Drilling speaking valves to promote phonation in tracheostomy-dependent children.
OBJECTIVE
Placement of a Passy-Muir speaking valve is considered best practice for infants and children with a tracheostomy. The Passy-Muir valve enables phonation by redirecting exhaled air via the glottis. Poor tolerance of the Passy-Muir valve is associated with excessive transtracheal pressures on exhalation due to upper airway obstruction. Drilling a small hole in the side of the Passy-Muir valve creates a pressure relief port to allow partial exhalation through the tracheostomy tube while enabling phonation.


METHODS
A retrospective case series is presented of 10 aphonic pediatric patients with a tracheostomy trialed with a drilled Passy-Muir valve.


METHODS
Valve tolerance was assessed clinically and objectively. Handheld manometry was used to determine transtracheal pressures on passive exhalation. All patients had a diagnosis of upper airway obstruction and demonstrated excessive pressures wearing a standard Passy-Muir valve. Patients were assessed wearing a Passy-Muir valve with up to two 1.6-mm holes drilled in the side of the valve. Patients progressed to trials if clinically stable and if transtracheal pressure did not exceed 10 cm H(2) O when wearing the valve.


RESULTS
Eight patients progressed to trial, with five of eight patients able to phonate within 1 week and six of eight able to tolerate wearing the valve for ≥ 2-hour periods within 2 weeks of introduction. All eight patients were able to phonate within 6 months of valve introduction.


CONCLUSIONS
These findings support drilling Passy-Muir speaking valves as a promising option to facilitate phonation in pediatric patients with a tracheostomy for upper airway obstruction.
Department of Speech Pathology, Princess Margaret Hospital, Perth, Australia. ali.buckland@gmail.com
Alison
A
Buckland
Lara
L
Jackson
Toni
T
Ilich
Jodi
J
Lipscombe
Graeme
G
Jones
Shyan
S
Vijayasekaran
D000293:Adolescent; D000402:Airway Obstruction / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D001044:Aphonia / Q000209:etiology / Q000503:physiopathology* / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D004867:Equipment Design; D006801:Humans; D007223:Infant; D010699:Phonation; D012189:Retrospective Studies; D014139:Tracheostomy / Q000295:instrumentation*; D016896:Treatment Outcome