Beside the “cosmetics” of a tracheostomy, the other major difficulty that patients encounter when trached, is the inability to speak or speak properly. Many people do not realize that a tracheostomy tube is placed below the level of the vocal cords and when the trach is “open”, air does not get up to the vocal cords to make vocalizations. You may notice most patients place a finger or thumb over the opening to the trach to speak. Phonation done this way is very harsh.
For some, a speaking valve cannot be used. It covers the opening to the trach tube and may impede breathing, or the patient may have too many secretions to use this device. It works by allowing the patient to breathe in via the valve, but on exhalation, the valve closes and air is forced up through the vocal cords so that the patient can speak. The most commonly ordered speaking valve is the Passy-Muir valve. This item is by order from a physician and is not indicated for everyone who may be trached. A doctor or facility will test the patient on the speaking valve to make sure they are able to tolerate having the trach opening covered.
Author Profile: Laura Castricone, Respiratory Therapist
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