Drilling speaking valves to promote phonation in tracheostomy‐dependent children

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