How to Speak with a Tracheostomy

After a tracheostomy you may find yourself cut-off from the rest of the world because you are no longer able to communicate with others through speech. However, you can learn ways to speak with a tracheostomy. It just takes practice. There are even speaking devices that may help you.

Speaking with a Tracheostomy Tube

Air passing through vocal cords (larynx) causes them to vibrate, creating sounds and speech. A tracheostomy tube blocks a lot of the air from passing through the vocal cords. Instead the air you breathe goes out through your tracheostomy tube.

At the time of your surgery, the first trach tube you will be given will have a balloon (cuff) that sits in your trachea. When the cuff is inflated and filled with air it creates a seal to keep air from leaking past the teach tube, but it’s going to prevent air from moving through your vocal cords. This will stop you from making noise or speech.

If the cuff is deflated, the air can move around the trach, into the upper airway and through your vocal cords, and you should be able to make sounds. However, after 5 to 7 days the trach will be changed into a smaller, cuffless trach. This will make speaking much easier.

Getting Started

If your tracheostomy has a cuff, it will need to be deflated. When the cuff is deflated and air can pass around your trach, you should try to speak and make sounds. It’s best to that your caregiver decide when to deflate your cuff. Speaking is going to be harder than before you had your trach. You will need to apply more force to push the air out through your mouth.

Here’s How:

  1. Take a deep breath in.
  2. Breathe out, using more force than you generally would to push the air out.
  3. Seal off the trach tube opening using your finger and then speak.

You might not hear much initially, but you will build up the strength to push the air out using your mouth, as you practice the sounds you make will get louder.

It is important that you place a clean finger over the trach to stop air from exiting through the trach. This helps the air move out through your mouth to produce voice. Be sure that your hands are clean so as not to introduce harmful bacteria into the trachea that can find it’s way into your lungs.

Speaking Valves

Passy-Muir Low Profile Tracheostomy & Ventilator Swallowing & Speaking Valve

Passy-Muir Low Profile Tracheostomy & Ventilator Swallowing & Speaking Valve

If it’s difficult to talk with a trach in place, special devices can assist you learn to create sounds.

One-way valves, called speaking valves, are placed onto your trach tube. Speaking valves allow air to enter through the tube and exit through your mouth and nose. This will allow you to speak easier without having to place your finger over the trach tube to block it each time you talk.

Some patients may not be able to use a speaking valve. If you have severe upper airway obstruction or a risk of aspiration, a large amount of secretions, impaired cognitive status, severe medical instability, or inability to tolerate cuff deflation, a speaking valve may not work for you. The speech therapist will work along with you to ensure you are a good candidate to use one.

If a speaking valve is positioned on your trach tube and you have trouble breathing, the valve may not be allowing enough air to move around your trach. If this happens the width of the tracheostomy tube may be a factor. If the tube takes up too much space inside your throat, there may not be enough room for the air to pass around the trach tube.

It is important to keep the speaking valve clean and clear of secretions to avoid mucus plugs. It should be cleaned with warm water and mild, fragrance-free soap, rinsed thoroughly, air-dried, then replaced in its storage container.

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