Drilling speaking valves to promote phonation in tracheostomy-dependent children.

Buckland A, Jackson L, Ilich T, Lipscombe J, Jones G, Vijayasekaran S.

Laryngoscope. 2012 Jul 9. doi: 10.1002/lary.23436.

 

Abstract

OBJECTIVES/HYPOTHESIS:

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.

STUDY DESIGN:

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. Laryngoscope, 2012.

Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc

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