Your voice is a big part of your identity – it’s how you express your thoughts, feelings and ideas. Your voice is produced by vocal cords located within the voice box. During exhalation, the air passes through the vocal cords, producing sound for your voice. The sound then travels to your mouth and you move your lips, teeth and tongue to produce meaningful speech.

After a tracheotomy, you will breathe through a tracheostomy tube in your neck and either no or less air with pass through your nose and mouth. This will depend on the type of tube you have and also the reason for your tracheostomy. This will therefore mean that your ability to speak will be affected.

If your cuff is deflated or you have a cuffless tube there may be some air passing around the tracheostomy tube and through your vocal cords during exhalation, producing a whispery, weak voice. There are different ways to direct more air through the vocal cords during exhalation to produce a stronger and better voice. Your clinician may also provide you with a fenestrated tracheostomy tube which also helps to produce a stronger voice.

Manual occlusion

There are special HMEs with a top that you can push or cover with a finger to occlude when exhaling. This then directs air up through the vocal cords that typically results in a stronger voice.

Speaking valve

A speaking valve is a device that you wear on top of your tube enabling hands-free speech. The speaking valve contains a membrane that is open when you inhale and is closed when you exhale. This means that you will always breathe in through the tube but out through your upper airways. You should never use a speaking valve with a cuffed tube.

Speaking with a cuffed tracheostomy tube

To direct the air through the vocal cords with a cuffed tube you need to have the cuff deflated, enabling air to pass through. Always check with your clinician to assess if it is safe and appropriate to deflate your cuff.


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