Airway considerations for professional singers--a survey of expert opinion

The objective of this study was to survey physician experts in voice disorders/treatment to establish consensus guidelines for translaryngeal intubation (TLI) and tracheotomy when treating professional singers or other voice professionals. A written survey was sent to all physician members of the Voice Foundation seeking opinions/recommendations about route of TLI, duration of TLI before tracheotomy, size of endotracheal and tracheotomy tubes, and special interventions during patient care as these might differ between professional singers and nonsingers. Fifty-five percent of the physicians responded, of whom 73% classified their experience in voice care as "extensive." A strong consensus (76%) favored a smaller endotracheal tube for singers (6-7 mm I.D. for males and 6.0 mm I.D. for females) via the oral (46%) versus nasal (36%) route. Intubation/extubation by the most expert/experienced personnel was emphasized so as to minimize direct trauma to the larynx. While intubated, strong recommendations were made to suppress gastric acid production and to minimize motion of the endotracheal tube, including patient sedation. Preferences for an early tracheotomy (6 days) versus their usual time (10 days) were approximately equal (44% vs. 50%, respectively) and most respondents (69%) recommended the same size tracheotomy tube (8.0 mm I.D. for males and 6.0 mm I.D. for females) for singers and nonsingers. Post extubation/decannulation care emphasized voice rest, retraining, continued gastric acid suppression, and the possibility of direct laryngoscopy to assess post-TLI or tracheotomy injuries.