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.