Ultrasonic Evaluation of the Thyrohyoid Approximation Percentage as Support for Clinical Swallowing Assessment in Decannulation of a Tracheostomized Patient: A Case Report

Abstract

Decannulation is crucial in the rehabilitation of tracheostomized patients, and its success depends on an interdisciplinary and rigorous assessment of airway patency, respiratory parameters, and secretion swallowing safety. However, clinical evaluation of swallowing, while essential, remains a subjective procedure that is highly dependent on the clinician’s experience. This case report explores the usefulness of ultrasound as a complementary tool that can enhance the objectivity of clinical evaluation. We present the case of a man with a tracheostomy and prolonged mechanical ventilation. After meeting the respiratory criteria for decannulation, the clinical evaluation of swallowing suggested a possible restriction in hyolaryngeal mobility. To objectively quantify this disturbance, ultrasound was employed, and the findings were later confirmed through an endoscopic swallowing evaluation. The results revealed that ultrasound enabled the objective measurement of hyolaryngeal excursion, identifying an impairment in its movement. This was quantified by calculating the percentage of change in the approximation between the thyroid cartilage and the hyoid bone compared to their resting positions. In conclusion, ultrasound appears to be a promising tool to complement the clinical evaluation of swallowing in individuals with a tracheostomy, allowing for objective measurement of hyolaryngeal function, particularly when conventional instrumental evaluations (videofluoroscopy or endoscopy) are not feasible. Clinicians are encouraged to share their experiences with the use of ultrasound to enhance knowledge in this and other clinical contexts.