Management of Post-Nasogastric Tube Dysphonia

Evaluation and Treatment

• The American Academy of Otolaryngology-Head and Neck Surgery recommends that the treatment of post-nasogastric tube dysphonia should include voice therapy by a specialized speech-language pathologist, as this intervention is fundamental for restoring vocal function and improving the patient's quality of life 1, 2
• Dysphonia should be identified as an alteration in vocal quality, tone, volume, or vocal effort that impairs communication or reduces quality of life 1
• The evaluation should include a clinical history and physical examination to determine underlying causes and factors that modify management 1
• If dysphonia does not improve within 4 weeks, a laryngoscopy should be performed or the patient should be referred to a specialist who can perform it 1, 3
• Diagnostic laryngoscopy should be performed before prescribing voice therapy, and the results should be documented and communicated to the speech-language pathologist 1, 4
• The American Academy of Otolaryngology-Head and Neck Surgery recommends that voice therapy is the primary treatment for post-nasogastric tube dysphonia 1, 2, 4
• Voice therapy is effective for dysphonia in all ages, from children to older adults 4
• It is especially effective in cases of muscle tension dysphonia (MTD) that may develop after nasogastric tube trauma 4
• Voice therapy should be performed by a certified and specialized speech-language pathologist 4
• The American Academy of Otolaryngology-Head and Neck Surgery recommends that patients with dysphonia should be informed about control and prevention measures, including adequate hydration 1, 3, 5, avoiding irritants such as tobacco and alcohol 3, adequate vocal rest 3, regular physical exercise (≥3 times a week) 3, and avoiding noisy environments, poor air quality, or dryness 3
• The American Academy of Otolaryngology-Head and Neck Surgery recommends that routine antibiotics should not be prescribed to treat dysphonia 1, 6, and that antireflux medications should not be prescribed to treat isolated dysphonia without prior laryngoscopy 1, 6
• The American Academy of Otolaryngology-Head and Neck Surgery recommends that corticosteroids should not be prescribed routinely without prior laryngoscopy 1, 6
• The patient's symptoms of dysphonia should be documented after treatment or observation, including resolution, improvement, or worsening of symptoms 1, 3
• The patient's quality of life related to voice should be evaluated 3
• If dysphonia persists despite treatment, further evaluation should be considered to rule out other pathologies 1, 7

Special Considerations

• In cases of severe or persistent dysphonia, surgical intervention should be considered if benign lesions of the vocal cords are identified that do not respond to conservative management 1, 2
• For patients with spastic dysphonia or other types of laryngeal dystonia, botulinum toxin injections should be considered 1, 6