Tracheostomy and Intubation-Related Dysphagia

  • Deepak Balasubramanian


Endotracheal intubation and tracheostomy are common artificial airway procedures done for ventilation and tracheobronchial toileting. They are most commonly seen in the intensive care setting and patients with head and neck cancers. From a functional point of view, the artificial airway appliances disrupt the normal coordinated physiology of swallowing in many ways. Patients who have recently been extubated or decannulated can have dysphagia for a variable amount of time. Several patient factors like concomitant neurological disorders and preexisting swallowing difficulties contribute to the development of dysphagia. However, in the present literature, there is a lack of consensus with regard to the incidence of airway appliance dysphagia and magnitude of the problem. Treatment guidelines are emerging, and patients may benefit from an individual case-by-case approach.


  1. 1.
    Skoretz SA, Flowers HL, Martino R. The incidence of dysphagia following endotracheal intubation: a systematic review. Chest J. 2010;137:665–73.CrossRefGoogle Scholar
  2. 2.
    Leder SB, Cohn SM, Moller BA. Fiberoptic endoscopic documentation of the high incidence of aspiration following extubation in critically ill trauma patients. Dysphagia. 1998;13:208–12.CrossRefGoogle Scholar
  3. 3.
    Carmona AF, Guarasa IM, Rodríguez RG, López PM, Castellanos MD. Dysphagia following prolonged mechanical ventilation and tracheostomy in critical ill patients. Results of edisval study pilot phase. Intensive Care Med Exp. 2015;3:A677.CrossRefGoogle Scholar
  4. 4.
    Muz J, Mathog RH, Nelson R, Jones LA. Aspiration in patients with head and neck cancer and tracheostomy. Am J Otolaryngol. 1989;10:282–6.CrossRefGoogle Scholar
  5. 5.
    Leder SB, Ross DA. Investigation of the causal relationship between tracheotomy and aspiration in the acute care setting. Laryngoscope. 2000;110:641–4.CrossRefGoogle Scholar
  6. 6.
    Brodsky MB, Gellar JE, Dinglas VD, Colantuoni E, Mendez-Tellez PA, Shanholtz C, Palmer JB, Needham DM. Duration of oral endotracheal intubation is associated with dysphagia symptoms in acute lung injury patients. J Crit Care. 2014;29:574–9.CrossRefGoogle Scholar
  7. 7.
    Bonanno PC. Swallowing dysfunction after tracheostomy. Ann Surg. 1971;174:29.CrossRefGoogle Scholar
  8. 8.
    Sasaki CT, Suzuki M, Horiuchi M, Kirchner JA. The effect of tracheostomy on the laryngeal closure reflex. Laryngoscope. 1977;87:1428–33.CrossRefGoogle Scholar
  9. 9.
    Ding R, Logemann JA. Swallow physiology in patients with trach cuff inflated or deflated: a retrospective study. Head Neck. 2005;27:809–13.CrossRefGoogle Scholar
  10. 10.
    Dettelbach MA, Gross RD, Mahlmann J, Eibling DE. Effects of the Passy-Muir valve on aspiration in patients with tracheostomy. Head Neck. 1995;17:297–302.CrossRefGoogle Scholar
  11. 11.
    Elpern EH, Borkgren Okonek M, Bacon M, Gerstung C, Skrzynski M. Effect of the Passy-Muir tracheostomy speaking valve on pulmonary aspiration in adults. Heart Lung. 2000;29:287–93.CrossRefGoogle Scholar
  12. 12.
    Gross RD, Mahlmann J, Grayhack JP. Physiologic effects of open and closed tracheostomy tubes on the pharyngeal swallow. Ann Otol Rhinol Laryngol. 2003;112:143–52.CrossRefGoogle Scholar
  13. 13.
    Leder SB, Tarro JM, Burrell MI. Effect of occlusion of a tracheotomy tube on aspiration. Dysphagia. 1996;11:254–8.CrossRefGoogle Scholar
  14. 14.
    Kang JY, Choi KH, Yun GJ, Kim MY, Ryu JS. Does removal of tracheostomy affect dysphagia? A kinematic analysis. Dysphagia. 2012;27:498–503.CrossRefGoogle Scholar
  15. 15.
    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. 2005;27:757–61.CrossRefGoogle Scholar
  16. 16.
    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. 2005;20:283–9.CrossRefGoogle Scholar
  17. 17.
    MA DVITA, Spierer-rundback L. Swallowing disorders in patients with prolonged orotracheal intubation or tracheostomy tubes. Crit Care Med. 1990;18:1328–30.CrossRefGoogle Scholar
  18. 18.
    Suiter DM, McCullough GH, Powell PW. Effects of cuff deflation and one-way tracheostomy speaking valve placement on swallow physiology. Dysphagia. 2003;18:284–92.CrossRefGoogle Scholar
  19. 19.
    Mah JW, Staff II, Fisher SR, Butler KL. Improving decannulation and swallowing function: a comprehensive, multidisciplinary approach to post-tracheostomy care. Respir Care. 2017;62:137–43.CrossRefGoogle Scholar
  20. 20.
    Goldsmith T. Evaluation and treatment of swallowing disorders following endotracheal intubation and tracheostomy. Int Anesthesiol Clin. 2000;38(3):219–42.CrossRefGoogle Scholar

Copyright information

© Springer Nature Singapore Pte Ltd. 2018

Authors and Affiliations

  • Deepak Balasubramanian
    • 1
  1. 1.Department of Head and Neck Surgery and OncologyAmrita Institute of Medical Sciences, Amrita Vishwa VidyapeethamKochiIndia

Personalised recommendations