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    Category: Communication options

    Blom Tracheostomy Speech Cannula

    Blom Tracheostomy Tube System

    The Blom Tracheostomy Tube System (Pulmodyne) is a specialized tracheostomy tube which can allow adults to vocalize either with the cuff inflated or deflated.  This…

    tracheducation February 28, 2022
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    Communication Tracheostomy

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    The decision for tracheostomy placement for a person with ALS is personal. Find out information on timing of tracheostomy, swallowing management and …
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    learn tracheostomy for kids

    Learning About Tracheostomy for Kids: Trachie-O Teaches Children!

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    Tracheostomy Education April 8, 2021
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    speech therapy for tracheostomy

    Speech Therapy for Kids with Trachs

    Children with tracheostomy may have difficulty producing voicing. Here are speech therapy techniques and tools to help improve speech, voicing and a…
    Tracheostomy Education April 28, 2020
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    ventilator application of speaking valve

    Ventilator Application of Speaking Valves

    Assessment, trouble-shooting and advanced placement techniques of a speaking valve in-line with mechanical ventilation.
    tracheducation March 10, 2019
    Passy-Muir Speaking Valves

    Speaking Valves

    Review the different types of speaking valves and benefits for those with tracheostomy and mechanical ventilation: Passy-Muir, Shiley, Shikani, and Mo…
    tracheducation March 10, 2019

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    This information has been collected and designed to help in clinical management, the authors do not accept any responsibility for any harm, loss or damage arising from actions or decisions based on the information contained within this website and associated publications. Ultimate responsibility for the treatment of patients and interpretation of these materials lies with the medical practitioner / user. The opinions expressed are those of the authors. The inclusion in this publication of material relating to a particular product or method does not amount to an endorsement of its value, quality, or the claims made by its manufacturer.

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    Forum Description

    Types of Speaking Valves

    In the previous section on communication options, we reviewed different types of ways an individual with tracheostomy may speak such as mouthing words, writing, communication boards, electrolarynx, assistive technology, leak speech, finger occlusion, talking tracheostomy tubes, speaking valves and flap valves.  

    Here we will review the different types of speaking valves on the market for patients with tracheostomy tubes and the differences between them.  Each individual resident is different and one valve may be more appropriate than another based on patient comfort, benefits and goals. 

    • Start Course Communication Tracheostomy 0 Lessons

      Nonverbal Communication for Individuals with Tracheostomy and Mechanical Ventilation

      tracheducation 0% Complete 0/0 Steps Individuals with tracheostomy and mechanical ventilation with an inflated cuff are unable to produce voicing, and many do not speak for an extended period of…
    • Start Course Tracheostomy communication webinar 19 Lessons

      Tracheostomy Communication Options: Mechanically Ventilated and Non-Ventilated Patients Webinar

      tracheducation 0% Complete Last activity on April 25, 2022 Verbal Communication Options for Patients with Tracheostomy and Mechanical Ventilation Webinar is a 2 hour recorded course that provides the available speech options including cuff deflation, fenestrated tracheostomy tubes, talking tracheostomy tubes (above the cuff ventilation), speech cannulas, and speaking valves.  The course will provide suggestions for patient candidacy and how to implement each option.  Determine cuff deflation status for each approach and ways to assess airway patency.  The learner will also be provided with techniques and ventilator manipulations to improve voicing.  Videos with demonstrations of patients will supplement the course.  There will be case studies to help determine the ideal option.  Free sample protocols are provided as well as a communication quick reference form. Course presenter: Nicole DePalma, MS CCC-SLP Nicole is the owner of NDoscopy Dysphagia Specialists, a mobile FEES (flexible endoscopic evaluation of swallowing) company contracting with skilled nursing, acute care, long term acute and subacute facilities in the New York and New Jersey.  Her areas of expertise include dysphagia management and management of critically complex patients including tracheostomy and mechanical ventilation.  She is also a Clinical Consultant for Passy-Muir, Inc. providing education nationwide. Disclosures: Financial: Ms. DePalma received payment for this course through Tracheostomy Education. Nonfinancial: Nicole is a clinical consultant for Passy-Muir, Inc. Course Format: Video Powerpoint with author narration and video samples Course Certificate is provided upon completion.    
    • Start Course Communication Tracheostomy 0 Lessons

