SUBGLOTTIC AIR-PRESSURE - A KEY COMPONENT OF SWALLOWING EFFICIENCY

The relationship between tracheostomy and swallowing dysfunction has b een long recognized, Often this dysfunction is manifested by aspiratio n, for which a number of etiologic factors may be responsible. Disrupt ion of glottic closure has been previously demonstrated in association with the presence of an indwelling tracheostomy tube. The plugging or removal of the tracheostomy tube, or the use of an expiratory air val ve, has been demonstrated to decrease aspiration and improve swallowin g function. Measurement of subglottic pressure through an indwelling t racheostomy tube during swallowing demonstrated pressure peaks occurri ng concomitant with swallowing and laryngeal elevation. This presentat ion will review the evidence supporting the role of subglottic pressur e rise in swallowing efficiency. Current investigational activity will be reviewed, and new areas for study will be suggested.