Among the most dreaded aspects of tracheostomy in the past was its interference with speaking. Fortunately, those days are virtually over, and no one need fear loss of speech just because of a trach (although severe bulbar muscle weakness can end speaking ability).
Various devices, such as the popular Passy-Muir speaking valve, can make speech with a trach nearly normal. This valve, invented in the 1980s by David Muir, who had muscular dystrophy and a trach, has a simple, but elegant, design.
When the trach user inhales air from the ventilator, a small, circular valve that’s attached to the trach tube opens; when the user exhales, the valve closes. When it closes, it prevents air from escaping out through an exhalation valve and instead forces it upward so that it passes over the vocal cords, allowing speech.
To allow air to move up past the trach tube to the vocal cords (see illustration), there has to be enough room around the tube — provided by deflating the trach’s balloon-like "cuff," if there is one — or there has to be a hole in the upper surface of the tube (called a fenestration).
Rita Yorke has a cuffed, fenestrated trach tube and a Passy-Muir valve. The cuff is designed to help keep food and liquid from sliding downward around her trach tube.
Even when it’s inflated, the fenestration allows air to move up to her vocal cords when she exhales. "They can’t shut me up," she says.