Open AccessMontgomery T‐tube for management of tracheomalacia: Impact on voice‐related quality of life
Author(s) -
Fiorelli Alfonso,
Natale Giovanni,
Freda Chiara,
Cascone Roberto,
Carlucci Annalisa,
Costanzo Saveria,
Ferrara Vincenzo,
Santini Mario
Publication year - 2020
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/crj.13098
Subject(s) - tracheomalacia , medicine , tube (container) , quality (philosophy) , audiology , surgery , airway , mechanical engineering , engineering , philosophy , epistemology
Tracheostomy is a common procedure for management of tracheomalacia. However, the limitation to speak related to tracheostomy cannula could affect the quality of life. Objectives we reported a new minimally invasive procedure to replace tracheostomy cannula with Montgomery T‐tube to improve the ability of speaking. Methods This is a single center study including all consecutive patients undergoing the replacement of standard tracheostomy cannula with T‐tube for management of tracheomalacia. The end‐points were to evaluate (a) the changes in Voice‐related quality of Life (V‐RQOL) before and after T‐tube placement; and (b) the complications related to T‐tube. Results Eleven patients were included in the study. T‐tube was placed using flexible bronchoscopy and laryngeal mask airway. A suture was inserted through the proximal end of T‐tube. Once the stent was introduced with a clamp into the trachea, a traction was applied on the suture to facilitate the alignment of the upper end of the stent. The comparison of V‐RQOL values before and after T‐tube insertion showed a significant improvement in social/emotional (39.2 ± 6.1 vs 66.8 ± 1.9; P = .0001); physical functioning (21 ± 5.7 vs 56.4 ± 5.3; P = 0.0001) and total V‐RQOL scores (33.9 + 5.4 vs 61.3 + 6.1; P = 0.0001). No complications were seen during the insertion of the stent. In two patients, T‐tube was obstructed by mucus that resolved with aspiration using flexible bronchoscopy (mean follow‐up: 18 ± 10 months). Conclusions Our technique is simple and safe, not needing specific skills and/or cumbersome devices. The replacement of tracheostomy cannula with T‐tube seems to improve the quality of voice without adding major complications.