Communicating when a tracheostomy tube is in placeCCommunicating when a tracheostomy tube is in placeCommunicating when a tracheostomy tube is in placeEnglishRespiratoryChild (0-12 years);Teen (13-18 years)Lungs;TracheaRespiratory systemNon-drug treatmentCaregivers Adult (19+) Hospital healthcare providersNA2017-06-29T04:00:00ZReshma Amin, MD, FRCPC, MSc;Faiza Syed, BHSc, RRT;Tuyen Tran, RRT000Flat ContentHealth A-Z

 

 

Communicating when a tracheostomy tube is in place2969.00000000000Communicating when a tracheostomy tube is in placeCommunicating when a tracheostomy tube is in placeCEnglishRespiratoryChild (0-12 years);Teen (13-18 years)Lungs;TracheaRespiratory systemNon-drug treatmentCaregivers Adult (19+) Hospital healthcare providersNA2017-06-29T04:00:00ZReshma Amin, MD, FRCPC, MSc;Faiza Syed, BHSc, RRT;Tuyen Tran, RRT000Flat ContentHealth A-Z<figure><img src="https://assets.aboutkidshealth.ca/akhassets/tracheostomy_speaking_valve_on_child_EN.jpg" alt="A child with a speaking valve on their tracheostomy" /> </figure> <h2>How do we produce our voice?</h2><p>We produce our voice with the help of:</p><ul><li>a “power source” (air)</li><li>a “vibrator” or main sound source (the larynx)</li><li>“resonators” (the throat, nose, mouth and sinuses).</li></ul><p>As air moves from our <a href="/Article?contentdi=2911&language=English">lungs​</a>, it passes through the larynx and between the vocal folds. The vocal folds are open when we breathe in or out but closed when we hold a breath.</p><p>When we speak, the vocal folds vibrate (that is, they open and close very quickly). This produces sound. This sound is affected by the shape of the throat, nose, mouth and sinuses (together known as the resonator tract).</p><p>The combination of air, vocal fold vibration and resonance (in the resonator tract) creates our unique human sounds — our voices. We then can produce a wide variety of different speech sounds (words) using our palate, tongue, teeth and lips.</p><h2>Voice and communication with a tracheostomy tube</h2><p>When a <a href="/Article?contentid=2916&language=English">tracheostomy tube</a> is placed, most of the air goes out through the tracheostomy tube instead of passing through the vocal folds. Because of this, a person with a tracheostomy tube cannot produce sound, although you may hear some sounds as air escapes around the tube.</p><p>Several factors may influence whether your child can produce vocalizations (speech sounds) with a tracheostomy tube. These may include:</p><ul><li>the degree to which their airways are blocked</li><li>whether their vocal cords and vocal folds are working properly</li><li>the size of your child’s tracheostomy tube and if there is a cuff (that is, a balloon at the end of the tube)</li><li>how much air goes around the tracheostomy tube and past the vocal folds.</li></ul><p>Some children may not be able to produce speech sounds, at least not at first. In these cases, a speech-language pathologist (SLP) can work with you and your child to help develop the best methods of communication. Even if your child is not able to produce speech sounds, speech-language therapy is still very important for helping your child's communication and development.</p><h2>What is a speaking valve?</h2> <figure><img src="https://assets.aboutkidshealth.ca/akhassets/IMD_trach_talkingcap_EN_72original.jpg" alt="A speaking valve attached to a tracheostomy tube" /><figcaption class="asset-image-caption">A tracheostomy tube speaking valve is sometimes called a talking cap.</figcaption> </figure> <p>A speaking valve, for example a Passy Muir valve™ (PMV), is a one-way valve connector that is placed on the end of your child’s tracheostomy tube to allow your child to speak.</p><h2>How does a speaking valve work?</h2><p>The speaking valve allows your child to breathe in through the tracheostomy tube and breathe out through the vocal folds, mouth and nose, which allows your child produce vocalizations and speech.</p><p>The valve opens while your child breathes in and then closes. If your child's tracheostomy tube is cuffed, the cuff must be deflated to allow the air your child breathes out to pass through the vocal folds, mouth and nose rather than the tracheostomy tube.</p><h2>What are the benefits of using a speaking valve?</h2><p>Using a speaking valve can:</p><ul><li>improve your child’s speech and tone</li><li>improve your child’s swallowing, cough strength and ability to clear <a href="/Article?contentid=2927&language=English">secretions</a></li><li>improve your child’s sense of smell and taste</li><li>help keep your child’s lungs inflated</li><li>improve your child’s quality of life and overall development</li><li>help wean your child from the tracheostomy tube and/or <a href="/Article?contentid=2937&language=English">ventilator</a> (if applicable)</li><li>help your baby vocalize (for example, cry, coo and babble), which is an important step to speech and improves parent/child bonding.