Ann Rehabil Med.  2012 Jun;36(3):356-364. 10.5535/arm.2012.36.3.356.

Effect of Decannulation on Pharyngeal and Laryngeal Movement in Post-Stroke Tracheostomized Patients

Affiliations
  • 1Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea. kimdy@yuhs.ac
  • 2Department of Otorhinolaryngology Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea.
  • 3Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea.

Abstract


OBJECTIVE
To investigate effects of tracheostomy tube on the movement of the hyoid bone and larynx during swallowing by quantitative analysis of videofluoroscopic swallowing study. METHOD: 19 adult stroke patients with tracheostomies, who met the criteria of decannulation participated. Serial videofluroscopic swallowing studies were done over 14 days before decannulation, within 24 hours before decannulation, within 24 hours after decannulation, and over 14 days after decannulation. The kinematic parameter such as pharyngeal transition time, stage transition duration, maximal hyoid bone movement, and maximal laryngeal prominence movement were obtained by 2-D quantitative analysis of videofluoroscopic swallowing study.
RESULTS
Pharyngeal transition time and stage transition duration were not significantly changed all the time. The maximal hyoid bone movement and maximal laryngeal prominence just after decannulation were improved significantly compared to just before decannulation (p<0.05), especially on vertical movement.
CONCLUSION
The hypothesis that a tracheostomy tube disturbs the hyoid bone and laryngeal movement during swallowing may be supported by this study.

Keyword

Tracheostomy; Decannulation; Hyoid bone; Laryngeal prominence; Movement

MeSH Terms

Adult
Deglutition
Humans
Hyoid Bone
Larynx
Stroke
Tracheostomy

Figure

  • Fig. 1 Study design of experiment. VFSS: Videofluoroscopic swallow study, T0: Over 2 weeks before decannulation, T1: Within 24 hrs before decannulation, T2: Within 24 hrs after decannulation, T3: Over 2 weeks after decannulation.

  • Fig. 2 Kinematic analysis using 2D graphic analysis program. (A) y-axis was defined as straight line connecting the antero-inferior border of the C4 vertebra to the antero-inferior border of the C2 vertebra. x-axis was defined as straight perpendicular line to y-axis crossing antero-inferior borderof the C4 vertebra. Red dot indicated anterior superior border of hyoid bone. Blue dot indicated laryngeal prominence. (B) The figure showed trajectory of hyoid bone movement (red spot), and that of laryngeal prominent movement (blue spot) during swallowing.

  • Fig. 3 Measurement of maximal, vertical, horizontal movement. A: Location at beginning, B: Location at maximal movement, a: Horizontal movement, b: Vertical movement, c: Total maximal movement.

  • Fig. 4 Changes of hyoid bone movement after decannulation. (A) Total maximal hyoid bone movement is significant different between T1, T2 but not T1, T3. (B) Horizontal hyoid bone movement is not significant different between T1, T2 nor T1, T3. (C) Vertical hyoid bone movement is significant different between T1, T2 but not T1, T3. *p<0.05 paired t-test. T0: Over 2 weeks before decannulation, T1: Within 24 hrs before decannulation, T2: Within 24 hrs after decannulation, T3: Over 2 weeks after decannulation.

  • Fig. 5 Changes of laryngeal prominence movement after decannulation. (A) Total maximal laryngeal prominence movement is significant different between T1, T2 and T1, T3. (B) Horizontal laryngeal prominence movement is significant different between T1, T3 not T1, T2. (C) Vertical laryngeal prominence movement is significant different between T1, T2 and T1, T3. *p<0.05 using paired t-test. T0; Over 2 weeks before decannulation, T1: Within 24 hrs before decannulation, T2: Within 24 hrs after decannulation, T3: Over 2 weeks after decannulation.


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