Devices, such as the Passy-Muir positive closure speaking valve, are one-way valves that are easily placed on the end of a cuffless, deflated tracheostomy tube.  The one way valve remains open during inhalation, allowing air to enter the lungs.  Upon exhalation, the valve closes.

  1. Benefits
    • Permits natural voicing, uninterrupted phonation, increased length of utterance, louder vocal intensity, and normal speech patterns
    • Used for patients on or off the ventilator, with a physician's order and participation of a respiratory therapist
    • Reduces secretions and makes them easier to manage, requiring less suctioning
    • Facilitates cough and oral expectoration
    • Facilitates swallowing by increasing the pharyngeal pressures needed to move the food bolus down the pharynx and into the esophagus
    • Restores sense of smell and taste, increasing appetite and facilitating nutritional intake
    • Reduces infection in the patient by eliminating the need for digital occlusion
    • Facilitates decannulation by:
      • Eliminating the need to cap or plug the tracheostomy tube
      • Building patient confidence and reducing anxiety
      • Expediting the decannulation process

  2. Contraindications include:
    • Severe upper airway obstruction
    • Tenacious pulmonary secretions
    • Incompatibility with foam filled, cuffed tracheostomy tube
    • Decreased cognitive status

The PoinTIS Speech Therapy site of the SCI Manual for Providers is based on information in Mason MF. Speech Pathology for Tracheostomized and Ventilator Dependent Patients. Newport Beach, CA, Voicing, 1993, and information in Hoit JD and Shea SA. Speech production and speech with a phrenic nerve pacer. American Journal of Speech-Language Pathology 1996 5(2):53-60 May.