3. Granuloma formation
Granuloma formation is a condition that occurs when there is inflammation in the area due to tracheal trauma resulting from not being attentive to aspiration techniques. During the healing process, the inflammation leads to the development of raised scar tissue on the surface, which can cause narrowing or complete blockage of the airway. Localized tracheomalacia may also develop due to inflammation at the stoma site.
Silver nitrate is the most recommended first-line agent for the treatment of granulomas, while other recommended agents include ciprofloxacin-dexamethasone otic suspension, topical steroid ointments, frequent dressing changes, or topical antibiotics 8. One study noted the choice of cuffless cannulas to ensure the possibility of using speaking valves and to reduce tracheal trauma. In the presence of excessive leakage, a new larger cannula was used if the exhaled tidal volumes could not be controlled 2.
When granulation tissue is detected, patients should be referred to head and neck surgery. If there is no response to medical treatment, the granulation tissue can be removed with optical forceps or potassium titanyl phosphate or laser coagulation. To prevent the recurrence, intralesional steroid injection can be performed 6.