A tracheostomy is a surgically created opening in the front of the neck into the windpipe (trachea). This opening, called a stoma, allows air to reach the lungs when the normal breathing pathway is blocked. A tracheostomy tube is inserted into this stoma to maintain the airway. While this procedure provides an alternative for breathing, many individuals with a tracheostomy can learn to speak, though it requires specific techniques or devices.
Understanding Speech After Tracheostomy
Normal speech involves a coordinated process. Air from the lungs travels up the windpipe and passes through the vocal cords in the larynx. As air moves past them, the vocal cords vibrate, creating sound, which is then shaped into words by the tongue, lips, and soft palate.
A tracheostomy tube is positioned below the vocal cords, altering airflow. Instead of exhaled air passing through the vocal cords, it is redirected out through the tracheostomy tube, bypassing the larynx and preventing vocal cord vibration and speech. Individuals with an inflated cuff on their tracheostomy tube are unable to speak because the cuff seals the airway, directing all airflow out through the tube.
Methods for Speaking with a Tracheostomy
Several methods enable speech for individuals with a tracheostomy by redirecting airflow past the vocal cords.
Speaking Valves
Speaking valves, such as the Passy-Muir Valve, are one-way valves that attach to the tracheostomy tube. They allow air to enter the lungs during inhalation but close during exhalation, preventing escape through the tube. This redirects exhaled air upwards, around the tracheostomy tube and through the vocal cords, allowing speech. For speaking valves to function, any inflatable cuff on the tracheostomy tube must be completely deflated to allow exhaled air to pass around the tube and through the upper airway.
Finger Occlusion
Finger occlusion involves placing a gloved finger over the end of the tracheostomy tube during exhalation. This temporary blockage forces exhaled air to flow around the tube and up through the vocal cords for speech. Like speaking valves, the cuff must be fully deflated for this method to be effective.
Specialized Speaking Tracheostomy Tubes
Specialized speaking tracheostomy tubes are another option. Some tubes feature a port that allows air to pass above an inflated cuff to the vocal cords. This enables speech even when the cuff remains inflated, beneficial for patients requiring an inflated cuff, such as for managing aspiration. While an alternative, voice quality may be softer, sometimes described as a whisper.
Factors Influencing Speech and Communication
Many factors influence speech with a tracheostomy. The condition of the vocal cords is important; if damaged, paralyzed, or impaired, producing clear speech may be difficult, even with appropriate airflow. Adequate lung capacity and respiratory muscle strength are essential to generate sufficient airflow and pressure to vibrate vocal cords and sustain speech.
Cognitive ability plays a role in forming thoughts into words and coordinating speech. The type and size of the tracheostomy tube can affect speech; a tube that is too large may restrict air passage around it, hindering vocal cord vibration even with a deflated cuff. Overall health and stamina impact energy levels for speaking, as it requires effort. Environmental factors, such as excessive noise, can further challenge communication.
Speech and Communication Support
Speech-language pathologists (SLPs) play a role in helping individuals with tracheostomies regain communication abilities. SLPs conduct assessments to evaluate speech and swallowing functions, considering vocal quality and breath control. They develop personalized treatment plans based on this evaluation.
Speech therapy includes exercises to improve breath support, vocal cord function, and articulation. SLPs guide patients in coordinating breathing with speech and selecting appropriate speaking methods or devices, such as speaking valves. They educate patients and caregivers on device use and maintenance.
While the focus is on restoring verbal speech, SLPs also address alternative communication strategies for individuals with initial or long-term verbal communication difficulties. These include non-verbal methods like writing, communication boards, or text-to-speech applications. Education for the patient and family about tracheostomy management and communication strategies is also important, fostering confidence and participation.