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A tracheostomy is a surgically created hole (stoma) in your windpipe (trachea) that provides an alternative airway for breathing. A tracheostomy tube is inserted through the hole and secured in place with a strap around your neck.

Tracheostomy (tray-key-OS-tuh-me) is a hole that surgeons make through the front of the neck and into the windpipe (trachea). A tracheostomy tube is placed into the hole to keep it open for breathing. The term for the surgical procedure to create this opening is tracheotomy.

A tracheostomy provides an air passage to help you breathe when the usual route for breathing is somehow blocked or reduced. A tracheostomy is often needed when health problems require long-term use of a machine (ventilator) to help you breathe. In rare cases, an emergency tracheotomy is performed when the airway is suddenly blocked, such as after a traumatic injury to the face or neck.

When a tracheostomy is no longer needed, it's allowed to heal shut or is surgically closed. For some people, a tracheostomy is permanent.

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Why it's done

Situations that may call for a tracheostomy include:

• Medical conditions that make it necessary to use a breathing machine (ventilator) for an extended period, usually more than one or two weeks
• Medical conditions that block or narrow your airway, such as vocal cord paralysis or throat cancer
• Paralysis, neurological problems or other conditions that make it difficult to cough up secretions from your throat and require direct suctioning of the windpipe (trachea) to clear your airway
• Preparation for major head or neck surgery to assist breathing during recovery
• Severe trauma to the head or neck that obstructs breathing
• Other emergency situations when breathing is obstructed and emergency personnel can't put a breathing tube through your mouth and into your trachea

Emergency care

Most tracheotomies are performed in a hospital setting. However, in the case of an emergency, it may be necessary to create a hole in a person's throat when outside of a hospital, such as at the scene of an accident.

Emergency tracheotomies are difficult to perform and have an increased risk of complications. A related and somewhat less risky procedure used in emergency care is a cricothyrotomy (kry-koe-thie-ROT-uh-me). This procedure creates a hole directly into the voice box (larynx) at a site immediately below the Adam's apple (thyroid cartilage).

Once a person is transferred to a hospital and stabilized, a cricothyrotomy is replaced by a tracheostomy if there's a need for long-term breathing assistance.

Tracheostomies are generally safe, but they do have risks. Some complications are particularly likely during or shortly after surgery. The risk of such problems greatly increases when the tracheotomy is performed as an emergency procedure.

Immediate complications include:

• Damage to the trachea, thyroid gland or nerves in the neck
• Misplacement or displacement of the tracheostomy tube
• Air trapped in tissue under the skin of the neck (subcutaneous emphysema), which can cause breathing problems and damage to the trachea or food pipe (esophagus)
• Buildup of air between the chest wall and lungs (pneumothorax), which causes pain, breathing problems or lung collapse
• A collection of blood (hematoma), which may form in the neck and compress the trachea, causing breathing problems

Long-term complications are more likely the longer a tracheostomy is in place. These problems include:

• Obstruction of the tracheostomy tube
• Displacement of the tracheostomy tube from the trachea
• Damage, scarring or narrowing of the trachea
• Development of an abnormal passage between the trachea and the esophagus (tracheoesophageal fistula), which can increase the risk of fluids or food entering the lungs
• Development of a passage between the trachea and the large artery that supplies blood to the right arm and right side of the head and neck (tracheoinnominate fistula), which can result in life-threatening bleeding
• Infection around the tracheostomy or infection in the trachea and bronchial tubes (tracheobronchitis) and lungs (pneumonia)

If you still need a tracheostomy after you've left the hospital, you'll need to keep regularly scheduled appointments for monitoring possible complications. You'll also receive instructions about when you should call your doctor about problems, such as:

• Bleeding at the tracheostomy site or from the trachea
• Difficulty breathing through the tube
• Pain or a change in comfort level
• Redness or swelling around the tracheostomy
• A change in the position of your tracheostomy tube

How you prepare

How you prepare for a tracheostomy depends on the type of procedure you'll undergo. If you'll be receiving general anesthesia, your doctor may ask that you avoid eating and drinking for several hours before your procedure. You may also be asked to stop certain medications.

