Rapid Bolus Inflow into the Esophagus in a Patient with a Tracheostomy after Surgical Treatment for Dysphagia

This report describes a case in which a patient with an open tracheostomy, following surgery for severe dysphagia, acquired vacuum swallowing and exhibited rapid bolus inflow into the esophagus. A 39-year-old man with bulbar palsy caused by medullary surgery demonstrated impaired pharyngeal contraction and upper esophageal sphincter opening. After undergoing laryngeal suspension and cricopharyngeal myotomy, videofluoroscopic evaluation of swallowing revealed rapid passage of the bolus from the pharynx into the esophagus. High-resolution manometry demonstrated markedly negative intraesophageal pressure accompanied by simultaneous elevation of lower esophageal sphincter pressure during swallowing. These findings suggest that the patient had spontaneously acquired vacuum swallowing despite the presence of a tracheostoma communicating with the atmosphere. Recognition of this compensatory mechanism is important because it may facilitate bolus transport in individuals with tracheostomy. Increased awareness of this swallowing pattern may prevent underdiagnosis and offer new insights into rehabilitation strategies for dysphagia.