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Enhancing Communication with Tracheostomy Speaking Valves

Normal Voice Production

Audible voice relies on controlled airflow from the lungs passing through the vocal cords, which vibrate to produce sound. This sound is then shaped by resonance and articulation to form intelligible speech. When airflow is disrupted, the ability to generate voice is compromised, leading to significant communication challenges.

    Communication Challenges in Patients with Tracheostomy Tubes

    Patients who require a tracheostomy tube often experience communication barriers related to altered airflow through the upper airway, which may be further impacted by cuff inflation. An inflated cuff prevents airflow from passing through the vocal folds, resulting in the inability to produce an audible voice. Reduced airflow to the upper airway may also contribute to sensorimotor dysfunction, which may negatively impact secretion management and swallowing function.

    What Is a Speaking Valve?

    A speaking valve is a device that attaches directly to the 15 mm connector of a tracheostomy tube. It allows inhalation through the tracheostomy tube while redirecting exhaled airflow through the upper airway. During exhalation, air is directed around the tracheostomy tube, through the larynx, and out the mouth and nose.

    This restoration of expiratory airflow through the glottis enables phonation and enhances subglottic pressure and airway sensation, supporting speech as well as other physiological functions. Clinical studies and systematic reviews have shown that speaking valve use can improve quality of life, swallowing function, reduce aspiration risk, enhance breathing–swallow coordination, and support lung recruitment in appropriately selected patients1-5.

    Types of Speaking Valves

    Several types of speaking valves are available for patients with tracheostomies:

    • Fully closed valves redirect all exhaled airflow through the upper airway to support phonation. Full closure may be challenging for patients with weak respiratory muscles, partial airway obstruction, or a tracheostomy tube that occupies significant airway space.
    • Adjustable or partially open valves allow some airflow to escape, which can reduce air trapping and improve valve tolerance for some patients.
    • Valves with integrated heat and moisture exchangers (HME) can provide humidification in addition to restoring speech.

    Key Safety Considerations

    Before placing a speaking valve, it is essential to follow safety guidelines, adhere to product instructions for use (IFUs), and carefully assess patient suitability for placement and use.

    • Ensure the patient has a cuffless tracheostomy tube or a fully deflated cuff prior to valve placement.
    • Confirm airway patency before use.
    • Suction as needed before valve placement.
    • During initial trials, monitor respiratory status and vital signs to ensure patient safety and speaking valve tolerance.

    Phon Assist Speaking Valve

    Phon Assist is an adjustable-resistance speaking valve designed for spontaneously breathing patients. It restores airflow to the upper airway to improve voice production. It features two adjustable side openings that allow clinicians to customize breathing resistance during exhalation.

    Phon Assist

    • When the valve is fully closed, exhaled air is directed entirely through the upper airway.
    • When the valve is partially or fully open, a portion of the exhaled air escapes from the side openings, while the remainder is directed through the upper airway. The more the valve is opened, the less airflow passes through the upper airway. This may reduce exhalation resistance and minimize the risk of air trapping for some patients.

      Adjustable side openings

      Additional Features

      • Available with or without an integrated oxygen supply port
      • Can be used for up to 6 months
      • Attaches to the 15 mm connector on standard tracheostomy tubes
      • Available in transparent or orange for enhanced visibility
      • Suitable for use with both children and adults
      • Note: The tracheostomy cuff must be fully deflated prior to valve use.
      Tracoe Phon Assist I

      For educational materials and Guidelines for Phon Assist

      Let us contact you

      DualCare

      Speaking Valve & HME

      Freevent DualCare is a two-part system consisting of a speaking valve and a heat and moisture exchanger (HME).

      • Patients can switch easily between HME mode and speaking mode with a simple twist, without changing devices.
      • This integrated design supports both humidification and communication.

        Restoring communication and humidification is essential for patients with tracheostomy, as communication improves quality of life, and HMEs can reduce mucus viscosity, decrease coughing, and improve respiratory function5-8.

        HME Mode

        Speaking Mode

        Additional Features

        • Connects to 15 mm hub of a standard tracheostomy tube
        • Freevent HME can be used for up to 24 hours
        • Reusable speaking valve; clean and reuse for up to 2 months
        • Easily switch between HME and speaking mode
        • Available in beige and DualCare Blue for enhanced visibility
        • Note: The tracheostomy cuff must be fully deflated prior to valve use.
        DualCare
        Trachoestomy Care: A Speaking Valve with the Benefits of a Heat and Moisture Exchanger (HME)

        For educational materials and Guidelines for DualCare

        let us contact you

        Related Products and Accessories to Support Speech

        Freevent HME DigiTop is designed for use during sleep and attaches directly to the Freevent DualCare HME to provide humidification overnight. DigiTop can be manually occluded for speaking and should only be used with a cuffless tracheostomy tube or fully deflated cuff.

        Freevent HME DigiTop & DigiTop 02

        TrachPhone HME combines a heat and moisture exchanger with a push-to-speak valve, offering an alternative approach to restoring voice while maintaining airway humidification. For more information on TrachPhone, visit our dedicated Heat and Moisture Exchangers page.

        HMES FOR PATIENTS WITH A TRACHEOSTOMY

        Speech Valve

        References

        1. O’Connor LR, Morris N, Paratz J. Physiological and clinical outcomes associated with use of one-way speaking valves on tracheostomised patients: a systematic review. J Clin Epidemiol. 2018;98:59–70.
        2. Lian Q, Teng Y, Mao J, Jiang Q. Clinical utility and future direction of speaking valve: a review. [Journal/Publication details may vary]. 2022.
        3. Prigent H, et al. Effect of a tracheostomy speaking valve on breathing-swallowing interaction in tracheostomised patients. Egypt J Hosp Med. 2023;91(1):4445–4449.
        4. Cardoso PM, et al. Speaking valves in tracheostomised ICU patients weaning off mechanical ventilation: do they facilitate lung recruitment? Crit Care. 2016;20:265.
        5. Freeman-Sanderson AL, Togher L, Elkins M, Kenny B. Quality of life improves for tracheostomy patients with return of voice: A mixed methods evaluation of the patient experience across the care continuum. Intensive Crit Care Nurs. 2018;46:10–16.
        6. Van den Boer C, Lansaat L, Muller SH, van den Brekel MW, Hilgers FJ. Comparative ex vivo study on humidifying function of three speaking valves with integrated heat and moisture exchanger for tracheotomised patients. Clin Otolaryngol. 2015;40(6):616–621.
        7. De Kleijn BJ, van As-Brooks CJ, Wedman J, van der Laan BFAM. Clinical feasibility study of Protrach DualCare, a new speaking valve with heat and moisture exchanger for tracheotomized patients. Laryngoscope Investig Otolaryngol. 2017;2(6):453–458.
        8. Wong CY, Shakir AA, Farboud A, Whittet HB. Active versus passive humidification for self-ventilating tracheostomy and laryngectomy patients: a systematic review of the literature. Clin Otolaryngol. 2016;41(6):646–651.

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