Plan for your hospital stay

After the tracheostomy procedure, you'll likely stay in the hospital for several days as your body heals. If possible, plan ahead for your hospital stay by bringing:

• Comfortable clothing, such as pajamas, a robe and slippers
• Personal care items, such as your toothbrush and shaving supplies
• Entertainment to help you pass the time, such as books, magazines or games
• A communication method, such as a pencil and a pad of paper, a smartphone, or a computer, as you'll be unable to talk at first

What you can expect

During the procedure.

A tracheotomy is most commonly performed in an operating room with general anesthesia, which makes you unaware of the surgical procedure. A local anesthetic to numb the neck and throat is used if the surgeon is worried about the airway being compromised from general anesthesia or if the procedure is being done in a hospital room rather than an operating room.

The type of procedure you undergo depends on why you need a tracheostomy and whether the procedure was planned. There are essentially two options:

• Surgical tracheotomy can be performed in an operating room or in a hospital room. The surgeon usually makes a horizontal incision through the skin at the lower part of the front of your neck. The surrounding muscles are carefully pulled back and a small portion of the thyroid gland is cut, exposing the windpipe (trachea). At a specific spot on your windpipe near the base of your neck, the surgeon creates a tracheostomy hole.
• Minimally invasive tracheotomy (percutaneous tracheotomy) is typically performed in a hospital room. The doctor makes a small incision near the base of the front of the neck. A special lens is fed through the mouth so that the surgeon can view the inside of the throat. Using this view of the throat, the surgeon guides a needle into the windpipe to create the tracheostomy hole, then expands it to the appropriate size for the tube.

For both procedures, the surgeon inserts a tracheostomy tube into the hole. A neck strap attached to the face plate of the tube keeps it from slipping out of the hole, and temporary sutures can be used to secure the faceplate to the skin of your neck.

After the procedure

You'll likely spend several days in the hospital as your body heals. During that time, you'll learn skills necessary for maintaining and coping with your tracheostomy:

• Caring for your tracheostomy tube. A nurse will teach you how to clean and change your tracheostomy tube to help prevent infection and reduce the risk of complications. You'll continue to do this as long as you have a tracheostomy.
• Speaking. Generally, a tracheostomy prevents speaking because exhaled air goes out the tracheostomy opening rather than up through your voice box. But there are devices and techniques for redirecting airflow enough to produce speech. Depending on the type of tube, width of your trachea and condition of your voice box, you may be able to speak with the tube in place. If necessary, a speech therapist or a nurse trained in tracheostomy care can suggest options for communicating and help you learn to use your voice again.
• Eating. While you're healing, swallowing will be difficult. You'll receive nutrients through an intravenous (IV) line inserted into a vein in your body, a feeding tube that passes through your mouth or nose, or a tube inserted directly into your stomach. When you're ready to eat again, you may need to work with a speech therapist, who can help you regain the muscle strength and coordination needed for swallowing.
• Coping with dry air. The air you breathe will be much drier because it no longer passes through your moist nose and throat before reaching your lungs. This can cause irritation, coughing and excess mucus coming out of the tracheostomy. Putting small amounts of saline directly into the tracheostomy tube, as directed, may help loosen secretions. Or a saline nebulizer treatment may help. A device called a heat and moisture exchanger captures moisture from the air you exhale and humidifies the air you inhale. A humidifier or vaporizer adds moisture to the air in a room.
• Managing other effects. Your health care team will show you ways to care for other common effects related to having a tracheostomy. For example, you may learn to use a suction machine to help you clear secretions from your throat or airway.

In most cases, a tracheostomy is temporary, providing an alternative breathing route until other medical issues are resolved. If you need to remain connected to a ventilator indefinitely, the tracheostomy is often the best permanent solution.

Your health care team will help you determine when it's appropriate to remove the tracheostomy tube. The hole may close and heal on its own, or it can be closed surgically.

