Swallowing physiology of toddlers with long-term tracheostomies: A preliminary study

This study investigated the swallowing physiology of toddler-aged patients with long-term tracheostomies. Structural movements and motility of the pha ryngeal stage of swallowing were studied in four toddlers ranging in age fr om 1:2 (years:months) to 2:9 with longterm tracheostomies. A patient aged 1 :2 years with no tracheostomy served as a toddler model for comparison. Vid eofluoroscopic recordings of the patients' liquid and puree bolus swallows were analyzed for a) onset times for pharyngeal stage events, laryngeal ves tibule closure, and tracheostomy tube movement; b) timeliness of swallow re sponse initiation; and c) pharyngeal transport function. Results found diff erences in timing of pharyngeal stage movements between the tracheostomized patients and the patient with no tracheostomy. Laryngeal vestibule closure occurred before or within the same 0.033-s video frame as onset of upper e sophageal sphincter (UES) opening in the patient with no tracheostomy, but occurred 0.033-.099 s after onset of UES opening in the tracheostomized pat ients. The time line required to close the laryngeal vestibule once the ary tenoids began their anterior movement was longer in the tracheostomized pat ients than in the patient with no tracheostomy and was associated with lary ngeal penetration. The patient with no tracheostomy displayed superior excu rsion of the arytenoid and epiglottis during the swallowing; the tracheosto mized patients did not. No association was found between onset of tracheost omy tube movement and laryngeal vestibule closure. Delayed swallow response initiation was observed across tracheostomized patients at a mean frequenc y of 45% with associated penetration. Pharyngeal dysmotility was not observ ed. Findings supported the concept that long-term tracheostomy in toddler-a ged patients affects swallowing physiology.