OBJECTIVE: To describe the evolution of a patient with swallowing disorder caused by tetanus. CASE REPORT: ISS, a 48-year-old woman, was born in Porto Alegre (RS), Brazil. She remained in the intensive care unit (ICU) for 59 days because of severe tetanus, a no contagious infectious disease that affects the central nervous system and causes severe dysphagia, tachycardia, hypertension, hyperthermia, and gastrointestinal bleeding. She was attended by the staff speech therapist who found severe oropharyngeal dysphagia, based on the GUSS scale (Trapl M et al. 2007). The patient had a nasogastric tube (SNE) and tracheotomy. Her presenting symptoms were trismus, dysphagia, facial muscle hypertonia, pneumo-phono-respiratory incoordination, reduced movement and tremors of the tongue, and the presence of stained material in the tracheal aspirate after the swallowing functional test. Speech therapy was begun in the ICU and continued until her transfer to a hospital room, and involved direct and indirect swallowing therapy. After 45 days of treatment, she started consuming a pureed diet and liquids orally (PO). She had oropharyngeal dysphagia (which lead to a reassessment of speech therapy) and improved vocal and respiratory functions. CONCLUSION: There are only few reports that have included a professional speech therapist for the care of a tetanus toxoid patient; in these patients, early speech therapy aids in the rehabilitation of food functions and in respiratory and vocal rehabilitation. The patient evolved from having mild-to-severe oropharyngeal dysphagia, and she initially exclusively received feeding by SNE and evolved to PO with pasty foods and liquids which provided better pneumo-phono-respiratory coordination and vocal quality.
