Speech for People with Tracheostomies or Ventilators

What is a Tracheostomy?

A tracheostomy is a surgical opening in the windpipe (trachea). This is done by an incision in the neck just below the Adam’s apple/vocal cords. A tube is placed in the opening through which the air moves in and out, allowing breathing through the tube rather than the mouth and the nose. A tracheostomy is short-term for some, but long-lasting and permanent for others.

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What happens when a person has a tracheostomy?

There are structures that heat and dampen air and filter air-borne debris when an individual breathes. These structures also cause coughing, sneezing, smelling, tasting, and swallowing. The Tracheostomy allows the air to flow without passing by these structures of the mouth and nose. A buildup of fluids and discharge in the lungs can be caused by additional debris. Suction through the tracheostomy tube can clear these bodily discharges. Issues involving smell, taste, and swallowing can reduce appetite and food consumption. Food and discharges can enter the lungs (aspiration) and potentially cause pneumonia or choking.

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What impact does a tracheostomy have on speech?

People who have a tracheostomy experience a difference in speech. It is more difficult to produce sound due to the air no longer passing through the vocal folds. In some cases, the individual may be able to make some sound, but will run out of air quickly.

This can sometimes lead to frustration when family members and caregivers cannot understand what the individual needs or wants. The individual may feel alone during a time of dramatic change.

Young children with tracheostomies cannot explore making sounds. Because of this, social interactions that are crucial to the development of language skills may be restricted. Caregivers tend to talk less to children who are unable to communicate. These children are then deprived of the model needed to discover the use of language.

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How do people with tracheostomies communicate?

There are various options for speaking with a tracheostomy. The tube that is placed into the tracheostomy can be plain or have an inflatable cuff. There is a greater seal in the throat when the cuff is pumped than with the plain tubes. A tight seal allows for more air to enter the lungs, but may also prevent the movement of enough air to the vocal folds. This can make speech rather difficult.

People with a plain tube or who may only need the cuff inflated at certain times (for example, during eating or sleeping) could possibly get enough air required for speech. They may also be able to speak by blocking the tube with their fingers or hand, making it possible for the person to breathe through their mouth and nose as they did before surgery, which vibrates the vocal folds and allows for speech.

These methods, however, may not work for every individual. Some people may not be able to handle the resistance to breathing that results from covering the tube. Infection may also be caused by the bacteria from the hand or fingers. This is an especially seriou situation for individual with issues swallowing. Some individuals may not be able to properly block the tube due to a lack of awareness, muscle movement, or muscle tone required.

A number of valves are available that can be attached to the tracheostomy tube. These valves can allow for air to enter through the tube, but exit through the mouth and nose. The use of certain valves can also provide the following benefits:

  • reduce secretions
  • increase the sense of smell
  • reduce aspiration
  • facilitate tube removal in people who do not need the tracheostomy permanently
  • increase the amount of oxygen in the blood

Because different valves result in different quality of speech and benefits, a should be chosen for a specific individual based on his or her own needs.

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What impact does having a ventilator have on speech?

For some individuals, a tracheostomy tube alone may not be sufficient. The tube may need to be connected to a breathing machine (ventilator) to provide a combination of gases for life support. Individuals on ventilators can only speak if the tracheostomy tube allows air to flow through the vocal folds. However, the speech patterns of ventilator users may vary.

Because of the ventilator’s design, air must be pushed out of the body in order for speech to occur (expiratory cycle). There is a period of silence until the next cycle of the ventilator. During this silence, the individual may lose their turn to speak as others fill the silence with their own words. The disruption of the normal rhythm of conversations may make it difficult for the listener to follow the individual’s communication.

The individual’s speech my suddenly become louder or softer. Their voice may suddenly sound different. This is caused by pressure in the trachea from the ventilator that is not constant, the way it is in typical speech. Making simple adjustments to ventilator settings may improve the individual’s speech on the ventilator, especially if there are no other problems besides insufficient breathing. speaking valve available that can be used with a ventilator.

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