Tracheostomy and Ventilator Dependence

People who have breathing problems may have a tracheostomy and may also need breathing support from a mechanical ventilator. Speech-language pathologists, or SLPs, can help with the associated speech and swallowing problems. Visit ASHA ProFind to locate a professional in your area.

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About Tracheostomy and Mechanical Ventilation

When a person has trouble breathing, they may need surgery to help them. A doctor makes an opening in the person’s windpipe, also known as the trachea. This opening is called a tracheostomy. Air goes through a metal or plastic tube placed in the opening instead of through the person’s nose or mouth. The need for a “trach,” pronounced trayk, can be short term or permanent. Some people may also need breathing help from a breathing machine, known as a mechanical ventilator.

Impact on Speech

When you talk, air moves from your lungs up through your vocal folds. The air makes the vocal folds vibrate to produce sound that comes out of your mouth. You cannot speak this way when you have a trach. With a trach, air goes in and out through the opening in your neck and not up through the vocal folds. So, you cannot make sounds the same way.

Young children who need a trach do not get to practice making sounds. This can lead to speech and language delays.

There are ways to talk with a trach in place.

Ways to Talk with a Tracheostomy in Place

When you cover the trach tube opening with your finger, air can go up through the vocal folds to your mouth. You can use this air to speak. Not everyone can use this method. You may not have enough strength to speak. Or, you may not have the right type of trach tube for this way of speaking to work.

Some people with a trach tube may use a special device known as a speaking valve to help them speak. A speaking valve is put on the outside of your trach tube and lets air into the tube. It then closes so the air goes out through your mouth and nose. You can use this air to speak. You must have the right type of trach tube to use a speaking valve. You will be tested to make sure it is safe for you to use.

Talking with a Ventilator in Place

In some cases, help is needed from a breathing machine called a mechanical ventilator. You may have a ventilator attached to the trach tube to control your breathing. You can still talk if air can get through your vocal folds. However, your voice will sound different. The ventilator pushes air out of your body in cycles. In between each cycle, you will not have the air you need to speak. So, your speech may sound choppy or may get louder and softer. It may be possible to use a speaking valve with a ventilator.

Speech and Swallowing Treatment

If you have a tracheostomy or need a ventilator to help you breathe, an SLP will help with any speech, language, and swallowing problems. The SLP will work with your doctor and/or respiratory therapist to find ways for you to speak. The SLP can help determine if you are a good candidate for a speaking valve and can work with you to learn how to speak with it. They can help you find other ways to communicate if you cannot speak by using your finger to cover the trach tube opening or a speaking valve. These other ways of communicating may include writing, texting, pointing to pictures on a board, or using a computer. These options are also known as augmentative and alternative communication, or AAC.

Some people with a trach have difficulty swallowing. An SLP can help you learn how to eat and drink safely. This may include eating different types of food, swallowing in different ways, or participating in swallow treatment.  

See ASHA’s information for professionals on the Practice Portal’s Tracheostomy and Ventilator Dependence page.  

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