Tracheostomy tube - speaking

Tracheostomy Tubes and Speaking

Air passing through vocal cords(larynx) causes them tovibrate, creating sounds and speech.

A tracheostomy tube blocks most of the air from passing through your vocal cords. Instead, your breath (air) goes out through your tracheostomy tube (trach).

Most trachs have a balloon (cuff) that lies in your trachea. 

• If the cuff is inflated (filled with air), it will prevent air from moving through your vocal cords. This will stop you from making noise or speech. 
• If the cuff is deflated, the air is able to move around the trach and through your vocal cords, and you will be able to make sounds. 

Practicing

If your tracheostomy has a cuff, it will need to be deflated.Your caregiver should make the decision about when to deflate your cuff.

When the cuff is deflated and air can pass around your trach, you should try to talk and make sounds.

Speaking will be harder than before you had your trach. You may need to use more “force” to push the air out through your mouth. 

• Take a deep breath in. When you breath out, push the air out using more force than you normally would.
• You may not hear much at first. Yet, with practice, you can build up the strength to “push” the air out through your mouth and make louder sounds.

When you are first learning, place a clean finger over the trach to prevent air from exiting through the trach. This will also help the air go out through your mouth. 

Speaking Valves

If it is hard to speak with a trach in place, special devices can help you learn to create sounds.

One-way valves, called speaking valves, are placed onto your tracheostomy. Speaking valves allow air to enter through the tube and exit through your mouth and nose. This will allow you to make noises and speech more easily. 

Some patients may not be able to use these valves. If a speaking valve is placed on your trach, and you have trouble breathing, the valve may not be allowing enough air to pass around your trach.

Other Factors to Think About

The width of the tracheostomy tube may play a role. If the tube takes up too much space in your throat, there may not be enough room for the air to pass around the tube.

Your trach may be fenestrated. This means the trach has extra holes built into it. These holes allow air to pass through your vocal cords. They can make it easier to eat and breathe with a tracheostomy tube.

It may take much longer to develop speech if you have: 

• Vocal cord damage
• Injury to the vocal cord nerves, which can change the way the vocal cords move

Alternate Names

Trach - speaking

Update Date: 3/14/2012

Updated by: Seth Schwartz, MD, MPH, Otolaryngologist, Virginia Mason Medical Center, Seattle, Washington. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M. Health Solutions, Ebix, Inc.