Quick Summary
Yes, it is often possible to talk with a tracheostomy tube and ventilator in place. However, speech may be challenging and require assistive devices. Methods to enable speech with a trach tube include:
- Using a talking tracheostomy tube with an integrated speaking valve
- Using a speaking valve that attaches to a standard trach tube
- Using a one-way speaking valve
- Using a tracheostomy button with a speaking valve
- Using aspeaking valve with manual occlusion of the trach tube
Factors like the size and position of the tracheostomy tube, airflow through the vocal cords, and strength of respiratory muscles impact speech ability. With practice and speech therapy, many people on ventilators can regain functional speech.
What is a Tracheostomy?
A tracheostomy is a surgical procedure where an opening (stoma) is created in the anterior neck and a trach tube is inserted into the trachea (windpipe) to facilitate breathing. Reasons for needing a tracheostomy include:
- Upper airway obstruction
- Need for prolonged mechanical ventilation
- Severe respiratory distress
- Inability to clear secretions
- Upper airway trauma
- Certain neurologic conditions
The trach tube bypasses the upper airway and allows air to flow directly into the lungs through the stoma. It also allows secretions to be suctioned out.
Trach tubes come in various shapes and sizes. Cuffed tubes have a balloon-like cuff that can be inflated to create a seal within the trachea. Uncuffed tubes do not have a sealing cuff.
How Tracheostomies Impact Speech
Normal speech occurs when air from the lungs passes through the vocal cords in the larynx causing them to vibrate and produce sound. This sound is then shaped into words by structures like the tongue, teeth, lips, and palate.
With a tracheostomy, the upper airway is bypassed so air cannot reach the vocal cords. This prevents normal speech. However, with the aid of special one-way speaking valves, speech can often be restored.
Methods to Enable Speech with a Trach Tube
There are several techniques and devices that allow speech with a tracheostomy tube:
Speaking Tracheostomy Tubes
Special tracheostomy tubes are available with a built-in speaking valve within the inner cannula. These function as a one-way valve – air can pass through during inhalation but is directed up through the vocal cords during exhalation, enabling speech. Examples include:
- Portex® Blue Line Ultra® Tracheostomy Tube
- TRACOE® Twist Plus System
Speaking Valves
These devices attach to a standard tracheostomy tube to enable speech. There are different types:
- One-way speaking valves only allow air flow on inspiration so that during exhalation air is redirected through the upper airway. This allows vocal cord vibration. Examples: Passy-Muir® Valve, Blom Tracheostoma Valve.
- Fenestrated speaking valves have a small opening that allows some air to exit through the trach tube during exhalation while some air goes through the vocal cords. This maintains safe airway pressures. Example: Passy-Muir® Fenestrated Valve.
Tracheostomy Buttons
These devices can be placed over a trach stoma once the need for a trach tube subsides. ThePassy-Muir® Valve can then be attached to the button to enable speech.
Manual Occlusion
Some patients can achieve speech by manually occluding or plugging the opening of the trach tube with a finger during exhalation. This redirects air through the vocal cords.
Considerations for Speech with a Trach
Several factors impact the ease and success of speech with a tracheostomy:
- Trach tube size and position – Smaller tubes positioned closer to the vocal cords tend to enable better speech.
- Adequate vocal cord airflow – Sufficient air must reach the vocal cords with adequate force to produce speech sounds.
- Vocal cord mobility – Paralysis or paresis of the vocal cords impairs speech.
- Respiratory muscle strength – Strong respiratory muscles allow better exhalation through the vocal cords.
- Supplemental oxygen needs – High oxygen needs can make speech difficult.
- Secretion management – Excess secretions can block the vocal cords.
- Swallowing ability – Dysphagia makes use of speaking valves riskier.
Patients with very high ventilator needs or poor respiratory drive may not be good candidates for speaking valves. For others, patience and practice using speaking aids can improve vocal communication.
The Process of Voice Restoration with a Trach
For many patients, use of speaking valves and speech restoration is attempted in the following stages:
Assess Readiness
To determine if speaking valves can be trialed safely, factors like oxygenation, respiratory secretions, swallowing status, respiratory drive, and ventilation needs are evaluated.
Test Tolerance of Speaking Valve
Initially, the speaking valve is applied and monitored for brief periods to assess its effects on oxygenation and respiratory distress. This ensures the patient can handle the increased airway resistance.
