Procedures: Tracheostomy

Tracheostomy is a surgical procedure involving opening the windpipe to the front of the neck for airflow. Below is some information for educational purposes regarding tracheostomy. Consult your physician for medical advice, and review this site disclaimer.

What is a tracheostomy?

A tracheostomy is a surgical procedure that involves creating an opening in the front of the neck, specifically in the trachea (the windpipe), to facilitate breathing. This procedure is typically performed in situations where a person has difficulty breathing through the mouth or nose due to various medical conditions, such as prolonged respiratory failure, airway obstruction, or severe neck injuries.

During a tracheostomy, a tube is inserted into the opening, allowing air to bypass obstructions in the upper airway, ensuring that the individual can breathe more easily. The tracheostomy tube can be temporary or permanent, depending on the underlying condition and the patient's needs.

Post-operative care is essential to prevent complications such as infections or dislodgment of the tube. Patients with a tracheostomy may require assistance in managing their airway and ensuring that the tube remains clear. Depending on the patient's condition, speech therapy may also be recommended to help them regain their ability to speak.

Can a person speak after undergoing tracheostomy?

Yes, a person can speak after undergoing a tracheostomy, with a few exceptions.

For a person to speak, air must be directed through the vocal cords. A tracheostomy tube allows air to pass from the opening in the neck to the lungs, bypassing the vocal cords. Thus, with a tracheostomy tube in place, speech depends on air passing from the lungs outside of the tracheostomy tube, up to the level of the vocal cords. This typically requires something to temporarily block air from passing out through the lumen of the tracheostomy tube as well as adequate space within the trachea for air to pass up the trachea to the vocal cords in the space between the tracheostomy tube and the tracheal wall.

Some tracheostomy tubes have a balloon (or “cuff”) on them for the purpose of blocking air from passing outside the tracheostomy tube. This is often necessary in the first few days after tracheostomy tube placement and with use of a ventilator machine.

One common method to facilitate speaking with a tracheostomy tube in place is to use a speaking valve, which is a device that can be placed on the external portion of the tracheostomy tube. This valve allows air to flow in through the tracheostomy tube, but prevents air from flowing out through the tube. By temporarily blocking exhaled air from passing through the tracheostomy tube, instead allowing it to pass through the vocal cords, sound may be generated.

The wall of the trachea is often swollen for a few days after the surgical placement of a new tracheostomy tube, and this swelling must resolve before speaking can occur.

Usually, individuals with a tracheostomy maximize their ability to speak with practice and speech therapy.

What are the reasons for needing a tracheostomy?

A tracheostomy is a surgical procedure that creates an opening in the neck to place a tube directly into the trachea (windpipe). There are several reasons for needing a tracheostomy, including:

1. Airway Obstruction: Conditions such as tumors, severe inflammation, swelling or foreign objects can block the airway. A tracheostomy can provide an alternate route for air to enter and exit the lungs.

2. Prolonged Mechanical Ventilation: Patients requiring long-term mechanical ventilation often need a tracheostomy for airway access, easier breathing, and less discomfort compared to a breathing tube passing through the mouth.

3. Neurological Conditions: Conditions that impair respiratory function, such as spinal cord injuries, stroke, or neuromuscular disorders, may necessitate a tracheostomy to ensure adequate ventilation.

4. Severe Respiratory Distress: In situations where there is severe respiratory distress or failure, a tracheostomy may help stabilize the patient and provide better management of respiratory needs.

5. Facilitating Secretions Management: Patients with conditions that cause excessive airway secretions may benefit from a tracheostomy to help clear mucus and maintain an open airway more effectively.

6. Injury or Trauma: Injuries to the head, neck, or chest that compromise the airway may require a tracheostomy as an emergency intervention.

7. Certain surgical procedures: Procedures for which the surgeon requires access to the mouth or throat without a breathing tube in the way necessitate a tracheotomy tube.

8. Congenital Abnormalities: Some individuals are born with conditions that affect the upper airway, making a tracheostomy necessary to ensure proper breathing.

9. Chronic Respiratory Conditions: Patients with chronic obstructive pulmonary disease (COPD), cystic fibrosis, or other long-term lung diseases may require a tracheostomy for ongoing respiratory support.

Each case is evaluated individually to determine whether a tracheostomy is the appropriate intervention, taking into account the patient’s overall health and specific medical needs.

Is a tracheostomy permanent?

