The Journal of Laryngology & Otology (2006), 120, 1059 –1060.

Short Communication
# 2006 JLO (1984) Limited
doi:10.1017/S0022215106003161
Printed in the United Kingdom
First published online 28 September 2006

A simple method for re-dilatation of an acute tracheostoma

stenosis
G SOO, M C F TONG

Abstract
Tracheostomy or laryngectomy stomas may sometimes re-stenose, resulting in respiratory distress for the patient
unless the stoma is rapidly re-dilated and an adequate airway re-established.
This article describes a simple and effective method for the acute re-dilatation of a tracheostoma stenosis,
using an aural speculum, prior to the insertion of a patent airway tube. This technique has been successfully
used in our department since 1995 and, in our experience, causes significantly less distress to our patients
when compared with other means employed previously.
Key words: Tracheostomy; Laryngectomy; Constriction, Pathologic; Dilatation

Introduction
Tracheostomy or laryngectomy stomas may sometimes
re-stenose.1 This results in respiratory distress for the
patient unless the stoma is rapidly re-dilated and an
adequate airway re-established. Several methods can be
used for acute re-dilatation of the stenosis, using a
Hegar’s dilator, tracheostoma vent2 or progressively sized
tracheostomy tubes.
We would like report our experience with the use of the
‘aural speculum’ technique. This is a simple and effective
method for acute re-dilatation of a tracheostoma stenosis
prior to insertion of a patent airway tube, which, in our
experience, causes significantly less distress to our patients
when compared with other means. FIG. 1
A selection of tapered aural specula used.

Method
After assessment of the stenosis, the appropriately sized
aural speculum is selected. Tapered aural specula should
be used (see Figure 1).
The selected aural speculum is lubricated with gel to aid
insertion. It is then inserted through the stoma. Constant,
firm and gentle pressure is applied to the aural speculum
rim until the desired dilated stoma size is reached; consecu-
tively larger-sized specula may be used if a larger dilatation
is required. Care is taken to direct the tip of the speculum
to the centre of the tracheal lumen at all times, in order to
avoid speculum tip trauma to the tracheal wall (see
Figure 2).
An appropriately sized tracheostomy tube or tracheo-
stoma vent is inserted into the re-dilated stoma to conclude
the procedure.
Anaesthesia is not usually required. However, if exces-
sive discomfort is anticipated or encountered, the peri-
stoma may be infiltrated with local anaesthesia and/or
topical anaesthetic spray administered to the immediate FIG. 2
post-stomal trachea. The dilatation procedure.

From the Division of Otorhinolaryngology, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales
Hospital, Shatin, Hong Kong, China.
Accepted for publication: 13 May 2006.

1059
1060 G SOO, M C F TONG

Discussion 2 Smiths Medical Product Catalogue 2006. Bivonaw tracheost-

omy accessories – Bivonaw Tracheostoma Vents
This is a relatively simple technique for acute re-dilatation
of a stenotic tracheostoma. It has several advantages, as
follows. Firstly, aural specula are easily available in
Address for correspondence:
ENT wards and clinics. Secondly, dilatation can be
Dr Gordon Soo,
achieved from a very small stoma to an adequate size Honorary Clinical Assistant Professor,
with minimal need for repeated re-introduction (as Division of Otorhinolaryngology,
required when using dilating sounds and tracheostomy Department of Surgery,
tubes), hence minimizing stomal trauma and patient dis- Prince of Wales Hospital,
comfort. Thirdly, the patient can continue breathing Ngan Shing Street, Shatin, NT,
through the lumen of the speculum during its insertion Hong Kong SAR, China.
and throughout the dilatation procedure, significantly
minimizing distress. Fax: þ852 26466312
This technique is used only to assist acute re-dilatation of E-mail: gsoo@surgery.cuhk.edu.hk
a stenosed stoma. Post-dilational patency is maintained by
insertion of an appropriately sized airway tube.

References Dr G Soo takes responsibility for the integrity of the

content of the paper.
1 Snyderman CH, Johnson JT. Tracheostomal stenosis after Competing interests: None declared
total laryngectomy. Laryngoscope 1994;104(6 Pt 1):786