Speech with a Tracheostomy

Normally speech is obtained by a steady stream of air that comes from the lungs and passes through the vocal cords.  When the trach tube is inserted, most of the air bypasses the vocal cords and goes out through the tube.  Some air may leak up to the vocal cords, but it may not be forceful enough to drive the vocal cords into vibration, or it may only allow enough force for very short utterances. 

All trach tubes should fit easily into the airway with some space around the tube. If the tube fits snugly inside the trachea, all of the exhaled air will leave the body via the tracheostomy tube and no air will be able to pass through the vocal cords. If mechanical ventilation is needed, a more “fitted” trach may be required.   If the airway is very small, scarred, or has a granuloma, the patient may not be able to move enough air past the vocal cords to vocalize. If the vocal cords are scarred or paralyzed, the patient’s voice may sound hoarse or unusual. The goal is to always match the patient with the smallest trach possible.

Ways to Achieve Vocalization with a Tracheostomy

Covering the tube

Having the patient cover the tube by holding a finger or placing a cap over the tube for short periods of time can be considered a solution.  This may, however, cause increased resistance to breathing that is intolerable to some patients.  Contaminants from the hand or fingers may introduce infection into the body, a particularly critical problem for patients with aspiration problems.  Some patients may get enough air for speech without blocking the tube, but may not have the awareness, muscle movement or muscle tone to make a good occlusion.

Talking/Speaking/Speech Valves

As an alternative, a variety of valves are available that can be attached to the tracheostomy tube. These valves allow air to enter via the tube, and exit through the mouth and nose. Use of certain valves is also reported to have secondary benefits of reducing secretions, increasing the sense of smell, reducing aspiration, facilitating decannulation (tube removal) in patients for whom tracheostomy is not permanent, and increasing oxygenation of blood in the arteries. Because all valves do not produce the same quality of speech or the same secondary benefits, a valve for a specific patient should be selected based on the scientific and clinical results.