Mrs Miriam Voortman1, Mrs Gulsen Ellul1, Ms Heather Cleland1, Ms Amanda Richards2
1Victorian Adult Burns Service, Melbourne, Australia, 2Epworth Healthcare, East Melbourne, Australia
Long term outcome post inhalation injury to the upper airway is not well reported in the literature. This single case study will explore the long term outcome of a patient with 28% deep dermal burns and severe inhalation injury due to building fire resulting in laryngeal stenosis and airway compromise.
On admission the patient had 3 failed attempts at intubation due to epiglottic oedema and required cricothoracotomy then surgical tracheostomy to secure the airway.
Speech pathology management of upper airway burns included tracheostomy weaning, perceptual voice assessment, Videofluoroscopic Swallowing Study (VFSS) and Fibreoptic Endoscopic Evaluation of Swallowing (FEES).
After decannulation the patient was severely dysphonic and FEES demonstrated nasal adhesions, reduced laryngeal sensation, copious secretions and a patent upper airway. The patient was unable to commence oral intake due to severe dysphagia and a Percutaneous Endoscopic Gastrostomy was inserted.
10 weeks post initial injury the patient developed stridor and exertional dyspnoea while at inpatient rehabilitation. He was seen as an outpatient and was immediately admitted for emergency tracheostomy insertion due to severe subglottic stenosis and posterior glottic stenosis. 12 months post injury the patient continues to have a permanent tracheostomy and is being considered for laryngotracheal reconstructive surgery. He remains severely dysphonic however has resumed regular oral intake.
Key learnings from this case included that close monitoring by speech pathology and ENT is beneficial in identifying early upper airway stenosis. A guideline for airway surveillance will be developed in future to identify patients at risk of laryngeal scarring. Laryngeal scarring will result in persisting dysphonia however severe dysphagia may resolve long term.
Miriam is a Senior Speech Pathologist at The Victorian Adult Burns Service and has worked extensively in the field of voice and dysphagia management.