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Ways to Achieve Vocalization with a Tracheostomy
Covering the tube
Having the patient cover the tube by holding a finger or placing a cap over the tube for short periods of time can be considered a solution. This may, however, cause increased resistance to breathing that is intolerable to some patients. Contaminants from the hand or fingers may introduce infection into the body, a particularly critical problem for patients with aspiration problems. Some patients may get enough air for speech without blocking the tube, but may not have the awareness, muscle movement or muscle tone to make a good occlusion.
As an alternative, a variety of valves are available that can be attached to the tracheostomy tube. These valves allow air to enter via the tube, and exit through the mouth and nose. Use of certain valves is also reported to have secondary benefits of reducing secretions, increasing the sense of smell, reducing aspiration, facilitating decannulation (tube removal) in patients for whom tracheostomy is not permanent, and increasing oxygenation of blood in the arteries. Because all valves do not produce the same quality of speech or the same secondary benefits, a valve for a specific patient should be selected based on the scientific and clinical results.