_Many patients reports changes in their
swallowing following a tracheostomy. Although many patients swallow very well
following a tracheostomy, there are several reasons why a change in swallowing
may be noticed.
For this reason, should you notice any
changes in your swallow ability, or begin coughing, choking during eating, it
is extremely important to notify your doctor/SLP. Following an evaluation, the
SLP staff be able to better manage your swallowing for the best function
possible.
If at
any time you notice food/drink material being coughed and expelled from the
tracheostomy tube, you should always contact your doctor and/or SLP
immediately. This may be an indication of a
swallowing problem that could have very severe health implications.
_
Subglottic Pressurization
_The closing of the vocal cords also plays a
very important role in the swallow process. By closing during the swallow, the
vocal cords prevent any air from leaving the lungs during the swallow. This subglottic pressure is important for
driving a strong swallow. For more information on how we swallow, see Normal Swallowing (link).
In a tracheostomy patient, even if the
vocal cords adduct (close) as they
should during the swallow, the typical subglottic pressurization is not
achieved since the open tracheostomy tube is creating an opening for air to
leave the lungs. As such, many patients may experience swallowing difficulty
following their tracheostomy.
A Passy-Muir Speaking Valve (PMV) can be
utilized to assist with swallowing difficulties when subglottic pressurization
appears to be a contributing factor. For this reason, if you have been provided
with a PMV, it is always recommended you are wearing the valve during meals,
but also as often as possible, while awake, is ideal in this regard, as it will
also help with the regular swallowing of saliva and other secretions throughout
the day.
_
Hyolaryngeal Movement
_During a normal swallow, the larynx (voice
box), along with other attached muscles/structures, moves upward and outward.
This is referred to as hyolaryngeal
movement and can be observed when you watch or feel your Adam’s apple
(thyroid cartilage) move up and down during a swallow.
In normal human anatomy, the larynx is
attached to the trachea, through which the tracheostomy tube has been inserted
and rests following a tracheostomy. In some cases, the tube can contribute to
less hyolaryngeal movement as a result. Any changes in swallowing following a
tracheostomy should always be reported to your doctor and/or SLP staff.
Although the tracheostomy may not be contributing to any perceived swallowing
problem, proper evaluation of the swallow function should be conducted to
ensure the patient is eating as safely and effectively as possible.