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Hyoid Bone and Laryngeal Movement Dependent Upon Presence of a Tracheotomy Tube

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Abstract

The aim of this prospective, consecutive study was to investigate the biomechanical effects, if any, of the presence of a tracheotomy tube and tube cuff status, tube capping status, and aspiration status on movement of the hyoid bone and larynx during normal swallowing. Seven adult patients (5 male, 2 female) with an age range of 46–82 years (mean = 63 years) participated. Criteria for inclusion were no history of cancer of or surgery to the head and neck (except tracheotomy), normal cognition, normal swallowing, and ability to tolerate decannulation. Digital videofluoroscopic swallowing studies were performed at 30 frames/s and with each patient seated upright in the lateral plane. Variables evaluated included maximum hyoid bone displacement and larynx-to-hyoid bone approximation under three randomized conditions: tracheotomy tube in and open with a 5-cc air-inflated cuff; tracheotomy tube in and capped with deflated cuff; and tracheotomy tube out (decannulated). Differences between maximum hyoid bone displacement and larynx-to-hyoid approximation (cm) based on presence/absence of a tracheotomy tube, tube cuff status, and tube capping status were analyzed with the Student’s t test. Reliability testing with a Pearson product moment correlation was performed on 21% of the data. No significant differences (p > 0.05) were found for both maximum hyoid bone displacement and larynx-to-hyoid bone approximation during normal swallowing based on tracheotomy tube presence, tube cuff status, or tube capping status. Intraobserver reliability for combined measurements of maximum hyoid displacement and larynx-to-hyoid approximation was r = 0.97 and interobserver reliability for the absence of aspiration was 100%. For the first time with objective data it was shown that the presence of a tracheotomy tube did not significantly alter two important components of normal pharyngeal swallow biomechanics, i.e., hyoid bone movement and laryngeal excursion. The hypothesis that a tracheotomy tube tethers the larynx thereby preventing hyoid bone and laryngeal movement during normal swallowing is not supported.

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References

  1. Kremen AJ: Cancer of the tongue - a surgical technique for a primary combined en bloc resection of tongue, floor of mouth, and cervical lymphatics. Surgery 30:227–240, 1951

    PubMed  CAS  Google Scholar 

  2. Feldman SA, Deal CW, Urquhart W: Disturbance of swallowing after tracheostomy. Lancet 1:954–955, 1966

    Article  PubMed  CAS  Google Scholar 

  3. Leder SB, Ross DA: Investigation of the causal relationship between tracheotomy and aspiration in the acute care setting. Laryngoscope 110:641–644, 2000

    Article  PubMed  CAS  Google Scholar 

  4. Bonanno PC: Swallowing dysfunction after tracheostomy. Ann Surg 174:29–33, 1971

    Article  PubMed  CAS  Google Scholar 

  5. Elpern EH, Scott MG, Petro L, Ries MH: Pulmonary aspiration in mechanically ventilated patients with tracheostomies. Chest 105:563–566, 1994

    PubMed  CAS  Google Scholar 

  6. Cameron JL, Reynolds J, Zuidema GD: Aspiration in patients with tracheostomies. Surg Gynecol Obstet 136:68–70, 1973

    PubMed  CAS  Google Scholar 

  7. Pinkus NB: The dangers of oral feeding in the presence of cuffed tracheotomy tubes. Med J Aust 1:1238–1240, 1973

    PubMed  CAS  Google Scholar 

  8. Leverment JN, Pearson FG, Rae S: A manometric study of the upper oesophagus in the dog following cuffed-tube tracheostomy. Br J Anaesth 48:83–89, 1976

    Article  PubMed  CAS  Google Scholar 

  9. Elpern EH, Jacobs ER, Bone RC: Incidence of aspiration in tracheally intubated patients. Heart Lung 16:527–531, 1987

    PubMed  CAS  Google Scholar 

  10. Muz J, Mathog RH, Nelson R, Jones LA: Aspiration in patients with head and neck cancer and tracheostomy. Am J Otolaryngol 10:282–286, 1989

    Article  PubMed  CAS  Google Scholar 

  11. Muz J, Hamlet S, Mathog R, Farris R: Scintigraphic assessment of aspiration in head and neck cancer patients with tracheostomy. Head Neck 16:17–20, 1994

    Article  PubMed  CAS  Google Scholar 

  12. DeVita MA, Spierer-Rundback L: Swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes. Crit Car Med 18:1328–1330, 1990

    Article  CAS  Google Scholar 

  13. Dettelbach MA, Gross RD, Mahlmann J, Eibling DE: The effect of the Passy–Muir valve on aspiration in patients with tracheostomy. Head Neck 17:297–302, 1995

    Article  PubMed  CAS  Google Scholar 

  14. Tolep K, Getch GL, Criner GJ: Swallowing dysfunction in patients receiving prolonged mechanical ventilation. Chest 109:167–172, 1996

    PubMed  CAS  Google Scholar 

  15. Logemann JA, Pauloski BR, Colangelo L: Light digital occlusion of the tracheostomy tube: a pilot study of effects on aspiration and biomechanics of the swallow. Head Neck 20:52–57, 1998

    Article  PubMed  CAS  Google Scholar 

  16. Buckwalter JA, Sasaki CT: Effect of tracheotomy on laryngeal function. Otolaryngol Clin North Am 17:41–48, 1984

    PubMed  CAS  Google Scholar 

  17. Nash M: Swallowing problems in the tracheotomized patient. Otolaryngol Clin North Am 21:701–709, 1988

    PubMed  CAS  Google Scholar 

  18. Logemann J: A Manual for Videofluoroscopic Evaluation of Swallowing, 2nd edn. Austin, TX: Pro-Ed, 1993

    Google Scholar 

  19. Dikeman KJ, Kazandjian MS: Communication and Swallowing Management of Tracheotomized and Ventilator Dependent Adults. San Diego, CA: Singular Publishing Group, 1995

