Speaking with a tracheostomy

After a tracheostomy, it is completely normal to feel unsure about speaking. At first, you might not be able to talk at all, which can be frustrating or even frightening. However, there are ways to help you communicate, and many people do regain their ability to speak. This page provides insights and guidance on regaining your ability to speak.

How a tracheostomy affects your ability to speak

A tracheostomy alters the way air flows through your throat. Speech happens when air moves from your lungs through your larynx (voice box) and vocal cords, then out through your nose and mouth. This airflow vibrates the vocal cords to create the sound of your voice. With a tracheostomy tube placed below the voice box, depending on the type of tracheostomy tube in place, it bypasses the vocal cords, making it difficult to speak and often changes voice quality, volume, and clarity.

Key factors that influence speech after a tracheostomy

Everyone’s journey is different, but there are a few factors that can affect how soon and how well you will be able to speak. These factors include: your overall health and breathing strength, any swelling or injury around your vocal cords, and your ability to tolerate tools and techniques designed to help with speech, such as one way speaking valves and the type of tracheostomy tube you have.

If your tracheostomy tube has the cuff inflated, then no airflow will be able to reach your vocal cords. A cuffless tubes may allow some air through, while fenestrated tubes have holes that help air reach the upper airway. The diameter of your tracheostomy tube also matters - narrower tubes may let more air travel around the tube and up to the voice box, whereas wider tubes can restrict airflow, making speech more difficult.

Overcoming speech challenges

Losing the ability to speak after a tracheostomy can be frustrating and isolating. It may take time to regain your voice, and the changes you experience may be temporary or sometimes permanent. With the right tools and support, many people with a tracheostomy can regain the ability to communicate effectively.

How to restore communication after a tracheostomy 

After a tracheostomy, speech may not be possible immediately; however, alternative communication tools can help you stay connected with those around you. Your healthcare team will help choose the best option based on your needs, considering your general condition, the type of tube you have in place, and whether you use a ventilator.

Remember, this can be a slow process, so be patient, practice, seek support, and acknowledge progress.

The role of speech therapy and your healthcare team in voice recovery

You won’t be doing this alone; voice habilitation after a tracheostomy often involves a multidisciplinary team. A speech-language pathologist (SLP) will work closely with you to check how your vocal cords are working, and will then create a tailored plan using exercises, techniques, and assistive devices to improve speech.

Alternative methods of communicating

Augmentative and Alternative Communication (AAC)

If speaking isn’t possible right away, there are other ways to express yourself. You might use sign language, gestures, or mouthing words. Furthermore, there are helpful tools, such as computers or mobile phone applications that convert text to speech, also speech amplification systems, and communication boards with icons and pictures. These tools can help you share your thoughts, ask questions, and stay involved in your care and can be particularly helpful during the early stages of recovery, or if your recovery is slower than anticipated.

Digital occlusion or capping

Covering the end of the tracheostomy tube with a finger prevents air from coming out of the tube and redirects it upwards through the vocal cords. This technique may not be suitable for everyone, and it is important to minimize the risk of infection by using surgical gloves. An occlusion cap offers a hands-free option to redirect airflow, though it increases breathing resistance and may be difficult to tolerate. For both methods, ensure the tracheostomy cuff is deflated; otherwise, you will not be able to breathe.

Electrolarynx

An electrolarynx is a handheld external device that has a vibrating head that you press against your neck or face to vocalize. The vibrating sound is then shaped by the tongue and lips and converts into understandable speech. For those who cannot use this device on their neck, an oral adapter can be placed in the corner of the mouth.

This video will give you an idea of what it sounds like when you speak with an electrolarynx.

Above Cuff Vocalization (ACV)

Above Cuff Vocalization (ACV) is a technique used to enable voice production in patients who cannot tolerate cuff deflation. A trained healthcare professional performs ACV by delivering a low flow of gas or oxygen above the cuff via the subglottic suction port.

One-Way Speaking Valves

One-Way Speaking Valves are devices that can be placed on the end of your tracheostomy tube. This device will allow air to be inhaled through the tube, but on exhalation the valve closes and redirects the air upwards through the vocal cords causing them to vibrate and produce sound. Some are suitable only for those breathing independently, while others work with mechanical ventilation. To use a one-way valve, your tracheostomy tube should have a deflated cuff or be cuffless; otherwise, you will not be able to breathe.

Learn more:

  • Wallace S, McGowan S, Sutt AL. Benefits and options for voice restoration in mechanically ventilated intensive care unit patients with a tracheostomy. J Intensive Care Soc. 2023 Feb;24(1):104-111.
  • Gentile MN, Irvine AD, King AM, Hembrom AS, Guruswamy KS, Palivela NE, Langton-Frost N, McElroy CR, Pandian V. Enhancing Communication in Critically Ill Patients with a Tracheostomy: A Systematic Review of Evidence-Based Interventions and Outcomes. Tracheostomy. 2024;1(1):26-41.
  • McGrath B, Lynch J, Wilson M, Nicholson L, Wallace S. Above cuff vocalisation: A novel technique for communication in the ventilator-dependent tracheostomy patient. J Intensive Care Soc. 2016 Feb;17(1):19-26.
  • Ten Hoorn S, Elbers PW, Girbes AR, Tuinman PR. Communicating with conscious and mechanically ventilated critically ill patients: a systematic review. Crit Care. 2016 Oct 19;20(1):333.
  • Hernández Martínez, G., Rodriguez, M.-L., Vaquero, M.-C., Ortiz, R., Masclans, J.-R., Roca, O., Colinas, L., de Pablo, R., Espinosa, M.-C., Garcia-de-Acilu, M., Climent, C. and Cuena-Boy, R., 2020. High-flow oxygen with capping or suctioning for tracheostomy decannulation. New England Journal of Medicine, 383(11), pp.1009-1017.
  • Lian S, Teng L, Mao Z, Jiang H. Clinical utility and future direction of speaking valve: A review. Front Surg. 2022 Sep 8; 9:913147.

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