      Nonverbal Communication for Individuals with Tracheostomy and Mechanical Ventilation

      tracheducation 0% Complete 0/0 Steps Individuals with tracheostomy and mechanical ventilation with an inflated cuff are unable to produce voicing, and many do not speak for an extended period of…
    • Start Course Tracheostomy communication webinar 19 Lessons

      Tracheostomy Communication Options: Mechanically Ventilated and Non-Ventilated Patients Webinar

      tracheducation 0% Complete Last activity on April 25, 2022 Verbal Communication Options for Patients with Tracheostomy and Mechanical Ventilation Webinar is a 2 hour recorded course that provides the available speech options including cuff deflation, fenestrated tracheostomy tubes, talking tracheostomy tubes (above the cuff ventilation), speech cannulas, and speaking valves.  The course will provide suggestions for patient candidacy and how to implement each option.  Determine cuff deflation status for each approach and ways to assess airway patency.  The learner will also be provided with techniques and ventilator manipulations to improve voicing.  Videos with demonstrations of patients will supplement the course.  There will be case studies to help determine the ideal option.  Free sample protocols are provided as well as a communication quick reference form. Course presenter: Nicole DePalma, MS CCC-SLP Nicole is the owner of NDoscopy Dysphagia Specialists, a mobile FEES (flexible endoscopic evaluation of swallowing) company contracting with skilled nursing, acute care, long term acute and subacute facilities in the New York and New Jersey.  Her areas of expertise include dysphagia management and management of critically complex patients including tracheostomy and mechanical ventilation.  She is also a Clinical Consultant for Passy-Muir, Inc. providing education nationwide. Disclosures: Financial: Ms. DePalma received payment for this course through Tracheostomy Education. Nonfinancial: Nicole is a clinical consultant for Passy-Muir, Inc. Course Format: Video Powerpoint with author narration and video samples Course Certificate is provided upon completion.    
    Tracheostomy cuff must be completed deflated All speaking valves connect to the universal 15mm hub of the tracheostomy tube. If the tracheostomy tube has a cuff, the cuff must be completely deflated. The patient will be unable to breathe if a valve is placed with an inflated cuff.

    Passy-Muir Tracheostomy and Ventilator Swallowing and Speaking Valves (PSMV)

    Passy-Muir Speaking Valves
    Images curtesy of Passy-Muir, Inc. Irvine, CA.

    The Passy-Muir Tracheostomy & Ventilator Swallowing & Speaking Valve is often referred to the shortened name of Passy-Muir Valve or by the acronym PMV or PMSV.  PMV is the term for prolonged mechanical ventilation and therefore if an acronym is used in a medical setting PMSV is preferred to reduce confusion.  

    The Passy-Muir Valve was invented by David Muir.  David had muscular dystrophy and required a tracheostomy and mechanical ventilation.  He was unable to speak.  In a time of frustration, he invented the Passy-Muir Valve, which has provided thousands of voices to individuals with tracheostomy and mechanical ventilation all over the world.  

    .  

    Passy-Muir Valve Design

    The Passy-Muir Valve is the only bias-closed position no -leak speaking valve on the market.  It is important to understand the design in order to understand the unique benefits that result.

    Click the video below to watch how the Passy-Muir Valve works.

    https://youtu.be/9yn5ekGJ0Qw

    Differences in Passy-Muir Valves

    Passy-Muir has developed several models that are available.  The PMV™ 005 (white), PMV™ 007 (aqua), PMV™ 2000 (clear) and the PMV™ 2001 (purple) which all can be used on both individuals spontaneously breathing with tracheostomy or those with mechanical ventilation.  

