This project examines the functional and biomechanical effects of tracheostomy on swallow in head and neck surgical patients who are about to be decannulated. Since many surgically treated head and neck cancer patients receive a tracheostomy at some point in their care, as do patients with various respiratory diseases, spinal cord injuries, and other neurologic disorders, and there is little quantified information and great divergence of clinical opinion regarding the effects of tracheostomy, this project proposes to examine and quantify the systematic effects of tracheostomy in particular types of head and neck surgical patients with tracheostomy who are about to be decannulated. Swallowing function of 40 head and neck cancer patients with tracheostomy who are about to be decannulated will be studied with simultaneous videofluoroscopy and endoscopy with the tracheostomy in place and after decannulation. Another 40 head and neck cancer patients will be studied with simultaneous pharyngeal manometry and videofluoroscopy. We hypothesize that tracheostomy changes the biomechanics of swallow, particularly laryngeal evaluation and anterior movement, laryngeal closure and cricopharyngeal opening. By comparing the biomechanical and pressure characteristics of swallow, bolus transit measures, and vocal fold movement patterns in these groups, we will be able to define any systematic effects of tracheostomy and the interaction of a tracheostomy with particular swallowing disorders and head and neck surgical procedures.
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