NEW YORK (Reuters Health) - A technique for creating a tube-free opening to the trachea allows patients on a ventilator to talk and cough without assistance.
Patients who have obstructed airways often have a tracheostomy, a procedure that inserts a tube in the front of the neck to assist breathing. In some patients, such as those with chronic diseases such as stroke or lung disease, a tracheostomy may be needed permanently. A tube is used to keep the opening patent, but this tube can cause problems--the new procedure, it is hoped, will improve on this.
''This is a different approach to bypassing the larynx or pharynx and establishing a non-obstructed airway,'' said Dr. Isaac Eliachar of the Cleveland Clinic Foundation in Ohio. He presented a report on the new technique, called long term tracheostomy, at the Triological Society meeting in Orlando, Florida.
Between 1992 and 1999, Eliachar established tube-free tracheostomies in 35 patients using a surgical technique that establishes a short, skin-lined, self-supporting nostril-like opening into the trachea or windpipe. According to Eliachar, the patients' average age was 52 years; about one-half of the total number of patients were male.
Following surgery, all patients were trained to intentionally constrict the stoma (surgically-created opening). Eighteen of the patients achieved unaided speech using intentional constriction of the stoma, Eliachar added. Four patients required a supplemental surgical technique, which utilizes muscle tendons in the neck to create a muscular 'sling'. ''The supplementary procedure augments the patients' ability to constrict the stoma,'' he explained.
The remaining patients achieved limited speech and opted for no further surgery.
The surgery, ''reestablishes the patients' normal tracheobronchial secretions,'' and permits patients to communicate, ''using their best voice, (to) cough, and (to) smell,'' Eliachar told Reuters Health.
Tube-free tracheostomy is reversible, Eliachar said. ''(It) can be used for any long term or permanent bypass of the airway,'' he added. ''Most patients are very pleased with the procedure, especially those (who) previously had a tube.''