Following a new tracheostomy, patients will often be managed with a cuffed tube and the cuff will be inflated. This means that no airflow is directed up and out past the vocal cords through the larynx (voice box), and no vocalisation is possible. Following a laryngectomy, the voice box has been removed.
Having no voice, or difficulties in vocalising, can lead to anxiety for patients, difficulty in participating in treatment decisions, a lack of engagement or motivation with care and anxieties and difficulties for families, carers and healthcare staff. We know that these problems can persist in up to 25% of patients that require long-term mechanical ventilation. Swallowing difficulties often coexist with vocalisation problems.
Fortunately, strategies and procedures exist to help patients communicate with new or established tracheostomies or laryngectomies. Being able to vocalise can transform care through the gift of speech, but getting the larynx working again can have benefits for secretion management, swallowing, coughing and breathing.