Objectives To compare the swallowing frequency in patients with neurogenic dysphagia with or without tracheotomy tubes (TT) to assess the underlying mechanisms of dysphagia to improve rehabilitation strategies. Study design and setting Prospective study, 10 patients (64 ± 7 years) with neurogenic dysphagia. Glasgow Coma Scale (GCS) less than 8 points, tracheotomy due to the dysphagia 2 weeks before the examination. The swallowing frequency (1 or less over 5 min) was assessed over 5 consecutive days with or without TT. Results The swallowing frequency increased after removal of the TT. These findings did not influence the GCS or the Coma Remission Scale. Over a 5-day period, the frequency of swallowing was increased. Conclusion TTs decisively influence the swallowing behavior of vegetative patients. This phenomenon could be based on an improved sensitivity under re-established physiological expiration. We strongly favor removing the TT or deflating the cuff of the TT under therapeutic conditions in a rehabilitation therapy setting.