Patients with tracheostomies and laryngectomies can have problems eating, drinking and swallowing food, drinks and medication. The anatomy and physiology working at the front of the neck and the airway is very closely linked to our swallowing mechanisms. Put your hand on the front of your neck and swallow. You can feel that there is a lot going on! Imagine how this is complicated by a tracheostomy tube (Fig 1).

Illness and disease can affect talking and swallowing as much as a tracheostomy, but there are things bedside staff can do to help.

Bedside clinical swallowing trials can be useful if the swallow is expected to be normal. However, complex patients require assessment by specialist Speech & Language Therapy staff. This might be clinical assessment or involve bedside FEES - Fibreoptic Endoscopic Evaluation of Swallow. Fig 2 is a video explaining all about FEES.

Here, a small endoscope is inserted via the nose and the larynx is visualised. Trials of oral fluids and food are undertaken with real-time visualisation of the larynx. Aspiration can be seen, laryngeal problems detected and a plan for rehabilitation made. Importantly, some patients that were thought to be high risk for aspiration can be demonstrated to have a safe swallow, meaning that they can commence oral intake much earlier than perhaps they would have.