Tracheostomy tube - speaking

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Trach - speaking


Speaking is a key part of communicating with people. Having a tracheostomy tube can change your ability to talk and interact with others.

However, you can learn how to speak with a tracheostomy tube. It just takes practice. There are even speaking devices that can help you.

Tracheostomy Tubes and Speaking

Air passing through vocal cords (larynx) causes them to vibrate, creating sounds and speech.

A tracheostomy tube blocks most of the air from passing through your vocal cords. Instead, your breath (air) goes out through your tracheostomy tube (trach).

Most trachs have a balloon (cuff) that lies in your trachea.

  • If the cuff is inflated (filled with air), it will prevent air from moving through your vocal cords. This will stop you from making noise or speech.
  • If the cuff is deflated, the air is able to move around the trach and through your vocal cords, and you will be able to make sounds.


If your tracheostomy has a cuff, it will need to be deflated. Your caregiver should make the decision about when to deflate your cuff.

When the cuff is deflated and air can pass around your trach, you should try to talk and make sounds.

Speaking will be harder than before you had your trach. You may need to use more force to push the air out through your mouth. To speak:

  • Take a deep breath in.
  • Breathe out, using more force than you normally would to push the air out.
  • You may not hear much at first.
  • You will build up the strength to push the air out through your mouth as you practice.
  • The sounds you make will get louder.

When you are first learning, place a clean finger over the trach to prevent air from exiting through the trach. This will also help the air go out through your mouth.

Speaking Valves

If it is hard to speak with a trach in place, special devices can help you learn to create sounds.

One-way valves, called speaking valves, are placed onto your tracheostomy. Speaking valves allow air to enter through the tube and exit through your mouth and nose. This will allow you to make noises and speak more easily.

Some patients may not be able to use these valves. If a speaking valve is placed on your trach, and you have trouble breathing, the valve may not be allowing enough air to pass around your trach.

Other Factors to Think About

The width of the tracheostomy tube may play a role. If the tube takes up too much space in your throat, there may not be enough room for the air to pass around the tube.

Your trach may be fenestrated. This means the trach has extra holes built into it. These holes allow air to pass through your vocal cords. They can make it easier to eat and breathe with a tracheostomy tube.

It may take much longer to develop speech if you have:

  • Vocal cord damage
  • Injury to the vocal cord nerves, which can change the way the vocal cords move


Dobkin BH. Principles and Practices of Neurological Rehabilitation. In: Daroff RB, Fenichel GM, Jankovic J, Mazziotta JC, eds. Bradley's Neurology in Clinical Practice. 6th ed. Philadelphia, PA: Saunders Elsevier; 2012:chap 48.

Version Info

  • Last reviewed on 2/3/2014
  • Ashutosh Kacker, MD, FACS, Professor of Clinical Otolaryngology, Weill Cornell Medical College, and Attending Otolaryngologist, New York-Presbyterian Hospital, New York, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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