Tracheostomy and communication

Also called Trache, Trachy, Speaking valve

A tube in the windpipe takes air away from the voice box. Speaking valves, cuff changes and plain alternatives can give the voice back.

What it is

A tracheostomy is an opening in the front of the neck with a tube into the windpipe, used to help someone breathe or to clear secretions. It can be for a few weeks in intensive care or for life.

Voice needs air passing up through the vocal cords. A tracheostomy sends that air out through the tube instead, so most people with one can't make a sound. Their language and thinking are unaffected. The problem is purely mechanical, and that's why it can often be solved.

Who it can help

Adults and children on wards, in intensive care, in rehabilitation and at home with a long-term tube, and the families and nurses around them.

Whether speech is possible depends on the type of tube, whether the cuff can be deflated, whether the person can breathe around it, and on medical decisions only the team can make.

How it works

The cuff is a small balloon that seals the windpipe. With it inflated, no air reaches the voice box. When the team judges it safe to deflate, air can pass around the tube.

A one-way speaking valve lets air in through the tube and forces it out past the vocal cords, so the person can speak. Some people manage "leak speech" with the cuff down. Where neither is possible, mouthing, an alphabet board, writing, a hospital communication board or a talking app fill the gap. An electrolarynx helps some people.

Speech and language therapists assess for valves, usually alongside physiotherapy, and also assess swallowing, which a tracheostomy affects too.

Getting started

Ask the team on day one: can a speaking valve be considered, and when will speech and language therapy assess? Get the answer written in the care plan.

Put an alphabet board and a pen within reach straight away, and a call bell the person can actually use. Agree a yes and no signal. Ask closed questions and wait.

If the person has a tablet, a free talking board such as Fiducia Talk works offline in a hospital with poor signal.

Where to get help

The ward speech and language therapist is the key person, and the RCSLT explains their role. The National Association of Laryngectomee Clubs supports people with neck breathing, including some with long-term tracheostomies. ICUsteps supports patients and families after intensive care.