Talking tracheostomy tubes permit vocalization with the cuff inflated (Figure 38-1).14-16 Positive airway pressure and airway protection are maintained. Examples are Bivona's tracheostomy tube with talk attachment, Portex's "Trach-Talk" tracheostomy tube, and Implant Technologies' "Communi-Trach I." These have a cuff inflation line and speaking port. The speaking port is a small bore tube, set into the curvature of the tracheostomy tube and stopping just above the cuff. The external end has a two-way connector. One end is connected to compressed gas at a flow rate of 4 to 8 L/min. Air flows into the trachea above the cuff and retrogrades through the vocal cords, allowing vocalization. During vocalization, the other end of the connector is occluded. The liter flow required for an audible voice may be different for each patient. Patients must understand that the quality will be different from their normal voice, usually at a lower pitch. The patient must be instructed to speak in short sentences; with long sentences, the voice will drift off to a whisper, due to the continuous flow of gas through the vocal cords. Common problems with these appliances are poor voice quality and occlusion of the talk port with secretions. The talk port can be cleared with a 50%-50% solution of saline and acetylcysteine (Mucomyst). Another complication is the potential for the compressed airflow to escape
through the tracheal stoma or into the pretracheal tissue. Thus, it is advisable to wait one or more days after tube placement to permit the stoma to close down before the talking option is used. Secretions that are pooled above the cuff can be removed by the application of a suction to the "talk port." It is important to monitor the potential for aspiration. This can be accomplished by the administration of blue-dyed ice chips via the oral route with suctioning through the talk port. This is only a rough guide to the degree of aspiration; the swallowing function must be evaluated more fully.
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