Speaking with a Tracheostomy
A tracheostomy is a surgical opening (stoma) in the neck, into the windpipe (trachea). This opening allows for the insertion of a breathing tube, bypassing the upper airway. A common question for individuals with a tracheostomy is whether they can still speak. While the presence of a tracheostomy tube alters the typical pathway of air, effective communication remains possible for many, often through specific methods and adaptations.
Speech relies on air passing over the vocal cords, located in the larynx (voice box). Normally, air from the lungs travels up through the trachea, past the vocal cords, causing them to vibrate and create sound. A tracheostomy tube is placed below the vocal cords, meaning inhaled and exhaled air moves directly through the tube and out of the stoma, bypassing the larynx. This altered airflow interrupts natural vocal sound production. To regain speech, exhaled air must be redirected from the lungs back up through the upper airway and over the vocal cords.
Achieving Speech
Redirecting exhaled air to the vocal cords can be achieved through specific devices and techniques. One method involves a speaking valve, such as a Passy-Muir valve. This small, one-way valve attaches to the tracheostomy tube’s outer opening. When inhaling, the valve opens, allowing air to enter the lungs through the tracheostomy tube. Upon exhalation, the valve closes, preventing air from escaping through the stoma and forcing it upward through the trachea, past the vocal cords, and out through the mouth and nose, which enables speech while still providing a secure airway for breathing.
Another method involves temporarily blocking the tracheostomy tube opening. This can be done through finger occlusion (placing a finger over the tube’s end) or by capping the tube with a specialized cap. Blocking the tube directs exhaled air upwards through the larynx, allowing vocal cords to vibrate and produce sound. This approach is used for short periods or when a speaking valve is not suitable or available. Both speaking valves and occlusion techniques restore the necessary airflow to the vocal cords, facilitating vocal communication.
Factors Influencing Speech
Several factors influence speech with a tracheostomy. Vocal cord health and function are primary considerations; paralyzed or damaged vocal cords make clear speech challenging even with proper airflow. Lung strength and capacity also play a role, as sufficient air pressure is required to generate sound. Limited lung function may make sustaining speech difficult.
The type and size of the tracheostomy tube also impact speech capabilities; many tracheostomy tubes have an inflatable cuff that seals against the tracheal wall. If this cuff is inflated, it prevents air from passing around the tube to the vocal cords, making speech impossible. Therefore, for speech to occur, the cuff must be deflated, or a cuffless tube must be in place. Any upper airway obstruction above the tracheostomy site, such as swelling or scar tissue, can also impede the passage of redirected air to the vocal cords. A person’s general health, cognitive status, and coordination of breathing and speaking efforts also affect their success with verbal communication, and speech-language pathologists evaluate these factors and provide tailored strategies to facilitate speech.
Alternative Communication Methods
For individuals with a tracheostomy who find spoken communication difficult or impossible, various alternative methods are available. Simple tools like pen and paper or a small whiteboard can facilitate written communication. Electronic devices like tablets or smartphones can be used for typing messages or accessing communication applications.
Communication boards, featuring pre-printed letters, words, or pictures, provide another effective option. Individuals can point to these symbols to construct sentences or express common needs. Non-verbal cues, including head nods, eye movements, and body language, are important and convey messages. Augmentative and alternative communication (AAC) devices, from simple voice output to eye-tracking systems, can generate speech or display messages, offering solutions for those who cannot rely on their voice.