2015 Volume 19 Issue 1 Pages 69-74
The patient was a 23-year-old male who had sustained injuries to his head, trunk and left arm at work. He was diagnosed with left scapula fracture, multiple rib fracture, left hemopneumothorax and bilateral pulmonary contusion. On the day of injury, the patient underwent conservative treatment with orotracheal intubation. The patient was found to have bilateral vocal cord paralysis, possibly due to intubation, on post-injury day 13. A tracheostomy was performed and the patient started to wear a cuffed unfenestrated tracheostomy cannula. The patient was found to have accumulated oropharyngeal secretions or aspiration of secretions on post-injury day 17, hence phonatory and swallowing rehabilitation (air blowing method) was begun, by blowing oxygen gas into a supra-cuff suctioning line. We blew secretions in the trachea or larynx up toward the mouth with oxygen gas at a rate of 1-3 l/min, and told the patient to repeatedly swallow secretions. Since we found that stimulation from endoscopy or blown oxygen gas induced excess secretions and made it difficult to continue rehabilitation by continuously blowing air on post-injury day 34, we changed from a continuous to intermittent method of blowing air. We found that bilateral vocal cord adduction movement was improved, and the secretions from hypopharyngeal to vocal cord were reduced. We changed the cannula to a speech cannula on post-injury day 42, and removed the speech cannula on post-injury day 50.
During the rehabilitation, we measured voluntary swallowing of secretions on post-injury days 17 and 50 when the rehabilitation started and the cannula was removed, respectively. The patient was told to repeatedly swallow secretions as frequently as possible, and the measurement was performed after moistening the patient's oral cavity with cotton swabs. The time taken for 10 consecutive times of voluntary swallowing with air blowing was shorter than that without air blowing on both post-injury day 17 and 50.
The air blowing temporarily increased the times of repetitive swallowing of secretions following instructions, and repetitive swallowing of secretions strengthened swallowing-related muscles in this case. We also speculate that phonation prevented the vocal cords from damage due to disuse and improved secretion management skills.
