The severe burns patient with tracheostomy: Implications for management of dysphagia, dysphonia and laryngotracheal pathology

IntroductionInsertion of a tracheostomy for a severe burn patient is not uncommon. The method of decannulation, effects of the tracheostomy on voice and swallowing and subsequent complications have not been described in the literature specifically for this population. The aim of this study was to investigate the risk of dysphagia, dysphonia and laryngotracheal pathology in severe burn patients with tracheostomy and following decannulation.MethodA retrospective chart review was conducted for severe burn patients admitted from January 2000 to December 2007 that received tracheostomy as part of their treatment.ResultsTwo hundred and thirty patients were admitted during the study period, 26 of whom underwent tracheostomy. Significant positive correlations were identified between tracheostomy duration and %TBSA burn, days to commence oral intake and days to commence pre-morbid oral diet. Several dysphagic features were identified within the oral and pharyngeal phases of swallowing and dysphonia was frequently demonstrated on perceptual voice assessment with the tracheostomy in situ and following decannulation. Laryngotracheal pathology was diagnosed in 12 of the 26 patients (46.2%) whilst the tracheostomy was in place; 2 with laryngeal granulation tissue, 2 with tracheal granulation tissue, 2 with supraglottic oedema and erythema and 6 with reduced vocal mobility.ConclusionSevere burn patients that have prolonged tracheostomy are likely to have a larger size burn, take longer to commence oral intake and achieve pre-morbid oral diet. These patients are also at risk for dysphagia, dysphonia and laryngotracheal pathology.