Impact of tracheostomy on swallowing performance in Duchenne muscular dystrophy

Abstract 

Mechanical ventilation has improved survival in patients with Duchenne muscular dystrophy (DMD). Over time, these patients experience upper airway dysfunction, swallowing impairments, and dependency on the ventilator that may require invasive mechanical ventilation via a tracheostomy. Tracheostomy is traditionally believed to further impair swallowing. We assessed swallowing performance and breathing-swallowing interactions before and after tracheostomy in 7 consecutive wheelchair-bound DMD patients, aged 25±4years, over a 4-year period. Chin electromyography, laryngeal motion, and inductive respiratory plethysmography recordings were obtained during swallowing of three water-bolus sizes in random order. Piecemeal deglutition occurred in all patients over several breathing cycles. Half the swallows were followed by inspiration before tracheostomy. Total bolus swallowing time was significantly shorter (P=0.009), and the number of swallows per bolus significantly smaller (P=0.01), after than before tracheostomy. Invasive ventilation via a tracheostomy may improve swallowing.

Keywords: Neuromuscular disorder, Swallowing, Tracheostomy, Invasive mechanical ventilation