Release: May 12, 2000
Contact: Kenneth Satterfield, 407-238-4161 (as of 5/12/2000)
Near Normal Speech with Increased Tolerance and Comfort, Now Possible for Patients Requiring Tracheostomy
A medical researcher/surgeon from the Cleveland Clinic
has developed a procedure enabling patients requiring long term or permanent opening to the trachea to speak without manual manipulation or the use of devices.
Orlando, FL -- A tracheotomy (the insertion of a tube through a surgically performed temporary opening intothe trachea) is universally accepted as a short-term medical solution for relieving upper airway obstruction and provides ventilation and clearance of secretions. Maintenance by means of a tube is mandatory after this operation, often causing side-affects and potential complications if sustained for an extended period of time.
However, a significant number of patients may require a procedure to bypass the larynx and pharynx for prolonged periods, sometimes even permanently. This group is preferably treated by establishment of an open, "mouth" like window between the skin and the wind pipe, called Long Term Tracheostomy. Indications include chronic or progressive neurological diseases such as brain strokes, myasthenia gravis, amyelotrophic lateral sclerosis (Lou Gehrig's disease), bilateral vocal cord immobility, morbid obesity, severe obstructive sleep apnea, chronic pulmonary disease and after neck surgery for removal of tumors. Such a tracheostomy may also be needed, after trauma or cancer surgery, in the course of staged laryngotracheal reconstruction.
An otolaryngologist--head and neck surgeon from the Cleveland Clinic Foundation has completed a study that demonstrates that a new surgical technique that has improved the efficacy of stomal constriction, enabling patients to speak without manual assistance or additional devices. This new procedure offers hope for improving the quality of life for thousands requiring long-term airway assistance.
The author of the study, "Unaided Speech in Long Term, Tube Free Tracheostomy," is Isaac Eliachar, MD, FACS, Head, Section of Laryngotracheal Reconstruction, Otolaryngology and Communicative Disorders, at The Cleveland Clinic Foundation, Cleveland, OH. His findings were presented before Triological Society, meeting May 15-18, in Orlando, FL.
Methodology: Historically, even well executed long term tracheostomy have often collapsed and closed over if left unsupported. A recent development in a surgical procedure produces a short, skin-lined, self- sustaining passage between the trachea and the skin, precluding the need for a supporting tube or prosthesis. Nevertheless, patients are still obliged to finger occlude the stoma or use one-way valves for the production of speech and/or cough.
Dr. Eliachar followed the progress of 212 patients on whom long term tracheostomy was performed by members of his research group between 1985 and 1992. He devised specially designed skin and muscle flaps for establishment of the stoma. The patients were able to willfully constrict the stoma, in a sphincter like manner, producing effective voice without manual assistance or devices. In addition, a supplementary new procedure applying local tendons as slings, is now available to assist those few patients that fail to achieve a tight seal in their efforts to constrict the stoma.
A clinical study was initiated between 1992 and 1999 to assess the ability to consistently establish such tube free and speech ready tracheostomy. Thirty-five selected and motivated patients were accepted for the study. Their ages ranged from 18 to 72.
Results: The procedure was performed under general anesthesia. The tube-free stoma was successfully established in each of the patients. 18 patients achieved optimal intentional constriction of the stoma and were able to produce unaided speech. Four patients required the addition of the newly invented supplementary "sling " procedure to achieve totally satisfying results. Thirteen patients succeeded in limited speech production but were satisfied and preferred not to undergo additional surgery.
Conclusions: Key findings include:
(1) With the proper indications and using special techniques, a tube free tracheostomy can be surgically established and maintained in select patients for extended periods. In the absence of a tube, there are no late complications. This stoma may provide access for assisted ventilation when indicated.
(2) Recovery after this procedure may be slightly longer, requiring special care.
(3) Intentional constriction of the stoma for unaided production of speech is attainable to various degrees by most patients.
(4) The totally new supplementary surgical operation, described as the "sling" procedure, is an effective adjunct for those patients who fail to achieve tight constriction for optimal voice results following the primary procedure.
(5) Relief may now be provided to patients for longer periods with safety and preservation of function.
The most significant impact of this surgery is that no tube is needed to sustain the stoma. Furthermore, the patients may talk and cough without the need to finger occlude the stoma freeing their hands for other purposes. The stoma is cleaner, non irritating and symptom-free. The patients can even blow their noses and smell at will. The airway remains secure with no loss of ability to communicate by means of a near normal voice. Physiologic functions are retained. The procedure is reversible when indicated. The new procedures offer hope for improving the quality of life for thousands requiring long-term airway assistance.
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