A tracheostomy is not necessarily a permanent procedure. It involves creating an opening in the neck to place a tube directly into the trachea (windpipe) to assist with breathing. The duration of the tracheostomy can vary based on the underlying medical condition that necessitated the procedure.

In some cases, a tracheostomy may be intended for short-term use, such as in patients recovering from severe respiratory issues or those needing prolonged ventilation support. In these instances, once the patient's condition improves, the tracheostomy can often be closed, allowing the patient to breathe normally again.

Conversely, for individuals with chronic respiratory problems, neurological conditions, or other long-term health challenges, a tracheostomy may be required for an extended period or even indefinitely. A healthcare provider will assess the patient's situation regularly to determine the appropriateness of keeping the tracheostomy or transitioning to another method of airway management.

How is a tracheostomy different from a laryngectomy?

A tracheostomy and a laryngectomy are both medical procedures related to the airway but serve different purposes and involve distinct anatomical changes.

A tracheostomy involves creating an opening in the trachea (windpipe) through the neck to facilitate breathing. This procedure is typically performed in patients who have obstruction or severe respiratory distress. The tracheostomy may be temporary or permanent, depending on the patient's condition. A tube is often inserted into the opening to maintain airway patency and allow for ventilation.

In contrast, a laryngectomy is a surgical procedure that involves the removal of the larynx (voice box). This procedure is most commonly performed in patients with laryngeal cancer. Following a laryngectomy, the airway is rerouted, creating a permanent stoma in the neck for breathing, since the normal passage through the larynx and throat is no longer available. Patients who undergo this procedure typically lose their natural voice and require alternative methods for speech, such as using an electrolarynx, or esophageal/tracheoesophageal speech.

In summary, while both procedures involve the airway, a tracheostomy is a temporary or sometimes permanent opening in the trachea for breathing, while a laryngectomy is the permanent removal of the larynx, resulting in significant changes to a patient’s respiratory and vocal capabilities.

How is a tracheostomy different from a cricothyroidotomy?

A cricothyroidotomy is an emergency procedure that involves making an incision in the neck slightly higher than used for a tracheostomy. This procedure is usually performed when immediate airway access is needed. A cricothyroidotomy may be undertaken in an emergency because it can allow faster establishment of an airway with less risk of bleeding. The cricothyroidotomy is typically a temporary solution and may only be used for a short period. If a surgical airway is still needed after a few days, a cricothyroidotomy is usually converted to a tracheostomy.

Mucus production and coughing

Coughing up mucus occurs for several weeks after surgical placement of a tracheostomy tube, This owes to the irritation of the trachea by the tracheostomy tube and the trachea’s normal response to generate mucus and a cough in response to the presence of a foreign body. This effect diminishes over time.

Avoiding accidental removal of the tracheostomy tube

Accidental removal of a new tracheostomy tube can be catastrophic—causing loss of the airway. For this reason, a new tracheostomy tube is typically sutured in to place and secured with a tie around the neck. After about 3-5 days, depending on the situation, the sutures may be removed, relying on the trach tie around the neck to prevent accidental removal. After a tracheostomy tube has been in place for several weeks, it has typically matured to the point that removal of the tracheostomy tube is less of a threat. At this stage, the mature tracheostomy tract is less likely to be lost without the tracheostomy tube, and the tube may usually be replaced.

As a reminder, this website is for educational purposes only and is not medical advice. Patients should seek advice of their doctor and call 9-1-1 in case of an emergency.

Can a person eat and drink with a tracheostomy tube?

Yes, after a week or so, on average, a person with a new tracheostomy tube is usually able to eat and drink safely.

Initially, when a tracheostomy tube is new, the swallowing mechanism will be altered with swelling, discomfort, pressure on the esophagus if the cuff is inflated. Additionally, a normal swallow requires the development of air pressure in the trachea—something that we do not think about when swallowing, but very helpful. In order to allow development of air pressure within the trachea, it is often necessary for a speaking valve (described above) to be in place.

In order to avoid aspiration (spillage of solids or liquids from the throat into the trachea) and consequent pneumonia, a speech pathologist typically evaluates and advises the physicians on swallowing progress and safety. This process may involve bedside instruction as well as various. swallowing evaluations.

Of course, if a patient is sedated and using a ventilator for mechanical ventilation, eating and drinking by mouth is not possible. Also, the reason for the tracheostomy, such as a throat tumor or trauma, may delay time to resuming an oral diet.