If swallowing remains a concern, this information can be used in the multidisciplinary planning and treatment of rehabilitation of the larynx and the swallowing. There are various strategies to promote and accelerate recovery of swallowing. Because of the intimate relationship between swallowing, coughing and airway protection, many of the problems and their treatments overlap.
As the patient’s general health and strength improves, then the cough and swallow often improve too. However, if we consider that the swallowing mechanism is a collection of muscles that need to be rehabilitated, just like the posture, standing or walking muscles, then it makes sense to target these functions specifically.
Specific therapies can improve the muscle function and also the nervous control. These include:
- Swallowing exercises
- Early cuff deflation and therefore stimulation of the larynx
- Early vocalisation
- Early introduction of oral intake (after careful MDT assessment)
- Targeted electro-physiological stimulation of the pharynx (Fig 1)
There is emerging evidence that focussed electro-physiological stimulation of the muscles of the pharynx can speed up recovery by 'awakening' the muscles and neurological control mechanisms involved in swallowing. The Phagenyx system is an example.
Question: What are the two most important things that patients tell us they want to get back to doing following a tracheostomy?
Answer: Patients tell us that speaking and swallowing are two of the most important things we can address for them whilst they are in hospital and so we need to ensure that we take every step possible to get patients eating, drinking and talking if we can.
