[DYSPHAGIA] Trach and MBS

[Hilda.Pressman@med.va.gov (Hilda.Pressman@med.va.gov)]

Dr. Leder's most recent study was done, I believe, with a valve in place.
There was no improvement in the swallow.

> -----Original Message-----
> From:	Phyllis Palmer [SMTP:ppalmer@medonline.com]
> Sent:	Sunday, March 04, 2001 11:01 PM
> To:	I Campbell-Taylor
> Cc:	dysphagia@medonline.com
> Subject:	Re: [DYSPHAGIA] Trach and MBS
> 
> 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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