Contribution of tracheotomy tubes and one-way speaking valves to swallowing success

The contribution, if any, of a tracheotomy tube on aspiration status and swallowing success is investigated. Specific topics discussed include presence of a tracheotomy tube, tracheotomy tube cuff status, tracheotomy tube occlusion status, one-way tracheotomy tube speaking valves, and ventilator dependency. A critical analysis on the role of aging revealed that the high incidence of aspiration in older individuals with tracheotomies can be attributed to the critical illness that necessitated the tracheotomy tube in the first place rather than the tracheotomy tube per se, that is, trauma, severe pulmonary disease, altered mental status, and the use of medications to treat the critically ill. Speaking valves may improve swallow function for some but not all individuals and for some bolus types (thin liquids) but not others (puree consistency). Overall recommendations and suggestions for further research are discussed.