[DYSPHAGIA] Trach and MBS

[ppalmer@medonline.com (Phyllis Palmer)]

Dear Irene,

THe history of this comes from the thought that when the system is closed
(without trach) the pressures in the system support the swallow and help
reduce risk of aspiration. Back in 1998 Dr. Leder et al tested this by
lookign at some (now this is from my memory, so some details may be off)
cancer patients with trachs. They did video with and without occlusion and
found no difference in the risk or rate of aspirtiaon. I do not recall if
patients where occluded with a valve or cork or if they used their
fingers, and that may be an important fact.

I another study (I think 1999) they looked at one way speaking vavles and
got similar results.

 In any event for good or bad, I see many therapists recomend this for
patients. I agree finger occlusion can cause another set of problems.
However if the system does behave more positively in an occluded version
(as indicated in some of the animal studies) then perhaps some occlusion
other than finger is beneficial. On the other hand if the occlusion method
changes the digital pressure on trachea, it may be detrimental. I used to
suggest that patients occlude trachs durign the swallow back in the late
80s/early 90s, but not anymore.

Dr. Leder if you are out there can you tell us your conclusions from the
investigations you have performed.

Hope all is well.

Phyllis
-- 
__________________________________________________________
Phyllis M. Palmer, Ph.D.       Speech Language Pathologist
               www. dysphagia.com
__________________________________________________________


On Sun, 4 Mar 2001, I Campbell-Taylor wrote:

> I often receive videos for analysis and comment. Recently I saw one
> that begs a question that I sincerely hope someone will answer.  The
> patient had a trach in place but was able to tolerate long periods
> with it corked and, shortly after this MBS was done, the trach was
> removed. This is a side issue and we'll leave, for the moment, the
> wisdom of performing MBS or VFSS of any kind with a trach in place.
> There were only two lateral shots. No AP. In the first, there was some
> laryngeal elevation but NO hyoid movement - as expected in a lateral
> medullary stroke, which this patient had. The UES therefore, could not
> open and aspiration resulted. The next thing is what I need some input
> about. For some reason, the clinician then had the patient occlude the
> stoma with his finger. This, of course, had the result of eliminating
> whatever laryngeal elevation he had which, coupled with the absence of
> hyoid movement made aspiration absolutely inevitable. Can anyone tell
> me why anyone would occlude the stoma with the finger in a case like
> this? For what reason? And, try it yourself. Put your finger at the
> usual location of a stoma and apply some moderate pressure. Then try
> to swallow. Anyone? Please? Irene.
>


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