ArticleFrontiers in medicine2025
The relationship between swallowing training after total laryngectomy and the incidence of pharyngeal fistula a retrospective study with nursing-related insights.
Article in Frontiers in medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Pharyngeal fistula (PF), a critical complication in 10%-30% of total laryngectomy (TL) patients, delays recovery and increases healthcare costs. Current guidelines lack consensus on non-surgical prevention strategies, particularly nursing-led interventions. This study introduces an evidence-based structured swallowing training protocol integrating viscosity-modified diets, breath-holding exercises, and sensory stimulation, which was associated with reduced PF risk under systematic nursing supervision. Methods: In this single-center retrospective cohort study, 430 TL patients were enrolled: 220 received structured swallowing training initiated 10-14 days postoperatively (3×/day for 4 weeks), while 210 received standard care. The intervention comprised (1) diet progression with dry swallowing exercises, (2) seated breath-holding to trigger glottic closure, (3) tongue resistance and laryngeal elevation, and (4) sensory stimulation (preoperative taste activation, intraoperative pharyngeal brushing, postoperative imagery). Primary outcomes were PF incidence and severity; multivariate logistic regression was used to identify independent predictors (adjusted OR, 95% CI). Results: Swallowing training was associated with a 34.2% lower PF incidence (10.0% vs. 15.2%, Conclusion: Nursing-led structured swallowing training was independently associated with a 45% lower risk of PF after TL, providing a scalable and cost-effective rehabilitation framework that underscores the essential role of nursing in postoperative complication prevention.
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