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