How does a tracheostomy tube affect voice and speech?

Speech and voice may be affected when a child has a tracheostomy tube because it re-routes all or some of the airstream away from the vocal cords.

How does a tracheostomy speaking valve work?

A tracheostomy speaking valve is a one-way valve that allows your child to breathe in through the tracheostomy tube, but not out.  When your child breathes out, the valve shuts, blocks the tube and redirects air out of the tracheostomy tube into your child’s airway to pass through the vocal cords and up out of the mouth and nose. This allows your child to produce voice and then speech as it passes out of the mouth and nose.

How will a tracheostomy speaking valve benefit my child?

The use of a speaking valve can benefit your child’s communication and speech development, as well as provide benefits for breathing and swallowing.

It does this by:

• Supporting production of voice – parents may be able to to hear their child cry and vocalise and infants can learn that they can make voice and develop early infant sounds such as cooing and babbling. This sound play prepares infants to use speech.
• Facilitating a louder voice (increase in volume).
• Being able to produce a more normal melody and rhythm of speech and better voice quality.

A speaking valve has benefits for breathing function as your child will be able to push air from the lungs, up through the throat and out of the mouth and nose. Benefits include:

• Children can learn to blow their nose properly (which helps prevent middle ear infections).
• Breathing air out of their nose/mouth may assist children in developing stronger breathing muscles. This better prepares them for decannulation – the removal of their tracheostomy tube.
• The speaking valve also allows children to clear secretions from their chest more easily and to develop a stronger cough response. This can also assist in decreasing the amount of their secretions.
• An increase in taste and smell sensations, as a result of increased sensation from the airflow.

A speaking valve also has benefits for swallowing by providing subglottal pressure during swallowing:

• During a swallow, the vocal cords close off and there is air pressure underneath the vocal cords. When a swallow finishes, this air is exhaled (breathed out) and any tiny amounts of food or fluid that might have entered the airway can be cleared by the exhaled air.
• The presence of a tracheostomy tube stops your child’s ability to form subglottal pressure underneath the vocal cords when he/she swallows. This might allow any tiny amounts of food or fluid to enter the airway during swallowing. This is called microaspiration.
• If your child is wearing a speaking valve during eating and drinking, it closes and stops air from escaping from the tracheostomy tube during swallowing. This allows subglottal pressure to build under the vocal cords and helps prevent microaspiration. It also assists your child to exhale after swallowing.

How do we assess whether my child is suitable for a tracheostomy speaking valve?

Generally, it is a team decision to allow your child to trial a speaking valve, assessing the following:

• Is your child medically stable?
• Does your child require less frequent suctioning?
• Does your child have a clear airway – for example, no granulation tissue or narrowing of the airway?
• Does your child have adequate space (also called ‘leak’) around the tracheostomy tube for air to pass around and travel up to the vocal cords, nose and mouth?

Not every child is able to wear a speaking valve. Children who may be unsuitable include those:

• Who require a ‘cuffed’ tracheostomy
• With severe tracheal stenosis
• With excessive secretions requiring frequent suctioning
• Who are unconscious/seriously ill

How will I know that my child is tolerating the speaking valve well?

• Easy breathing (chest moving in and out)
• Good/normal face and lip colour
• Does not fatigue (get tired) easily with the speaking valve in place
• Able to perform normal body activities such as sitting, rolling, crawling and walking
• Does not pop off the valve

Children often need to gradually increase the wearing time of the speaking valve in order to develop the strength of their respiratory (breathing) muscles. Your child should only wear the speaking valve when they are awake and when you are close by to watch their progress.

Cues indicating that your child is having difficulty with the speaking valve:

• Breathing difficulty (chest stops moving after one or two breaths)
• Grimacing, crying expression, tense body, back-arching or pushing back, arms and legs splayed
• Flushed colour in the face or dusky/pale
• Blue tinge around the lips or fingers
• Fatigues easily or gets lethargic very quickly
• Floppy body

Even if your child is just learning to use a speaking valve or tolerates it well, the speech pathologist may also use other types of communication such as signing or communication boards/apps as part of a total communication approach.

Who should I contact to talk about my child’s communication development?

You can contact your local speech pathologist to discuss where to best access services for your child. The speech pathologist will assess your child’s communication development in the context of any cognitive, sensory, physical or environmental factors and then make suitable recommendations.

For more information

See these other fact sheets in our Tracheostomy tubes series:
Tracheostomy tubes (general information)
Tracheostomy tubes: Feeding, eating and drinking
Tracheostomy tubes: Communication options

Contact us

Speech Pathology Department Queensland Children’s Hospital
t: 07 3068 2375
e: QCH-Speech@health.qld.gov.au

ENT Clinical Nurse Consultant / Clinical Nurse Queensland Children’s Hospital
t: 07 3068 1379
e: CHQ_CNC-ENT@health.qld.gov.au