Evidence for Above Cuff Vocalization in Patients With a Tracheostomy: A Systematic Review

Claire S Mills, Emilia Michou, Natalie King, Mark C Bellamy, Heidi J Siddle, Cathy A Brennan, Chris Bojke

Research output: Contribution to journalReview articlepeer-review


OBJECTIVES/HYPOTHESIS: To determine how above cuff vocalization (ACV) is implemented in clinical practice, to identify what evidence exists on the effectiveness and safety of ACV, and to evaluate the acceptability of ACV.

STUDY DESIGN: Systematic review.

METHODS: A literature search was conducted in eight databases (MEDLINE, Embase, AMED, CINAHL, Cochrane Library, PsycINFO, Scopus, and Web of Science) in May 2019 and updated in June 2020. Two reviewers independently screened, selected, and extracted data. Study quality was appraised using the Joanna Briggs Institute Critical Appraisal Tools and a narrative synthesis was conducted. Systematic review registration number: CRD42019133942.

RESULTS: The searches identified 1327 records. The 13 eligible studies included four case studies, three case series, four observational studies without a control group, one quasi-experimental study, and one randomized controlled trial. Study quality was low, with most studies having high risk of bias. There was a high level of heterogeneity in study design and outcome measures used. Detailed information on ACV application and dose-delivered was lacking in 12 studies. Positive effects were reported for communication (n = 7), swallowing (n = 4), cough response (n = 2), and quality-of-life (n = 2), but with inconsistent use of objective outcome measures. There is limited quantitative or qualitative evidence for acceptability. Adverse events and complications were reported in nine studies, and four highlighted the importance of involving an experienced speech and language therapist.

CONCLUSIONS: There is limited evidence for the acceptability, effectiveness, safety, or optimal implementation of ACV. The evidence is insufficient to provide recommendations regarding optimal intervention delivery. Future research should ensure detailed recording of ACV delivery and utilize a core outcome set. Laryngoscope, 2021.

Original languageEnglish
JournalThe Laryngoscope
Publication statusPublished - 1 May 2021


  • Above cuff vocalization
  • communication
  • deglutition
  • talking tracheostomy
  • tracheostomy


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