title: Tracheostomy speaking valves for children: tolerance and clinical benefits.
abstract: BACKGROUND
  Use of a tracheostomy speaking valve allows the expiratory flow of air to exit over the vocal folds promoting phonation. The purpose of this retrospective review was to determine: (1) what percentage of trial candidates tolerated a speaking valve; (2) whether candidates achieved phonation with a valve; and (3) which secondary benefits (coughing ability, secretion management, swallowing/feeding and oxygenation) could be clinically observed.
  
  
  METHODS
  Twelve cases of children and youth (ages 8 months to 21 years) evaluated for a tracheostomy speaking valve at an inpatient rehabilitation hospital were reviewed. A speech-language pathologist and respiratory therapist evaluated the children for valve tolerance and candidacy for ongoing use. Clinical observations were used to determine phonation ability and to examine potential secondary benefits.
  
  
  RESULTS
  All 10 subjects who tolerated the valve achieved phonation. Vocalizations included audible crying, non-specific vocalizations, word approximations, single words and short phrases. Minimal-to-no improvement was noted for coughing, secretion management, swallowing and oxygenation with clinical assessment.
  
  
  CONCLUSIONS
  With supervision and training, speaking valves can enhance communication options for children and youth with tracheostomies and oxygen and ventilator dependence. Physiological and functional secondary benefits were observed but were more difficult to assess.
authors.affiliation: Speech-Language-Hearing Department, Franciscan Hospital for Children, Boston, MA (EMH, RAC), USA. ehull@fchrc.org
authors.forename: Ellen M
authors.initials: EM
authors.lastname: Hull
authors.forename: Helene M
authors.initials: HM
authors.lastname: Dumas
authors.forename: Ruth A
authors.initials: RA
authors.lastname: Crowley
authors.forename: Virginia S
authors.initials: VS
authors.lastname: Kharasch
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003371:Cough / Q000503:physiopathology; D003448:Crying / Q000502:physiology; D003679:Deglutition / Q000502:physiology; D004435:Eating / Q000502:physiology; D045853:Exhalation / Q000502:physiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D018579:Patient Selection; D010699:Phonation / Q000502:physiology; D012119:Respiration; D012121:Respiration, Artificial; D012189:Retrospective Studies; D013060:Speech / Q000502:physiology*; D014132:Trachea / Q000378:metabolism; D014139:Tracheostomy / Q000295:instrumentation*; D014827:Vocal Cords / Q000502:physiology