Tracheostomy care at Mayo Clinic

• Brown AY. Allscripts EPSi. Mayo Clinic. Aug. 28, 2019.
• Tracheostomy. National Heart, Lung, and Blood Institute. https://www.nhlbi.nih.gov/health-topics/tracheostomy. Accessed Sept. 23, 2019.
• Tracheostomy and ventilator dependence. American Speech-Language-Hearing Association. https://www.asha.org/public/speech/disorders/tracheostomies/. Accessed Sept. 19, 2019.
• Surgical airway. Merck Manual Professional Version. https://www.merckmanuals.com/professional/critical-care-medicine/respiratory-arrest/surgical-airway#. Accessed Sept. 23, 2019.
• Roberts JR, et al., eds. Tracheostomy care. In: Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care. 7th ed. Elsevier; 2019. https://www.clinicalkey.com. Accessed Sept. 23, 2019.
• Patton J. Tracheostomy care. British Journal of Nursing. 2019; doi:10.12968/bjon.2019.28.16.1060.
• Mitchell RB, et al. Clinical consensus statement: Tracheostomy care. Otolaryngology — Head and Neck Surgery. 2013; doi:10.1177/0194599812460376.
• Landsberg JW. Pulmonary and critical care pearls. In: Clinical Practice Manual for Pulmonary and Critical Care Medicine. Elsevier; 2018. https://www.clinicalkey.com. Accessed Sept. 25, 2019.
• Rashid AO, et al. Percutaneous tracheostomy: A comprehensive review. Journal of Thoracic Disease. 2017; doi:10.21037/jtd.2017.09.33.
• Moore EJ (expert opinion). Mayo Clinic. Oct. 1, 2019.
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Expert Health Articles

Intubation vs. Tracheostomy

When you hear a physician say that you or a loved one needs to be intubated or needs a tracheostomy, it is important to understand the purpose of these and how they differ.

A tracheostomy (trach) is a procedure in which a doctor surgically makes an incision in the trachea, sometimes called the “windpipe.” Tracheostomy procedures are performed when there is an obstruction in the airway and intubation is medically not possible, a patient has inefficient oxygen delivery or has problems with secretions.

Once the incision is made, a tube is placed in the windpipe. This tube holds the airway open and allows air to move in and out of the lungs. When a trach is placed, one may be able to breathe without a breathing machine, also known as a ventilator, or a ventilator may be needed.

When a tracheostomy is no longer needed, it can be removed and allowed to heal on its own, or the physician may close it surgically. Patients can be discharged home with a trach; but with that, comes new learning experiences. A trained respiratory therapist or a professional nurse will help you and your family learn to care for the trach.

Intubation (or being intubated) is the process in which a breathing tube is placed into the mouth and down the throat to provide oxygen via a machine. Intubation is done when one cannot maintain their airway on their own due to anesthesia or illness. Often, a person is intubated for a short time, and a person would not go home when they are intubated. Patients cannot be discharged with intubation and must have medical supervision.

Emily Dulgar RN

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Living with a tracheostomy

By: My Vanderbilt Health

February 28, 2022

If you or a loved one suddenly needs a tracheostomy, you may have questions.

A tracheostomy is an opening created in the neck so that a tube can be placed in the trachea, often called the windpipe, to aid breathing. A tracheostomy, or “trach,” may be needed if you have a blockage in your airway or severe lung disease, or for other reasons. Living with a tracheostomy can take some time to adapt to, but you can still enjoy a good quality of life. And in some cases, a tracheostomy may only be needed temporarily during a recovery period.

“We’re one of the highest volume airway centers in the country that specializes in disorders of the voice box and the trachea,” explained Alexander Gelbard, M.D., an otolaryngologist with Vanderbilt Center for Complex Airway Reconstruction . “And we really take a team approach that can provide a high level of personalized care to improve people’s recovery from severe illness.”

Understanding Complex Airway Disorders

Download our guide to learn about various disorders and their symptoms, diagnosis for complex airway disorders, and surgical and nonsurgical treatment options.

Reasons for a tracheostomy

To breathe, air must pass your vocal cords and move down your windpipe. Then it moves into your lungs, where it hops across a thin membrane in your alveoli to get into your bloodstream, Gelbard explained. If you have problems along the way at any one of those points, he added, you can feel like you’re not getting enough air.