     

    PMV 005 Image curtesy of Passy-Muir, Inc. Irvine, CA.
    PMV 007 Image curtesy of Passy-Muir, Inc. Irvine, CA
    PMV 2000 Image curtesy of Passy-Muir, Inc. Irvine, CA
    PMV 2001 Image curtesy of Passy-Muir, Inc. Irvine, CA
    PMV 2020 Image Curtesy of Passy-Muir, Inc. Irvine, CA

    All models fit with any tracheostomy tube size, neonatal, pediatric or adult.  The only requirement is that the tube must have the universal 15mm hub.  

    Tracheostomy Tube parts

    The PMV™ 005 is the original version and has mostly been replaced with the PMV™ 2000.  Both these valves are designed for individuals in a home environment as they are lower profile.  The PMV™ 007 and 2001 are for use in an institutional setting to alert staff that the speaking valve is in place or for color preference in a home environment.  The PMV 007 can be used with disposable ventilator tubing for ventilator application.  The PMV™ 005, 2000 and 2001 require rubber non-disposable tubing to fit securely in-line for ventilator application.  

    All Passy-Muir Valves have the same bias-closed position design.  The Passy-Muir Valve has independently been found to produce the best speech quality, as reported by listeners and participants (Leder, 1994). 

    The closed position “no leak” design of the Passy-Muir Valves promotes the establishment of a more normal “closed respiratory system.  These valves are designed in a biased-closed position and offer less work of breathing. There is no air leakage out of the Passy-Muir Valve during expiration.  Instead, all of the exhaled air is directed around the tracheostomy tube, up through the vocal cords, and then out through the oral and nasal cavities. Since the Passy-Muir Valve remains closed except when the patient inspires, a column of air is trapped within the valve and tracheostomy tube which acts as a buffer to resist the movement of secretions up the tracheostomy tube and onto the valve. 

    Due to the unique closed-position, the Passy-Muir Valve offers benefits that other speaking valves do not provide. 

    Visit  Passy-Muir.com for more information.

    Open Position Speaking Valves

    Open position speaking valves are one way valves that open to allow inspiration to occur through the tracheostomy tube, but require reverse airflow from exhalation to close the membrane of the valve. This air leakage during exhalation can permit secretions to travel up into the tracheostomy tube and onto the valve.  The inability of an open position valve to completely seal negates any benefit other than to restore voice for the tracheostomized patient and may provide some ability to cough and expel secretions through the upper airway.  Examples of open position valves include Shikani Speaking Valves, Shiley Phonate, Tracoe Phon Assist, and Montgomery Speaking Valve.  

    Shikani Speaking Valves™ (SSV)

    Shikani speaking valve and comparisons
    Clear Shikani Speaking Valve
    Shikani Speaking Valve
    Blue Shikani Speaking Valve

    Shikani Speaking Valves™ are another option for individuals with tracheostomy to use to produce speech.  The SSV uses a unique ball design and a strategically placed chamber.  There is a slight tilted ramp that guides the ball toward the front of the chamber with expiration.  The ball moves towards the back of the chamber due to the act of inspiration and then the ball is redirected to the  front of the chamber with expiration. The expired air moves the ball to allow speech to travel through the upper airway, taking the path of least resistance.  

    The patient can vary the position of the valve (valve “up” or valve “down”) by rotating it 180°, which allows the ball to be seated in the proximal part of the chamber. 

    Valve up (12 o'clock)

    This is the valve "up" position with the notch and green line are facing up. Upon resting breathing, this allows airflow in and out of the tracheostomy as if there were no valve in place at all. When the patient speaks, the ball is pushed up to close the frontal opening, thus redirecting airflow through the upper airway for speech.

    Valve down (6 o'clock)

    This is the valve in the "down' position with the notch and green line facing down. When the valve is in this position, the ball automatically moves forward, closing the frontal opening. Inhalation directs the ball posteriorly to allow airflow through the tracheostomy tube and into the lungs. Exhalation pushes the ball back to the closed position, to redirect airflow through the upper airway.

