A Systematic Review of Tracheostomy Modifications and Swallowing in Adults.
Stacey A Skoretz, Nicole Anger, Leslie Wellman and 2 others
PMID 32377977WHAT IT FOUND
Swallowing outcomes after tracheostomy modifications are highly variable.
Cuff deflation improved some physiology measures, but speaking valves and occlusion showed inconsistent results. Evidence is inconclusive, so do not expect a specific modification to reliably improve safety or function.
Key findings
01The review found no consensus on whether tracheostomy modifications improve swallow physiology, with results varying widely across the included studies.
02Cuff deflation was associated with improved anterior hyoid excursion in two studies, but did not significantly change aspiration or penetration-aspiration scores in others.
03One-way speaking valves significantly lowered penetration-aspiration scores compared to cuff inflation or deflation in one study, but other studies found no significant effect on aspiration.
STILL TO COME
How it was doneWhat they foundWhat it means for SLPs
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What it does not show
All included studies were case series, which are prone to bias and cannot establish causality. Sample sizes were small (11 to 40 patients) and highly heterogeneous in terms of patient diagnoses and medical status. Assessor blinding was unclear or absent in most studies, increasing the risk of bias in outcome reporting. Variability in how swallowing outcomes were defined and measured (e.g., different scales, binary presence/absence vs. quantitative metrics) prevented meta-analysis and made comparisons between studies difficult. Many studies did not report key confounding variables such as pulmonary status, tracheostomy tube size, or duration of modification.
Declared interests
The review was supported by non-U.S. government funding. No specific conflicts of interest were declared by the authors in the provided text.
The easy way to misread this
Do not interpret the significant changes in quantitative measures (like anterior hyoid excursion) as proof of improved clinical swallowing safety. The review found that these physiological changes did not consistently translate to reduced aspiration or penetration-aspiration scores, and the overall evidence remains inconclusive.