Enhancing Tracheostomy Care: The Impact of One-Way Speaking Valves  

For individuals living with a tracheostomy, the ability to speak can be challenging, potentially impacting communication with others and quality of life. In this blog, we will dive deeper into the mechanics of one-way speaking valves, explore their numerous benefits which extend beyond solely speech, and discuss their practical use in the care of tracheostomized patients. Join us as we talk with a clinician and discover how these devices are making a difference in the lives of those living with a tracheostomy.

Nicole Albertsson is a Speech-Language Pathologist with 7 years of experience working in different hospital settings throughout the USA including Oregon, Hawaii, Utah, and North Carolina. She has specialized in dysphagia and head and neck cancer and truly enjoys working with this patient population. Nicole also enjoys the multidisciplinary work involved in medical Speech Pathology. Nicole currently lives in Sweden and is working as a consultant for Atos Medical.

Can you describe what a one-way speaking valve is?

A one-way speaking valve is a device that can be coupled with a tracheostomy tube. It opens to allow airflow through the tracheostomy tube on inhalation but closes off to prevent airflow through the tracheostomy tube on exhalation. This allows tracheostomized patients to communicate verbally and can provide many other benefits in addition to voicing. ⁴ Naturally, we breathe in through our nose and mouth and air passes through the larynx to our lungs. When we exhale, air passes back through the larynx including the vocal folds which vibrate to create sound, then out through our mouth and nose which form the sound into words. A tracheostomy tube bypasses the upper airway so air flows in and out below the vocal cords, making it difficult, if not impossible to vocalize. With one-way speaking valve use, a person can still have the benefits of breathing in through the tracheostomy tube, but upon exhalation, air can be redirected around the tracheostomy tube and out through the vocal folds, mouth and nose so the patient can produce voice. There are multiple different types of one-way speaking valves including biased-open and biased-closed valves, and valves with a humidification function. Additionally, some one-way valves can be placed in-line with a ventilator so a person can speak while on a ventilator.

How are one-way speaking valves utilized in the care of tracheostomized patients?

One-way speaking valves are placed on patients with tracheostomies who are deemed an appropriate candidate after assessment by the treating clinician. They can be utilized to help improve secretion management, cough function, swallowing function, and voicing.^1,3 Often, one-way valves can be utilized as a step in the process of weaning ventilator support and preparing the patient for decannulation.⁴

What criteria must a patient meet to be considered for a one-way valve?

A patient must be able to tolerate cuff deflation with stable oxygen saturations and a stable respiratory rate. Additionally, a patient cannot have an upper airway obstruction that prevents exhalation through the mouth and nose. If an upper airway obstruction is present, a one-way valve will allow for inhalation through the tracheostomy tube, but the patient will be unable to completely exhale, causing air to become trapped and build up under the obstruction, known as air trapping. A patient must also be able to tolerate the one-way speaking valve with stable oxygen saturations, respiratory rate, and heart rate over time. Candidates need to have fine motor and cognitive skills to remove and replace the speaking valve independently, and if not, be under constant supervision of a trained caregiver during device use.

Are there any specific contraindications or risks associated with the use of one-way valves?

As mentioned above, the largest risk associated with one-way valves is air trapping which can be a result of upper airway obstruction (including too large of a tracheostomy tube, swelling, mass, vocal fold paralysis, etc.), or inadequate respiratory status with inability to exhale adequately around the tracheostomy tube through the upper airway, the consequences of which could be an adverse respiratory event or potentially fatal to the patient. To help avoid this, an airway assessment should be performed by a clinician prior to use.

What are the common challenges patients face when adapting to a one-way valve, and how can they be addressed?

There are many different challenges patients can face when adapting to one-way valves. Initially, patients are often not used to airflow through the upper airway, especially if they have been intubated and on a ventilator for a prolonged period or have had their tracheostomy tube for a while. This can lead to irritation, coughing, discomfort, and fatigue when airflow is restored. Often this is resolved relatively quickly as the patient becomes used to airflow again and can be managed by increasing the use of the valve over time if needed. I’ve experienced that patients report feeling improvements in their breathing with continued use of one-way valves due to the restoration of natural airflow. Additionally, patients initially can have difficulty placing and removing the one-way valve as it is unfamiliar and often the tracheostomy is new. This can be improved with practice and training or by using a mirror.

What are the benefits of using a one-way valve in tracheostomy patients?

Applying a one-way biased valve after cuff deflation aids in laryngeal rehabilitation by restoring airflow to the upper airway on exhalation and providing a small amount of increased resistance.⁴ This is beneficial in re-establishing more natural pulmonary pressure including PEEP, restoring subglottic pressure, and supporting glottic closure and laryngeal stimulation which can improve secretion management, coughing, swallowing, olfaction, and voicing.^2-4

How does the use of a one-way valve influence the overall quality of life for tracheostomy patients?

In my experience, I have seen one-way speaking valves play a significant role in improving the overall quality of life for tracheostomy patients. Patients with a tracheostomy can have a very difficult time, especially when in the hospital. In a situation with limited control, the inability to communicate verbally can be detrimental and increases that lack of control. Often patients have a difficult time communicating even basic wants and needs. Some patients also don’t have the ability to write and rely on communication boards or gestures to communicate. One’s voice and communication is such a big part of their personality as well. Restoring voice is a large step for patients who are recovering. I’ve experienced that the ability to vocalize needs and desires greatly improves a patient’s quality of life and their ability to receive the best care. Additionally, improvements in swallowing function and eating/drinking I’ve often witnessed greatly enhance their quality of life. The best part of my job is when I have a patient who has not been able to verbally communicate, and they tolerate a speaking valve and are able to speak for the first time in a while. It is even more special when a relative hears their loved-one’s voice. It is a big motivation for those recovering and often leads to happy tears all around.

For more information on this topic, explore our One-Way Speaking Valves page.

Any recommendations in this educational material are a general guide for best practice, to be implemented by qualified healthcare professionals subject to clinical judgement and availability of healthcare resources.
The information presented should not be considered medical advice for specific conditions. A patient’s individual circumstances and preferences should always be considered and clinical practice should be in accordance with the principles of protection, participation and partnership.

References

• Schwegler, H. (2022). Trachealknülenmanagement (4. Auflage). Schulz-Kirchner Verlag.
• Skoretz SA, Anger N, Wellman L, Takai O, Empey A. A systematic review of tracheostomy modifications and swallowing in adults. Dysphagia. 2020 Dec;35:935-47.
• O’Connor LR, Morris NR, Paratz J. Physiological and clinical outcomes associated with use of one-way speaking valves on tracheostomised patients: A systematic review. Heart & Lung. 2019 Jul;48(4):356–64
• Wallace S, McGowan S, Sutt AL. Benefits and options for voice restoration in mechanically ventilated intensive care unit patients with a tracheostomy. J Intensive Care Soc. 2023 Feb;24(1):104-111. doi: 10.1177/17511437221113162. Epub 2022 Jul 10. PMID: 36874291; PMCID: PMC9975806