Abstract
Tracheotomized patients (Tp) are often dysphagic and videofluoroscopy (VF) represents the gold standard diagnostic technique. We wanted to evaluate with VF the swallowing function (SF) of a group of 80 Tp admitted to our centre: 48 (group N) were free from a chronic respiratory disease (CRD) and had been tracheotomized for a central nervous system hemorrhage or ischemia while the other 32 had been tracheotomized for the exacerbation of a CRD (group P). All patients were studied with VF twice: few days after admission (t0) and after the rehabilitation period (t1). The following aspects of SF were assessed: glottis elevation (E), epiglottis folding (EF), oral phase (OP), pharyngeal retention (PR), onset of reflex (OR), penetration (P) and inhalation (I). Every item was scored 1, 2 or 3 when it was judged, respectively, normal, slightly altered of abnormal. Differences in terms of categorical scores distributions between the two groups were tested with Pearson's chi square test, while t0 and t1 scores were compared separately for each group by Wilcoxon test to search for an improvement. At t0, Tp in group N exhibited better scores than Tp in group P with respect to EF, PR, P and I (p<0.02). At t1, Tp in group N had significantly improved their scores compared to t0 with respect to AE, EF, OP, PR, P and I (p<0.02), while Tp in group P improved only for I (p<0.01).
In conclusion, the presence of a CRD significantly impairs the SF, mainly for the disrupted coordination between swallowing and breathing. Even at the end of a rehabilitation course, Tp affected by a CRD exhibit limited improvement, while those suffering from previous cerebral ischemia or hemorrhage significantly improve their SF.
- © 2011 ERS