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