Dr Nicola Clayton1,2,3,4,5, Mr Jason Hall6, Prof Elizabeth Ward4,7, Dr Mark Kol2,8, Prof Peter Maitz
1Burns Unit, Concord Repatriation General Hospital, Sydney, Australia, 2Speech Pathology Department, Concord Repatriation General Hospital, Sydney, Australia, 3Intensive Care Unit, Concord Repatriation General Hospital, Sydney, Australia, 4School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia, 5Faculty of Health Sciences, The University of Sydney, Sydney, Australia, 6Speech Pathology Department, The Alfred Hospital, Melbourne, Australia, 7Centre for Functioning & Health Research, Queensland Health, Brisbane, Australia, 8Faculty of Medicine, University of Sydney, Sydney, Australia
Background: The impact of inhalation burn injury on laryngeal function is not well understood. Limited evidence suggests that inhalation injury to the upper aerodigestive tract may be associated with increased risk for dysphonia, however specific features of laryngeal pathology, recovery pattern and non-surgical treatment options have not been documented.
Aim: To investigate the clinical characteristics and recovery pattern of voice and laryngeal pathology for a cohort of burn patients with confirmed inhalation injury.
Methods: Speech Pathology assessment is routinely conducted on all thermal burn patients including suspected inhalation component admitted to Concord and The Alfred Hospitals. Retrospective clinical data recorded for all patients admitted over a ten-year period, was reviewed for inclusion. Those diagnosed with inhalation injury based on laryngoscopy and/or bronchoscopy formed the final cohort. Demographic, burn and critical care data were collected in addition to voice and laryngeal outcomes from admission to discharge.
Results: Total cohort data collected to date includes 75 patients with confirmed inhalation burns during the study period (74.7% male; m=44.13years). %TBSA burn ranged from 0-90%, 90.7% had head and neck burns, mechanical ventilation duration ranged from 0-42 days (mean 7.72days), 13.3% required tracheostomy and 73.3% exhibited dysphonia. Resolution of dysphonia was evident in 76% at 6 months post injury. Frequent laryngeal pathology observed included oedema/erythema, laryngeal granulation, vocal cord palsy/paresis and laryngeal contracture.
Conclusions: Dysphonia and laryngeal pathology following inhalation burn injury is prevalent. Whilst some patients achieve functional voice, recovery can be protracted and many exhibit long term dysphonia and/or laryngeal pathology.
Dr Nicola Clayton is a Clinical Specialist Speech Pathologist in ICU and the Burns Unit at Concord Hospital in Sydney. She is internationally recognised for her expertise, research and education in the field of dysphagia and critical care, including severe burn injury.