Prolonged trans-laryngeal intubation and/or subsequent tracheostomy typically occur in critical care environments. Trans-laryngeal or tracheostomy tubes can damage or impair the larynx, affecting airway patency and function and make vocalisation and swallowing difficult or impossible. As a result, this patient group can have complex communication and swallowing needs that may be further compounded by underlying or critical illness or comorbidities. Laryngeal injury and dysfunction are often undetected and can lead to delays and failure of primary extubation, tracheostomy decannulation, recovery of speech and swallowing and recovery of functional cough. These factors can contribute to complications such as aspiration pneumonia and significantly delay recovery, resulting in prolonged hospital stays, financial burdens and increased risks of mortality.
Speech and Language Therapists (SLTs) have an important and evolving role in the detection, assessment and rehabilitation of laryngeal complications as part of the multidisciplinary team. Early intervention is vital for accurate assessment, proactive decision-making and acceleration of vocalisation and oral feeding. Fibreoptic Endoscopic Evaluation of Swallowing (FEES) is an essential tool enabling SLTs to support the multidisciplinary team in the optimal management of laryngeal complications.