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Rehabilitation Practice and Science

Abstract

Swallowing disorders are prevalent in tracheostomized patients and are associated with a high incidence of aspiration. This narrative review discusses the primary causes and subsequent management strategies for dysphagia in this population. Factors such as reduced laryngeal elevation, compromised hypopharyngeal and laryngeal sensations, impaired vocal cord function, loss of glottic airflow and subglottic pressure, weakened cough reflex, increased respiratory secretions, and disuse muscle atrophy have been identified as major contributors. These challenges can lead to severe complications, including aspiration pneumonia and respiratory failure. Comprehensive evaluations that combine clinical assessments with a thorough review of a patient’s medical history are crucial. The integration of objective tests, such as the blue dye test, along with instrumental examinations like videofluoroscopic swallow study and flexible endoscopic evaluation of swallowing, offers a holistic perspective on the swallowing function. Once identified, personalized treatment plans are imperative. Initially, the focus should be on preventing muscle atrophy, especially in patients requiring respiratory support. As patients achieve respiratory stability, interventions such as cuff deflation and the use of a one-way speaking valve become essential. The use of a one-way speaking valve aids in reconstructing a closed respiratory system, which can restore normal subglottic pressure, improve laryngeal sensations, reduce the accumulation of respiratory secretions, and enhance swallowing functions. By incorporating these interventions with a combination of direct and indirect swallowing exercises, the duration until oral intake can be safely resumed may be shortened.

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