“People who develop scarring on their vocal cords or trachea after having a breathing tube,” Gelbard said, “can feel like they’re short of breath. And they need a tracheostomy to bypass the blockage.”

Additionally, some people with advanced lung disease may also need a tracheostomy to help supply extra pressure and oxygen at night to support breathing if their lungs are weakened.

Tracheostomy care at home

Your care team will teach you and any caregivers how to maintain the tracheostomy. Tracheostomy care will include regularly cleaning the skin at the tracheostomy site and the stoma, which is the hole where the tube inserts into your neck. Cleaning is crucial to prevent irritation and infection and to keep your tracheostomy functioning properly. Another task is suctioning. Suctioning helps remove mucus plugs that you’re unable to cough up.

Some aspects of living with a trach will take some time to get used to. One consideration is that you may have difficulty smelling and tasting your food. “If there’s not a lot of air passing your nose,” Gelbard explained, “it can be tough to smell. And a lot of times when you don’t smell well, your sense of taste is off.” Some people with a tracheostomy will require a feeding tube for nutrition, however.

“There’s also a psychologic impact of having to live with this airway prosthesis,” Gelbard added. “It can affect body image for some people. And that can take a lot of adjustment.” He said he spends a lot of time in the office talking with his tracheostomy patients about this aspect if it’s affecting them.

Although some people may need a tracheostomy long term or permanently, others may only require one for a short time as part of recovery after an illness like COVID-19 .

“Decisions about tracheostomy often occur when you’re battling severe illness,” Gelbard said. “A tracheostomy can be really necessary to help you recover and move out of the hospital.” But once someone has moved out of the hospital and has gone through rehab and started to recover, their situation may change. “They should seek out an otolaryngologist to talk about if they still need to have their tracheostomy,” Gelbard explained. Even if you do need a tracheostomy long term, see a specialist who sees a lot of patients with tracheostomies. “This can be of benefit,” he said, “to help find an airway prosthesis that fits best and functions the highest to really keep you breathing, talking and swallowing optimally.”

Vanderbilt Health’s specialists in the Complex Airway Reconstruction Program  have the expertise to accurately evaluate, diagnose and treat a wide array of complex airway disorders. Our comprehensive team works with you to develop a personalized care plan, so you can swallow, speak and breathe with ease. Call 615-343-0540 for more information.

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• Second Opinion

Tracheostomy (Tracheotomy)

What is a tracheostomy?

The term tracheostomy is used to describe a surgically created hole in the neck that extends to the trachea (windpipe) to allow for safe breathing. A tracheostomy tube is the plastic breathing tube that is placed into the hole.

Who needs a tracheostomy?

There are many reasons why a child may need a tracheostomy. Two common reasons include:

• Upper airway obstruction
• The requirement for mechanical ventilation (a breathing machine)

Upper airway obstruction may occur due to bilateral vocal cord paralysis, tracheal or laryngeal stenosis, infection, trauma, or due to a cyst or tumor. A tracheostomy provides an alternative pathway for air to easily bypass the upper airway and  enter the lungs.

Long-term mechanical ventilation may be required as a result of lower airway obstruction (such as bronchomalacia or tracheomalacia) or due to neurologic conditions or chronic lung or heart disease. A tracheostomy allows for a ventilator to be used without a breathing tube that goes through the mouth or nose (endotracheal tube.) For long-term ventilation, a tracheostomy is considered safer and more comfortable than an endotracheal tube.

Is a tracheostomy permanent?

For most children the tracheostomy is not permanent. The length of time it stays in place depends on the individual patient and the reason it was initially placed. Although some tracheostomy tubes stay in place for many months or years, many are temporary and can be removed after a shorter period of time. After the tracheostomy tube is removed, the hole frequently closes by itself. If it does not close by itself, the hole can be surgically closed.

How is a tracheostomy performed?

