry 70:363–371Google Scholar
  25. 25.
    Gross RD, Atwood CW Jr, Ross SB, Olszewski JW, Eichhorn KA (2009) The coordination of breathing and swallowing in chronic obstructive pulmonary disease. Am J Respir Crit Care Med 179:559–565PubMedCrossRefGoogle Scholar
  26. 26.
    Nishino T, Hasegawa R, Ide T, Isono S (1998) Hypercapnia enhances the development of coughing during continuous infusion of water into the pharynx. Am J Respir Crit Care Med 157:815–821PubMedGoogle Scholar
  27. 27.
    Kijima M, Isono S, Nishino T (1999) Coordination of swallowing and phases of respiration during added respiratory loads in awake subjects. Am J Respir Crit Care Med 159:1898–1902PubMedGoogle Scholar
  28. 28.
    Pane M, Vasta I, Messina S, Sorleti D, Aloysius A, Sciarra F, Mangiola F, Kinali M, Ricci E, Mercuri E (2006) Feeding problems and weight gain in Duchenne muscular dystrophy. Eur J Paediatr Neurol 10:231–236PubMedCrossRefGoogle Scholar
  29. 29.
    Hadjikoutis S, Pickersgill TP, Dawson K, Wiles CM (2000) Abnormal patterns of breathing during swallowing in neurological disorders. Brain 123(Pt 9):1863–1873PubMedCrossRefGoogle Scholar
  30. 30.
    Terzi N, Prigent H, Lejaille M, Falaize L, Annane D, Orlikowski D, Lofaso F (2010) Impact of tracheostomy on swallowing performance in Duchenne muscular dystrophy. Neuromuscul Disord 20:493–498PubMedCrossRefGoogle Scholar

Copyright information

© Copyright jointly held by Springer and ESICM 2011

Authors and Affiliations

  • Hélène Prigent
    • 1
    • 4
  • Michèle Lejaille
    • 1
    • 4
  • Nicolas Terzi
    • 2
  • Djillali Annane
    • 1
  • Marjorie Figere
    • 1
    • 4
  • David Orlikowski
    • 1
    • 4
  • Frédéric Lofaso
    • 1
    • 3
    • 4
  1. 1.Hôpital Raymond Poincaré, Services de Physiologie-Explorations Fonctionnelles, Réanimation Médicale, Centre d’Investigation Clinique et d’Innovation Technologique (INSERM Unit 805)APHPGarchesFrance
  2. 2.INSERM, ERI27, Service de Réanimation Médicale, CHRU CaenCaenFrance
  3. 3.INSERMU 955CréteilFrance
  4. 4.EA 4497, Université de Versailles Saint-Quentin-en-YvelinesGuyancourtFrance

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