title: Presence of a tracheotomy tube and aspiration status in early, postsurgical head and neck cancer patients.
abstract: BACKGROUND
  We sought to investigate the effects, if any, that the presence of a tracheotomy tube has on aspiration status in early, postsurgical head and neck cancer patients.
  
  
  METHODS
  Twenty-two consecutive adult, postoperative head and neck cancer patients were prospectively evaluated with fiberoptic endoscopic evaluation of swallowing (FEES) under three conditions: (1) tracheotomy tube present, (2) tracheotomy tube removed and tracheostoma covered with gauze sponge; and (3) tracheotomy tube removed and tracheostoma left open and uncovered. For each condition, the endoscope was first inserted transnasally to determine aspiration status during FEES and then inserted through the tracheostoma to corroborate aspiration status by examining the distal trachea inferiorly to the carina. Three experienced examiners determined aspiration status under each condition and endoscope placement.
  
  
  RESULTS
  There was 100% agreement on aspiration status between FEES results and endoscopic examination through the tracheostoma. Specifically, 13 of 22 patients (59%) swallowed successfully and nine of 22 (41%) aspirated. There was also 100% agreement on aspiration status for tracheotomy tube present, decannulation and tracheostoma covered by gauze sponge, and decannulation and tracheostoma left open and uncovered.
  
  
  CONCLUSIONS
  Neither presence of a tracheotomy tube nor decannulation affected aspiration status in early, postsurgical head and neck cancer patients. The clinical impressions that a tracheotomy or tracheotomy tube increases aspiration risk or that decannulation results in improved swallowing function are not supported. Rather, need for a tracheotomy indicates comorbidities (eg, respiratory failure, trauma, stroke, advanced age, reduced functional reserve, and medications used to treat the critically ill) that by themselves predispose patients for dysphagia and aspiration.
authors.affiliation: Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, P.O. Box 208041, New Haven, CT 06520-8041, USA. Steven.Leder@Yale.edu
authors.forename: Steven B
authors.initials: SB
authors.lastname: Leder
authors.forename: John K
authors.initials: JK
authors.lastname: Joe
authors.forename: Douglas A
authors.initials: DA
authors.lastname: Ross
authors.forename: Daniel H
authors.initials: DH
authors.lastname: Coelho
authors.forename: Joseph
authors.initials: J
authors.lastname: Mendes
mesh_terms: D000328:Adult; D000368:Aged; D003680:Deglutition Disorders / Q000175:diagnosis*; D004724:Endoscopy; D005260:Female; D005336:Fiber Optic Technology; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011446:Prospective Studies; D014139:Tracheostomy; D014140:Tracheotomy