    Google Scholar 

  20. Perlman AL, Schulze-Delvieu K: Deglutition and Its Disorders. San Diego, CA: Singular Publishing Group, 1997

    Google Scholar 

  21. Logemann JA: Evaluation and Treatment of Swallowing Disorders, 2nd edn. Austin, TX: Pro-Ed, 1998

    Google Scholar 

  22. Leder SB, Joe JK: Effect of tracheotomy tube occlusion on upper esophageal sphincter and pharyngeal pressures in aspirating and nonaspirationg patients. Dysphagia 16:79–82, 2001

    Article  PubMed  CAS  Google Scholar 

  23. Leonard RJ, Kendall KA, McKenzie S, Goncalves MI, Walker A: Structural displacements in normal swallowing: a videofluoroscopic study. Dysphagia 15:146–152, 2000

    PubMed  CAS  Google Scholar 

  24. Suiter DM, McCullough GH, Powell PW: Effects of cuff deflation and one-way tracheostomy speaking valve placement on swallow physiology. Dysphagia 18:284–292, 2003

    Article  PubMed  Google Scholar 

  25. Leder SB, Tarro JM, Burrell MI: Effect of occlusion of a tracheotomy tube on aspiration. Dysphagia 11:254–258, 1996

    Article  PubMed  CAS  Google Scholar 

  26. Leder SB, Ross DA, Burrell MI, Sasaki CT: Tracheotomy tube occlusion status and aspiration in early postsurgical head and neck cancer patients. Dysphagia 13:167–171, 1998

    Article  PubMed  CAS  Google Scholar 

  27. Leder SB: Effect of a one-way tracheotomy speaking valve on the incidence of aspiration in previously aspirating patients with tracheotomy. Dysphagia 14:73–77, 1999

    Article  PubMed  CAS  Google Scholar 

  28. Leder SB, Joe JK, Ross DA, Coelho DH, Mendes J: Presence of a tracheotomy tube and aspiration status in early, postsurgical head and neck cancer patients. Head Neck 27:757–761, 2005

    Article  PubMed  Google Scholar 

  29. Donzelli J, Brady S, Wesling M, Theisen M: Effects of the removal of the tracheotomy tube on swallowing during the fiberoptic endoscopic exam of the swallow (FEES). Dysphagia 20:283–289, 2006

    Article  Google Scholar 

  30. Newman LA, Martin S, Scarpetti M: Impact of intubation and tracheostomy on airway protection during swallowing in young, previously healthy population. Dysphagia 20:351, 2006

    Google Scholar 

  31. Conley JJ: Swallowing dysfunctions associated with radical surgery of the head and neck. Arch Surgery 80:602–612, 1960

    CAS  Google Scholar 

  32. Leder SB, Espinosa JF: Aspiration risk after acute stroke: comparison of clinical examination and fiberoptic endoscopic evaluation of swallowing. Dysphagia 17:214–218, 2002

    Article  PubMed  Google Scholar 

  33. Baskin JZ, Panagopoulos G, Parks C, Rothstein S, Komisar A: Clinical outcomes for the elderly patients receiving a tracheotomy. Head Neck 26:71–76, 2004

    Article  PubMed  Google Scholar 

  34. Norton SA, Quill TE: Editorial comment: complex questions embedded in tracheotomy decisions. Head Neck 26:75–76, 2004

    PubMed  Google Scholar 

  35. Leder SB, Cohn SM, Moller BA: Fiberoptic endoscopic documentation of the high incidence of aspiration following extubation in critically ill trauma patients. Dysphagia 13:208–212, 1998

    Article  PubMed  CAS  Google Scholar 

  36. Daniels SK, Brailey K, Priestly DH, Herrington LR, Weisberg LA, Foundas AL: Aspiration in patients with acute stroke. Arch Phys Med Rehabil 79:14–19, 1998

    Article  PubMed  CAS  Google Scholar 

  37. Leder SB: Fiberoptic endoscopic evaluation of swallowing in patients with acute traumatic brain injury. J Head Trauma Res 14:448–453, 1999

    CAS  Google Scholar 

  38. Robbins J, Hamilton JW, Lof GL, Kempster GB: Oropharyngeal swallowing in normal adults of different ages. Gastroenterology 103:823–829, 1992

    PubMed  CAS  Google Scholar 

  39. Leder SB: Incidence and type of aspiration in acute care patients requiring mechanical ventilation via a new tracheotomy. Chest 122:1721–1726, 2002

    Article  PubMed  Google Scholar 

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Acknowledgment

This research was supported in part by the McFadden, Harmon, and Mirikitani Endowments.

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Authors and Affiliations

  1. Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, New Haven, Connecticut, USA

    Alyssa R. Terk MD & Steven B. Leder PhD

  2. Department of Diagnostic Radiology, Yale University School of Medicine, New Haven, Connecticut, USA

    Morton I. Burrell MD

  3. Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, P.O. Box 208041, New Haven, CT, 06520-8041, USA

    Steven B. Leder PhD

Authors
  1. Alyssa R. Terk MD
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  2. Steven B. Leder PhD
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  3. Morton I. Burrell MD
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Correspondence to Steven B. Leder PhD.

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Terk, A.R., Leder, S.B. & Burrell, M.I. Hyoid Bone and Laryngeal Movement Dependent Upon Presence of a Tracheotomy Tube. Dysphagia 22, 89–93 (2007). https://doi.org/10.1007/s00455-006-9057-0

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  • DOI: https://doi.org/10.1007/s00455-006-9057-0

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