关键词: 气管切开, 吞咽障碍, 环咽肌失弛缓, 说话瓣膜, 康复

Abstract: Objective To explore the rehabilitation for dysphagia in young patient after tracheotomy and cricopharyngeal achalasia without cough reflex. Methods A child was reviewed, who accepted tracheotomy after resection of cerebellar pilocytic astrocytoma for dysphagia. The features characterized as severe silent aspiration and failure of cricopharyngeus muscle relaxation. Therapies included Passy-Muir valve placement, breathing exercises, balloon dilatation, surface electromyography biofeedback, and electrical stimulation. Results The aspiration was observed when she drank thin liquid with weak cough reflex, and disappeared as eating thick liquid and paste food, with complete cricopharyngeus muscle opening, 7 weeks after treatment. She was removed the tracheotomy tube and nasal feeding tube 11 weeks after treatment, and got sufficient nutrition by fully oral intake. Conclusion The application of Passy-Muir valve and comprehensive swallowing training is helpful for patient post tracheotomy with silent aspiration in decreasing the risk of aspiration, improving cough reflex and prompting swallowing function.

Key words: tracheotomy, dysphagia, cricopharyngeal achalasia, Passy-Muir valve, rehabilitation