Swollen Airway?

[Carl R]

In December of last year, I was hospitalized for pneumonia for 10 days. I was on the vent for about 7 days and I have a trach that has been in place since my injury 2 1/2 years ago. I kept the trach plugged except for suctioning and breathing treatments daily before December. A couple of weeks after I was released from the hospital, I began to have problems breathing thru my nose and mouth. When I remove the plug from my trach, I breath fine. I have seen my primary physician, an ENT, and my spinal cord Dr and no one seems to have an answer. I had a CAT scan a couple of months ago and it seemed fine. I have used a speaking valve for about 6 months and can tolerate it most of the day, but usually have to remove it at least a couple of hours daily and at night to sleep. It also seems to get a little easier after trach changes which are every 6 weeks roughly, but not a major difference. Has anyone experienced anything like this?

[SCI-Nurse]

Carl, have you had a direct endoscopy (where a flexible scope is passed down your airway from your mouth)? The first thing I would want to know is if you have tracheal stenosis (narrowing of the trachea) or scarring of your vocal cords that could be obstructing your upper airway. Is your trach cuffed (even if the cuff is never inflated)? Is it fenestrated?

If your ENT did not do this, or does not want to do it, I would recommend getting a second opinion. I would assume (but ask to be sure) that your tonsils and adnoids are not swollen. Do you have any problems with swallowing or aspiration (was your pneumonia preceeded by an infection or was it due to aspiration?). (KLD)

[Scorpion]

Why would one need a trach if one can breath on their own? I had a trach for several weeks after my injury due to a partial drowning, but it was removed. If you're not on a vent,why would you have a trach indefinitely? As I understand, the trach itself is responsible for most of the secretions that need to be suctioned. I'm just curious.

~Rus

[Carl R]

I have been scoped by my ENT twice in the past 6 months. He said everything looked pretty normal. He did mention once that my vocal cord was not opening and closing properly all the time, but said it shouldn't cause a problem. I tried a fenestrative trach, but it did not help becuase secretions got stuck in the hole regurally which made it harder to suction. I did have a granuloma removed off my vocal cord about 4 months after injury, March 1999. The ENT said it looked fine. The pneumonia in december was due to infection. The plural cavity was infected and 2 chest tubes were inserted to remove fluid. No swelling of adnoids or tonsils. At the back of my tongue, top of my throat, it gets irritated and we get a little blood when suctioning every 6 weeks or so, but nothing shows up on culture.

Scorpion, I think my case is rather rare. Most people get off the vent and either their secretions dry up or they are strong enough to cough them up on their own. Neither has happened for me and I have tried several things to strengthen my cough and/or dry up secretions. The doctors keep telling me that I should be able to remove the trach at some point, but no luck to date. Part of the problem also is that I had pneumonia 5 seperate times in the first 6 months after injury and the bases of my lungs are very scarred or dead. I have cultured the secretions several times as well, nothing shows up except for pseudomonus(sp) bug which I was told is colonized and probabley will never be able to get rid of.

Maybe I do need to get a second opinion from another ENT. I get more concerned the closer we get to winter. The major problem is I can't talk without the plug or speaking valve, and I get exhausted when the trach is plugged.

[Scorpion]

Carl, thanks for the explanation, not that it's any of my business. http://sci.rutgers.edu/forum/images/smilies/smile.gif You do what ya gotta do bro. I just remember vividly having the trach and the painful suctioning that went along with it. I'm rootin' for ya to get off it at some point if possible. BTW, what's your level? Have you had any luck with 'quad coughs'? I remember doing that to help get me off the suctioning and eventually the trach. I'm just throwing ideas out there. Good luck!

~Rus

[SCI-Nurse]

I would recommend that you consider a second opinion, ideally at a teaching hospital. This sounds like classic upper airway partial obstruction, and it could explain your difficulty in tolerating plugging or use of a speaking valve. Most people who have a SCI and can get off the vent do get rid of their trach, but this is not possible with upper airway obstruction. A trach will stimulate more secretions, which can be a vicious cycle, and this can often be broken by going to something like an Olympic trach button, but these can only be used by those who can tolerate plugging all the time. (KLD)

[Carl R]

My injury is at C5. Actually, we have to suction about 4 or 5 time daily but we do it via assisted cough. the assisted cough method we use still won't allow me to cough secretions into my mouth, but only through the trach with the suction tubing put up to the end of my trach. the vacuum is just enough to help remove the secretions. It is still a pain in the ass, but much less invasive than going down with a catheter.