Use Speaking Valve Intermittently
The speaking valve is then applied for increasing lengths of time each day. It is removed at night and when respiratory secretions need to be cleared.
Use Continuously During Day
Once tolerated well during the day, the speaking valve is left on continuously except during times needed for suctioning or tracheostomy tube changes.
Decannulation Trial
If ventilator support is no longer needed, the trach tube may be removed (decannulated) and the stoma can close. Speech continues through the upper airway.
Speech Language Therapy
Speech therapy by a qualified speech-language pathologist is an important part of the voice restoration process. Goals include:
- Assessing speech and swallowing ability
- Determining appropriate speaking valves and aids
- Maximizing intelligibility of speech
- Increasing vocal intensity and duration
- Coordinating breathing, speech, and swallowing
- Assessing safety and communicating methods
- Counseling and educating the patient/family
With regular speech therapy, patients can make significant gains in communication ability. Alternative augmentative communication methods like alphabet boards or electronic voice output devices can also be used short-term.
Special Considerations for Mechanical Ventilation
For patients on mechanical ventilators via a tracheostomy tube, additional considerations come into play:
Ventilation Modes and Settings
Some ventilation modes like pressure support ventilation (PSV) allow more spontaneous breathing compared to fully controlled modes. PSV and modes permitting longer exhalation times enable better use of speaking valves.
Monitoring Airway Pressures
Peak inspiratory and expiratory airway pressures need to be monitored closely when speaking valves are used to avoid unsafe pressure build up in the lungs.
Alarm Settings
Ventilator alarms may need adjustment when speaking valves are applied to prevent unwanted triggering.
Humidification
Adequate humidification prevents thick secretions from obstructing the speaking valve. This may require a heated humidifier.
Suctioning
Routine suctioning clears secretions so they do not block the speaking valve.
Sedation
Less sedation enables better tolerance of speaking valves and more vocalization. But agitation may require more sedation.
With close monitoring and the right settings, mechanically ventilated patients can often utilize speaking valves successfully.
Examples of Speech Aids for Ventilator-Dependent Patients
Here are some examples of devices that can help restore speech in ventilator-dependent patients:
One-Way Speaking Valves
- Passy-Muir Valve
- Blom Tracheostoma Valve
Fenestrated Speaking Valves
- Passy Muir Fenestrated Valve
Specialized Trach Tubes for Speech
- TRACOE Twist Plus
- Portex Blue Line Ultra Suctionaid
Cuffless Trach Tubes
- Bivona Fome-Cuf Tube
Tracheostomy Buttons
- Passy-Muir Tracheostomy Button
Electrolarynx Devices
- TruTone Electrolarynx
With the help of speech-language pathology experts, ventilator patients can explore these and other speech aids to enable vocal communication.
Frequently Asked Questions
Can you talk with a trach?
Yes, speech is often possible with a trach tube using special speaking valves and aids. Vocal communication may be effortful at first but can improve significantly with devices and speech therapy.
How soon can you talk after getting a trach?
Attempts at speech can usually begin within a few days after a trach procedure once any swelling subsides. The timing depends on the patient’s overall condition. Gradual reintroduction of speaking valves helps build tolerance.
Does a trach affect your voice permanently?
Not necessarily. With vocal rehabilitation, patients can regain functional speech, though the voice may sound slightly hoarse or weak compared to pre-trach. Some vibration and volume can be lost from scarring.
Can you whisper with a trach?
Whispering doesn’t work well with a trach tube since it requires vocal cord vibration. Speaking valves are needed to direct air through the vocal cords for audible speech of any kind.
How do mute people talk with a trach?
For mute patients, mouthing of words and assistive communication devices are used for expression rather than speaking valves. Special tracheostomy tubes with an adjustable suction opening can enable communication.
Key Takeaways
- Using specialized speaking valves and trach tubes, speech is often possible with a tracheostomy.
- One-way valves redirect exhaled air through the vocal cords to produce speech sounds.
- Smaller tracheostomy tubes and proper cuff inflation improve speech.
- Adequate respiratory drive and airway conditioning enable better voice.
- With practice and speech therapy, vocal communication can improve substantially.
- For ventilator-dependent patients, close monitoring and ventilator adjustments are needed.
With the right tools and techniques, people with tracheostomies can regain the ability to communicate vocally. A team approach helps optimize outcomes.