The tracheostomy procedure is performed in the operating room under general anesthesia. A small incision is made in the skin overlying the trachea in the middle of the neck. The surgeon exposes the airway and makes a small incision into the trachea. The tracheostomy tube is placed in the hole, and secured to the neck.

What can I expect after the tracheostomy?

The tracheostomy tube is changed to a new tube by the surgeon several days after the operation. Occasionally, the ties around the neck are changed during the first week after the operation. After the tracheostomy incision site is noted to be healing well, a tracheostomy care nurse will begin working with the family to learn how to care for a tracheostomy.

What are the effects of tracheostomy?

The specific effects of the tracheostomy tube will  depend on the age of the child, the reason the tracheostomy tube was placed, and the need for long-term ventilation. It is important that you discuss your child’s tracheostomy and the effects of the procedure with your child’s surgeon. When a tracheostomy is present, care must be taken to prevent water or sand from getting into the tracheostomy tube (no swimming.) As a general rule, the tracheostomy tube will not  keep your child from being able to eat normally or use their voice, although some children may not be able to eat orally or speak for other reasons. Many children with a tracheostomy tube are able to lead happy lives.

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Tracheotomy

A tracheotomy is a surgical procedure that opens up the windpipe (trachea). It is performed in emergency situations, in the operating room , or at bedside of critically ill patients. The term tracheostomy is sometimes used interchangeably with tracheotomy. Strictly speaking, however, tracheostomy usually refers to the opening itself while a tracheotomy is the actual operation.

A tracheotomy is performed if enough air is not getting to the lungs, if the person cannot breathe without help, or is having problems with mucus and other secretions getting into the windpipe because of difficulty swallowing. There are many reasons why air cannot get to the lungs. The windpipe may be blocked by a swelling; by a severe injury to the neck, nose, or mouth; by a large foreign object; by paralysis of the throat muscles; or by a tumor. The patient may be in a coma, or need a ventilator to pump air into the lungs for a long period of time.

Demographics

Emergency tracheotomies are performed as needed in any person requiring one.

Description

Emergency tracheotomy.

There are two different procedures that are called tracheotomies. The first is done only in emergency situations and can be performed quite rapidly. The emergency room physician or surgeon makes a cut in a thin part of the voice box (larynx) called the cricothyroid membrane. A tube is inserted and connected to an oxygen bag. This emergency procedure is sometimes called a cricothyroidotomy .

Surgical tracheotomy

The second type of tracheotomy takes more time and is usually done in an operating room. The surgeon first makes a cut (incision) in the skin of the neck that lies over the trachea. This incision is in the lower part of the neck between the Adam's apple and top of the breastbone. The neck muscles are separated and the thyroid gland, which overlies the trachea, is usually cut down the middle. The surgeon identifies the rings of cartilage that make up the trachea and cuts into the tough walls. A metal or plastic tube, called a tracheotomy tube, is inserted through the opening. This tube acts like a windpipe and allows the person to breathe. Oxygen or a mechanical ventilator may be hooked up to the tube to bring oxygen to the lungs. A dressing is placed around the opening. Tape or stitches (sutures) are used to hold the tube in place.

After a nonemergency tracheotomy, the patient usually stays in the hospital for three to five days, unless there is a complicating condition. It takes about two weeks to recover fully from the surgery.

Diagnosis/Preparation

In the emergency tracheotomy, there is no time to explain the procedure or the need for it to the patient. The patient is placed on his or her back with face upward (supine), with a rolled-up towel between the shoulders. This positioning of the patient makes it easier for the doctor to feel and see the structures in the throat. A local anesthetic is injected across the cricothyroid membrane.

Nonemergency tracheotomy

Postoperative care.

A chest x ray is often taken, especially in children, to check whether the tube has become displaced or if complications have occurred. The doctor may prescribe antibiotics to reduce the risk of infection. If the patient can breathe without a ventilator, the room is humidified; otherwise, if the tracheotomy tube is to remain in place, the air entering the tube from a ventilator is humidified. During the hospital stay, the patient and his or her family members will learn how to care for the tracheotomy tube, including suctioning and clearing it. Secretions are removed by passing a smaller tube (catheter) into the tracheotomy tube.

