Tracheostomy and Dysphagia: True, True, and Unrelated?

The relationship between tracheostomy and dysphagia remains controversial. Many centers require swallow evaluations for all patients after tracheostomy because of the assumed increased rate of dysphagia and aspiration that they are thought to promote. Tracheostomies are now most commonly placed in the intensive care setting in adult patients with polytrauma or severe medical illness who are on mechanical ventilation. While tracheostomy and dysphagia often coexist in this population, they may not be directly related, as physiologic alterations observed in tracheostomized patients have not demonstrably translated into clinically significant complications of dysphagia. Instead, there is growing evidence that chronicity and severity of underlying illness, comorbidities, and recent intubation are the major arbiters of dysphagia in patient population. This brief report reviews the literature investigating the association between tracheostomy and dysphagia in adults, and discusses the role that illness severity, comorbidity, and intubation play in dysphagia etiology and how they confound the tracheostomy-dysphagia relationship.