</li></ul><p>Your child will get the most benfit from a speaking valve if they work with a speech-language pathologist on communication training.</p><h2>Who can use a speaking valve?</h2><p>Not all children with tracheostomies will benefit from a speaking valve. An assessment will be done in the hospital or clinic to see if a speaking valve is safe for your child.</p><p>In general, children with tracheostomies who use a speaking valve:</p><ul><li>are awake, responsive and attempting to communicate</li><li>are medically stable, for example, their medications, routines, ventilator settings and other treatments are stable</li><li>are able to tolerate having the tracheostomy tube cuff deflated (if applicable)</li><li>do not have an excessive amount of mucus, which can block the speaking valve</li><li>have space between the tracheostomy tube and the trachea for air to move up to the vocal cords </li><li>have a safe swallow and are not at a significant risk of aspiration (letting food or liquids enter their trachea). This may need to be confirmed with a swallow study.</li></ul><h2>When should I use a speaking valve with my child?</h2><p>Your child's healthcare team will work with you to put together a recommended daily schedule for using the speaking valve with your child.</p><p>The length of time the speaking valve is worn will gradually increase. With increased comfort and familiarity (and approval from your healthcare team), your child may wear the speaking valve when eating and/or drinking.</p><h2>When should I not use a speaking valve?</h2><ul><li>Do not use a speaking valve when your child is asleep.</li><li>Do not use the speaking valve if your child is sick; their <a href="/Article?contentid=2962&language=English">oxygen saturation levels</a> decrease and secretions increase.</li><li>Do not use the speaking valve when your child is receiving a <a href="/Article?contentid=2951&language=English">medicated aerosol or nebulizer treatment​</a>.</li><li>Do not use the speaking valve if it feels uncomfortable for your child. Some days it might be comfortable, but other days it might not be.</li></ul><h2>What are the possible risks of using a speaking valve?</h2><p>When your child first uses the speaking valve, they may cough more and/or experience respiratory distress (breathing difficulties). </p><p>Increased coughing can occur because, at first, the flow of air through the upper airway will feel different. In addition, mucus will move into the upper airway for clearance.</p><p>As your child practises and becomes more comfortable with the valve, they will be better able to bring secretions into the upper airway and clear them. This will reduce their coughing. </p><p>Respiratory distress may occur if secretions are allowed to build up in the speaking valve. Always check that no secretions are blocking the inside of the valve before you place it back on the tracheostomy.</p><p></p><div class="caution"><h3>Precautions</h3><p>Remove the speaking valve immediately if:</p><ul><li>your child is experiencing an increased respiratory rate (faster breathing)</li><li>your child's nostrils are flaring</li><li>you see skin pulling around your child's neck or ribs</li><li>your child's skin is pale</li><li>your child appears frightened</li><li>there is a blue colour around your child's fingernails or mouth.​​</li></ul></div><h2>Are there different types of speaking valves and adjuncts?</h2><p>Several types of speaking valves are appropriate for children. Passy-Muir<sup>®</sup> ​is the main provider of speaking valves within Ontario.</p><div class="asset-3-up"> <figure> <img src="https://assets.aboutkidshealth.ca/akhassets/trach_speaking_valve_01_EN.jpg" alt="A speaking valve" /> <figcaption class="asset-image-caption">A speaking valve</figcaption> </figure><figure> <img src="https://assets.aboutkidshealth.ca/akhassets/trach_speaking_valve_02_EN.jpg" alt="Inline ventilator speaking valves" /> <figcaption class="asset-image-caption">Inline ventilator speaking valves</figcaption> </figure><figure> <img src="https://assets.aboutkidshealth.ca/akhassets/trach_speaking_valve_03_EN.jpg" alt="A tracheostomy speaking valve" /> <figcaption class="asset-image-caption"> A tracheostomy speaking valve with an oxygen connector</figcaption> </figure> </div><h2>How long should a speaking valve last?</h2><p>Each speaking valve is guaranteed to last at least two months. However, you may need to replace a valve sooner if it:</p><ul><li>becomes sticky and doesn't work properly</li><li>vibrates</li><li>becomes noisy, even after cleaning.</li></ul><p></p> <a class="btn btn-primary" href="https://www.aboutkidshealth.ca/trachvent">Return to trach-vent learning hub</a><br>Communicating when a tracheostomy tube is in placeTruehttps://www.aboutkidshealth.ca/Article?contentid=2970&language=Englishhttps://www.aboutkidshealth.ca/Article?contentid=2968&language=English

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