気管切開孔を有する嚥下障害症例に対するスピーチバルブ装着の有用性―喉頭クリアランスに対する影響

Abstract

Tracheostomy placement affects swallowing function, increasing the risk of aspiration. Recent studies suggest that because of increased risk of swallowing disturbance associated with tracheostomy, one-way speaking valve placement may help to reduce aspiration in tracheostomized patients. We hypothesize that airflow exhaled through the laryngeal cavity using the one-way speaking valve may improve the clearance of residual bolus from the upper airway, thus preventing bolus penetration and aspiration. We studied the effects of one way speaking valve placement on laryngeal clearance and swallowing physiology. Videoendoscopic and videofluoroscopic swallowing were examined in 16 patients with the tracheostomy, and swallowing was compared with and without the one-way speaking valve in place. Valve Valve placement significantly improved laryngeal clearance and the incidence of penetration during swallowing. placement did not, however, significantly affect pharyngeal bolus residue, laryngeal elevation, pharyngeal delay or aspiration. Factors associated with the resumption of oral feedings were sufficient laryngeal elevation during swallow and the prevention of laryngeal penetration and aspiration. We concluded that one-way speaking valve placement improves laryngeal clearance and prevents laryngeal penetration, resulting in better oropharyngeal swallowing physiology and oral feeding.