    Some patients may be more comfortable when the valve is in an alternative position, such as 3 o'clock or 9 o'clock.  

    Shikani speaking valves are considered open position valves, resulting in some air leaking out of the valve on expiration.  The benefit of air leakage is that there is less resistance, making it easier to breathe on exhalation.  The drawback is that there will be a loss of positive airway pressure so that the cough reflex will not be as strong and subglottic pressure would escape through the tracheostomy tube, which is important for swallowing, secretion management and decannulation.  An open position design may benefit individuals who do not tolerate the biased closed-position design of the Passy-Muir Valve.  However, it is recommended to first determine the reason if the patient is having difficulty exhaling through the upper airway.  An ENT referral may help to determine the etiology.  

    Since there is leakage of airflow during exhalation when using the Shikani Speaking Valve, it is possible to simultaneously use an HME device.  The Shikani HME™ functions as an artificial nose and is designed to restore some of the essential respiratory functions which are lost when the breathed air is directed away from the nose. In particular, the Shikani HME™ filters airborne environmental particles from air inhaled by the patient with a tracheostomy; it retains moisture and heat from air that is exhaled out of the lungs; and upon re-inhalation, it filters, humidifies, and warms air returned to the lungs.

    Shikani HME™

     Visit The Airway Company for more information about Shikani Speaking Valves.

    Shiley™ Phonate Valve

    Shiley Speaking Valve and comparison to other valves
    Medtronic 2019. All rights reserved. Permission to use from Medtronics.

    The Shiley™ Phonate Valve is an open position, one way valve designed for use on alert, awake tracheostomy patients who breathe spontaneously.  This valve is not compatible for individuals on mechanical ventilation. Compared to finger occlusion, it reduces hygiene and infection concerns.  One model is available with a built in nipple port for the addition of supplemental oxygen.

    The Shiley™ Phonate Valve opens on inhalation to allow airflow to the lungs.  Exhalation is required to force the membrane of the valve to the closed position.  Therefore, some air escapes out the tracheostomy tube at the end of inspiration and during exhalation which may allow secretions to build inside the tracheostomy tube.  A flip top lid was designed to allow for secretion removal and cleaning of the Shiley™ Valve.  

    Visit Medline for more product information. 

    Tracoe phon assist I

    The Tracoe phon assist I is an open position speaking valves for individuals with tracheostomy, breathing spontaneously.  It is not compatible for patients on mechanical ventilation.  The valve has a silicone membrane which closes during exhalation at a fast occlusion time (25 ms), to redirect airflow through the upper airway.  There are two side openings to adjust the air flow resistance individually.  When the valve is turned to allow for an opening in the side, airflow will escape both through the upper airway as well as through the tracheostomy tube on exhalation.  Therefore by increasing the side openings, there will be less resistance and easy breathing with the valve in place.  The more closed the valve, the more airflow is directed through the upper airway.  There is an oxygen supply port to provide supplemental oxygen. 

    Tracoe phon assist comes in both bright orange for improved visibility as well as in white. 

    See Tracoe for more product information. 

    Montgomery® Speaking Valves

    Montgomery® Tracheostomy Speaking Valve

    The Montgomery®  Tracheostomy Speaking Valve is an open position, one way valve designed for use on awake tracheostomy patients who breathe spontaneously. The valve is not to be used for individuals on mechanical ventilation.  The valve provides one-way airflow using a thin silicone diaphragm that opens on inspiration and closes on expiration.  An exclusive feature of this valve is a "cough-release" mechanism, eliminating valve or tube dislodgment as a result of coughing or excessive airway pressure.

    Montgomery® Ventrach™ Speaking Valve

    Montgomery® Ventrach™ Speaking Valve is an open position, one way valve designed for individuals on mechanical ventilation. It provides airflow through the membrane of the speaking valve on inspiration and closes on expiration to redirect airflow through the vocal folds and upper airway.  Significant air loss has been demonstrated during exhalation, when the valve should be closed (Zajak et al, 1999). 