It takes most patients several days to adjust to breathing through the tracheotomy tube. At first, it will be hard even to make sounds. If the tube allows some air to escape and pass over the vocal cords, then the patient may be able to speak by holding a finger over the tube. Special tracheostomy tubes are also available that facilitate speech.

The tube will be removed if the tracheotomy is temporary. Then the wound will heal quickly and only a small scar may remain. If the tracheotomy is permanent, the hole stays open and, if it is no longer needed, it will be surgically closed.

After the patient is discharged, he or she will need help at home to manage the tracheotomy tube. Warm compresses can be used to relieve pain at the incision site. The patient is advised to keep the area dry. It is recommended that the patient wear a loose scarf over the opening when going outside. He or she should also avoid contact with water, food particles, and powdery substances that could enter the opening and cause serious breathing problems. The doctor may prescribe pain medication and antibiotics to minimize the risk of infections. If the tube is to be kept in place permanently, the patient can be referred to a speech therapist in order to learn to speak with the tube in place. The tracheotomy tube may be replaced four to 10 days after surgery.

Patients are encouraged to go about most of their normal activities once they leave the hospital. Vigorous activity is restricted for about six weeks. If the tracheotomy is permanent, further surgery may be needed to widen the opening, which narrows with time.

Immediate risks

There are several short-term risks associated with tracheotomies. Severe bleeding is one possible complication. The voice box or esophagus may be damaged during surgery. Air may become trapped in the surrounding tissues or the lung may collapse. The tracheotomy tube can be blocked by blood clots, mucus, or the pressure of the airway walls. Blockages can be prevented by suctioning, humidifying the air, and selecting the appropriate tracheotomy tube. Serious infections are rare.

Long-term risks

Over time, other complications may develop following a tracheotomy. The windpipe itself may become damaged for a number of reasons, including pressure from the tube, infectious bacteria that forms scar tissue, or friction from a tube that moves too much. Sometimes the opening does not close on its own after the tube is removed. This risk is higher in tracheotomies with tubes remaining in place for 16 weeks or longer. In these cases, the wound is surgically closed. Increased secretions may occur in patients with tracheostomies, which require more frequent suctioning.

High-risk groups

The risks associated with tracheotomies are higher in the following groups of patients:

• children, especially newborns and infants
• obese adults
• persons over 60
• persons with chronic diseases or respiratory infections
• persons taking muscle relaxants , sleeping medications, tranquilizers, or cortisone

Normal results

Normal results include uncomplicated healing of the incision and successful maintenance of long-term tube placement.

Morbidity and mortality rates

The overall risk of death from a tracheotomy is less than 5%.

Alternatives

For most patients, there is no alternative to emergency tracheotomy. Some patients with pre-existing neuromuscular disease (such as ALS or muscular dystrophy) can be sucessfully managed with emergency noninvasive ventilation via a face mask, rather than with tracheotomy. Patients who receive nonemergency tracheotomy in preparation for mechanical ventilation may often be managed instead with noninvasive ventilation, with proper planning and education on the part of the patient, caregiver, and medical staff.

Bach, John R. Noninvasive Mechanical Ventilation. NJ: Hanley and Belfus, 2002.

Fagan, Johannes J., et al. Tracheotomy. Alexandria, VA: American Academy of Otolaryngology-Head and Neck Surgery Foundation, Inc., 1997.

"Neck Surgery." In The Surgery Book: An Illustrated Guide to 73 of the Most Common Operations , ed. Robert M. Younson, et al. New York: St. Martin's Press, 1993.

Schantz, Nancy V. "Emergency Cricothyroidotomy and Tracheostomy." In Procedures for the Primary Care Physician , ed. John Pfenninger and Grant Fowler. New York: Mosby, 1994.

"Answers to Common Otolaryngology Health Care Questions." Department of Otolaryngology–Head and Neck Surgery Page. University of Washington School of Medicine [cited July 1, 2003]. http://weber.u.washington.edu/~otoweb/trach.html .

