Impact of Tracheostomy on Dysphagia in Children

To evaluate the characteristics of dysphagia in children with tracheostomy and determine the effect of tracheostomy tubes on swallowing function.

A retrospective chart review on demographics, past medical history, and swallowing function of children who underwent tracheostomy. Video fluoroscopic swallow study (VFSS) and flexible endoscopic evaluation swallowing reports were utilized to define swallowing abnormalities. Prevalence of swallowing abnormalities, penetration aspiration scale, and functional oral intake scores were compared using Wilcoxon signed rank test, chi-square, and McNemar's tests. A p < 0.05 was considered significant.

A total of 194 (37%) of the 525 children had symptom-based dysphagia before and 282 (54%) had symptom-based dysphagia after tracheostomy placement (p < 0.001). VFSS was performed in 65 children before tracheostomy and 225 children after tracheostomy. The rate of oral phase impairment (88%) was higher than swallow triggering (53%), pharyngeal phase (67%), and esophageal phase (2%) impairment after tracheostomy (p ≤ 0.001). Rates of penetration (28% vs. 16%) and aspiration (28% vs. 17%) were higher with thin than thick liquids after surgery (p = 0.002). In 25 children who had VFSS before and after tracheostomy, rates of abnormal swallow triggering (40% to 80%, p = 0.004) and thick liquid penetration (12% to 40%, p = 0.008) increased significantly after tracheostomy. Penetration aspiration scale score decreased in 14 children. FOIS score increased in 21.

Dysphagia is a common symptom in children requiring tracheostomy. Oral intake and penetration-aspiration severity improve in most children after tracheostomy. Clinicians should be cognizant of persistent swallowing dysfunction after tracheostomy to prevent the respiratory and nutritional consequences of dysphagia.

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