    Speech Therapy with a Speaking Valve

    Once a speaking valve is in place, speech therapy can focus on increasing valve wear time, improving voicing, improving breathing and speech coordination.  

    With children, use of a speaking valve may be a frustrating time due to the changes in airflow.  Music can be a less stressful approach to therapy.  

    Finding Your Voice- Songs for Kids with Tracheostomy is the perfect adjunct for therapy.  There are 15 songs plus 3 instrumentals to help ease children to use the upper airway.  Our Animal Faces and Tracheostomy Tube with Speaking Valve are great to use either with the songs or on their own.  They can be used to help children imitate.  All animal face cut outs are made on laminated 8.5x11 poster board.  

     

    Summary

    speaking valve comparisons chart

    Speaking valves allow patients with tracheostomy the opportunity to produce speech naturally.  Exhaled air is redirected around the tracheostomy tube and deflated cuff (if present), through the vocal folds and upper airway.  The cuff of the tracheostomy tube must always be completely deflated (if present) or the patient will be unable to breathe.  The Passy-Muir Valve is the only bias-closed position valve which provides additional benefits.  The Passy-Muir Valve and Montgomery Ventrach may be used in-line with mechanical ventilation.  

    See ventilator application of speaking valves for more information about in-line speaking valve use with mechanical ventilation. 

    Related Webinars:

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      Swallowing Evaluation for Patients with Tracheostomy and Mechanical Ventilation Course provides in-depth information about how to perform an initial swallow assessment for this patient population.    Total course time is 1 hour 38 minutes.  The course includes effects of tracheostomy on swallowing, research of cuff deflation and how/when to perform cuff deflation, explanation of common mechanical ventilation settings and mechanical ventilation considerations with swallowing, timing of swallow evaluation, Blue Dye testing information, and speaking valves.  Instrumental swallow assessment comparison of modified barium swallow studies (MBS) and flexible endoscopic evaluation of swallowing (FEES) and the advantages and disadvantages.  Ventilator associated-pneumonia factors is also included.  Covid-19 considerations for patients with tracheostomy and mechanical ventilation is also covered.  

      Free access to the Evidenced-Based Swallowing Evaluation Community is also included.  Here, you can ask the instructor any questions in a private forum.  

      Learning Outcomes:

      1.Learner will understand the normal breathing and swallowing relationship

      2.List at least 5 complications of tracheostomy on swallowing

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      4.Understand the difference between Flexible Endoscopic Evaluation of Swallowing (FEES) and Modified Barium Swallow Study

      5.Provide 5 ways to prevent Ventilator Associated Pneumonia (VAP)

      Course presenter: Nicole M. DePalma, MS CCC-SLP

      Nicole is the owner of NDoscopy Dysphagia Specialists, a mobile FEES (flexible endoscopic evaluation of swallowing) company servicing New York and New Jersey.  Her areas of expertise include dysphagia management and critically complex patients including tracheostomy and mechanical ventilation in a variety of settings including acute care, long term acute, subacute, and skilled nursing.  She is also a Clinical Consultant for Passy-Muir, Inc. 

      Course Format: Video Powerpoint with author narration and video samples

      Course Certificate is provided upon completion. 

      Course access: 1 year from registration

      Disclosures: Financial: Paid by Tracheostomy Education

      Non-financial: Passy-Muir Clinical Consultant

      Refunds:

      No partial or full refunds for self-study courses, including on-demand webinars.
      No refunds for participants who enroll without agreeing to terms of use.
      You must complete the course within the time frame indicated at enrollment; course access will automatically expire after that time.

      Accessibility:

      Tracheostomy Education is committed to ensuring accessibility to the widest possible audience. We are continually improving the user experience for everyone. If you have questions, requests, or would like to report an accessibility-related issue, please email [email protected]  We will review your request and respond in a timely manner.

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