ORIGINAL RESEARCH article
Front. Med.
Sec. Family Medicine and Primary Care
Volume 12 - 2025 | doi: 10.3389/fmed.2025.1632382
The Relationship between Swallowing Training after Total Laryngectomy and the Incidence of Pharyngeal Fistula A Retrospective Study with Nursing-related Insights
Provisionally accepted
Xi Yang1
Wenbi Jia2*- 1Department of Otolaryngology, Head and Neck Surgery, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
- 2Department of Gastroenterology, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
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Background: Pharyngeal fistula (PF), a critical complication in 10–30% of total laryngectomy (TL) patients, delays recovery and increases healthcare costs. Current guidelines lack consensus on non-surgical prevention strategies, particularly nursing-led interventions. This study introduces an evidence-based structured swallowing training protocol integrating viscosity-modified diets, breath-holding exercises, and sensory stimulation, which was associated with reduced PF risk under systematic nursing supervision. Methods: In this single-center retrospective cohort study, 430 TL patients were enrolled: 220 received structured swallowing training initiated 10–14 days postoperatively (3×/day for 4 weeks), while 210 received standard care. The intervention comprised (1) diet progression with dry swallowing exercises, (2) seated breath-holding to trigger glottic closure, (3) tongue resistance and laryngeal elevation, and (4) sensory stimulation (preoperative taste activation, intraoperative pharyngeal brushing, postoperative imagery). Primary outcomes were PF incidence and severity; multivariate logistic regression was used to identify independent predictors (adjusted OR, 95% CI). Results: Swallowing training was associated with a 34.2% lower PF incidence (10.0% vs. 15.2%, P=0.034) and fewer severe cases (68.2% mild vs. 37.5%, P=0.021). Multivariate analysis confirmed training as an independent protective factor (adjusted OR = 0.55, 95% CI = 0.32–0.95, P = 0.031), while intraoperative blood loss ≥ 400 mL was an independent risk factor (adjusted OR = 1.75, 95% CI = 1.02–3.00, P = 0.043). Adherence was high (84.1%), and protocol fidelity reached 98.6%. Conclusion: Nursing-led structured swallowing training was independently associated with a 45% lower risk of PF after TL, providing a scalable and cost-effective rehabilitation framework that underscores the essential role of nursing in postoperative complication prevention.
Keywords: Total laryngectomy, Pharyngeal fistula, swallowing rehabilitation, Nursing intervention, Postoperative Complications, Dysphagia management, multidisciplinary care
Received: 29 May 2025; Accepted: 20 Oct 2025.
Copyright: © 2025 Yang and Jia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Wenbi Jia, jiawenbi2025@163.com
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