DEFLATE THE CUFF!
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For the methods described here, any cuff
must be deflated, -as much as possible. Even a deflated cuff can take up space
in the airway, limiting the airflow available to speech. Because of this, it’s
best to deflate the cuff as much as possible.
Speaking valves
_Speaking valves are the most common method
of restoring voice following a tracheostomy. These may also be used in-line
with a ventilator in some cases. Although a speaking valve provides excellent
voice restoration, these valves are not appropriate for all patients. Your
doctor/SLP staff will determine if you are a candidate for a speaking valve and
select the most appropriate valve for you. In this practice, there are two main
types of speaking valves prescribed/utilized.
Passy-Muir Speaking Valve (PMV)_
The PMV is a speaking valve placed as a
cap, over the end of the tracheostomy tube. There are various versions,
although the technical function is the same across valves.
The PMV is the most commonly used speaking valve in this practice for the many benefits its “positive closure” design offers. Although other speaking valves exist, this is the only one with the “positive closure” feature. The “positive closure” valve means that the valve remains closed until a sufficient amount of inhalation pressure is applied. In contrast, other speaking valves close in response to exhaled air pressure, otherwise they remain open to some degree. There are several benefits to the positive closure design for our patients.
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Shikani Speaking Valve
_Although the PMV is preferred for its
positive closure design, for those patients that are unable to tolerate it, the
Shikani Speaking Valve may provide a viable option, especially for the head
& neck cancer patients.
This valve is designed with a small plastic ball that forms the valve and the valve itself can be configured different ways to allow for more easy breathing through the tube vs easier valve closure for talking. As a result, this valve design can be better tolerated by those patients who are unable to breath comfortably with the PMV. |
Alternatives to Speaking Valves
Finger occlusion
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For tracheostomy patients not breathing with the help of a
ventilator, the finger occlusion technique is the quickest, easiest and least
expensive way to restore speech. For this method, simply use your finger to
seal the end of the tube when you want to talk. This will divert the air
through the vocal cords (instead of exiting out the tube). After speaking,
remove your finger to allow for normal respiration through the tracheostomy.
This technique, however, should only be used when the hands are clean as bacteria can easily be introduced from the fingers to the tube, presenting a potential for infecting the airway and lungs. Click on image to enlarge |
_ Specialty Tubes
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There are certain tracheostomy tubes
designed with the sole purpose of allowing for oral speech when more
traditional options are not possible. The SLP staff will work with you to
ensure your optimal communication/swallowing status and can discuss the
potential benefits of these tube options as appropriate. Typically speaking,
however, the vast majority of patients can achieve a functional communication
status without the need of a specialty tube for this purpose.
Electrolarynx
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Although not commonly used, an
electrolarynx is an option for producing speech following a tracheostomy.
Although speech methods that use the patient’s own voice (produced by the vocal
cords) is always preferred, there may be times when this is not possible. For
example, in the event the larynx
(voicebox) is not functioning properly, or if the patients is unable to
have enough airflow through the vocal cords to produce their own voice, then an
electrolarynx is an option.
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