Drilling speaking valves to promote phonation in tracheostomy-dependent children

Laryngoscope. 2012 Oct;122(10):2316-22. doi: 10.1002/lary.23436. Epub 2012 Jul 9.


Objectives/hypothesis: Placement of a Passy-Muir speaking valve is considered best practice for infants and children with a tracheostomy. The Passy-Muir valve enables phonation by redirecting exhaled air via the glottis. Poor tolerance of the Passy-Muir valve is associated with excessive transtracheal pressures on exhalation due to upper airway obstruction. Drilling a small hole in the side of the Passy-Muir valve creates a pressure relief port to allow partial exhalation through the tracheostomy tube while enabling phonation.

Study design: A retrospective case series is presented of 10 aphonic pediatric patients with a tracheostomy trialed with a drilled Passy-Muir valve.

Methods: Valve tolerance was assessed clinically and objectively. Handheld manometry was used to determine transtracheal pressures on passive exhalation. All patients had a diagnosis of upper airway obstruction and demonstrated excessive pressures wearing a standard Passy-Muir valve. Patients were assessed wearing a Passy-Muir valve with up to two 1.6-mm holes drilled in the side of the valve. Patients progressed to trials if clinically stable and if transtracheal pressure did not exceed 10 cm H(2) O when wearing the valve.

Results: Eight patients progressed to trial, with five of eight patients able to phonate within 1 week and six of eight able to tolerate wearing the valve for ≥ 2-hour periods within 2 weeks of introduction. All eight patients were able to phonate within 6 months of valve introduction.

Conclusions: These findings support drilling Passy-Muir speaking valves as a promising option to facilitate phonation in pediatric patients with a tracheostomy for upper airway obstruction.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Airway Obstruction / complications
  • Airway Obstruction / diagnosis
  • Airway Obstruction / physiopathology
  • Airway Obstruction / surgery*
  • Aphonia / etiology
  • Aphonia / physiopathology*
  • Aphonia / surgery*
  • Child
  • Child, Preschool
  • Equipment Design
  • Humans
  • Infant
  • Phonation*
  • Retrospective Studies
  • Tracheostomy / instrumentation*
  • Treatment Outcome