Sicard, Michael W. "Complications of Tracheotomy." The Bobby R. Alford Department of Otorhinolaryngology and Communicative Sciences. December 1, 1994 [cited July 1, 2003]. http://http:www.bcm.tmc.edu/oto/grand/12194.html .

Jeanine Barone, Physiologist Richard Robinson

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

Tracheotomy is performed by a surgeon in a hospital.

QUESTIONS TO ASK THE DOCTOR

• How do I take care of my trachesotomy?
• How many of your patients use noninvasive ventilation?
• Am I a candidate for noninvasive ventilation?

User Contributions:

Comment about this article, ask questions, or add new information about this topic:.

Tracheostomy

A tracheostomy (also called a tracheotomy) is a procedure where a hole is made at the front of the neck. A tube is inserted through the opening and into the windpipe (trachea) to help you breathe.

Why a tracheostomy is done

Reasons you may need to have a tracheostomy include:

• to help you breathe if your throat is blocked
• to remove excess fluid and mucus from your lungs
• to deliver oxygen from a machine called a ventilator to your lungs

A tracheostomy is often planned in advance, but sometimes it needs to be done as soon as possible in an emergency.

If you need a tracheostomy but are unable to give your consent , it will be discussed with your family.

What happens during a tracheostomy

A tracheostomy is usually done under general anaesthetic , so you'll be asleep during the operation and will not feel any pain.

If it needs to be done in an emergency, you'll have a local anaesthetic , where you'll be awake but your neck will be numb.

The surgeon makes a cut in the skin at the front of your neck and creates a small hole in your windpipe.

A tracheostomy tube is inserted through the hole and into your windpipe. It's held in place by a piece of tape around your neck.

You breathe through the tracheostomy tube rather than through your nose and mouth.

After the operation

You'll need to stay in hospital for a while after having a tracheostomy. How long depends on why you had the procedure and your recovery.

Some people only need a tracheostomy for a few days, while others need it for much longer.

If you're able to go home with a tracheostomy, you or the person looking after you will be shown how to clean and care for it before you leave hospital. You'll also be given help and support after you've left.

After having a tracheostomy

It may take a while to get used to having a tracheostomy.

Tracheostomy tubes often have an air-filled cuff around them. You will not be able to speak when the cuff is inflated.

To begin with, you may need to communicate using writing and gestures.

As you recover, air will gradually be removed from the cuff and you'll be able to start to speak.

A speaking valve is sometimes fitted to the tracheostomy tube, which can help make your voice stronger.

Eating and drinking

You may be able to eat and drink with a tracheostomy.

But if you cannot swallow, you may need to have a thin feeding tube inserted through your nose and down into your stomach.

This allows liquid food and fluids to be given to you directly.

Changing your tracheostomy tube

Your tracheostomy tube may need to be changed if it's been in for 28 days or you need a different tube to help with your breathing and talking.

Changing the tube is a quick and simple procedure that's usually done in hospital.

Removing your tracheostomy tube

Your tracheostomy tube will be removed when you no longer need help breathing. This might be a few days or weeks, but some people need it for longer.

A dressing will be put over the hole after the tube has been removed. The hole usually takes about 7 to 10 days to heal.

You may have some pain or discomfort in the area where the tube was, but this should improve as the hole heals.

You'll also have a small scar on your neck, but it will fade over time.

Risks and complications of a tracheostomy

A tracheostomy is a common procedure, but as with any type of surgery there are risks and possible complications.

Your doctor will discuss these with you before you agree to have a planned tracheostomy.

Risks of a tracheostomy include:

• bleeding in or around the tracheostomy
• damage to the windpipe or area around it
• the tracheostomy tube becoming blocked or moving out of place
• problems with the hole healing after the tube is removed, such as it becoming infected
• a build-up of air between your lungs and chest wall, which can cause pain, difficulty breathing or a collapsed lung in severe cases

Urgent advice: Call NHS 111 or get an urgent GP appointment if:

You're at home after having a tracheostomy and:

• you're having problems swallowing
• you're coughing or being sick after eating or drinking
• your breathing is noisy during the day or at night (including snoring)
• your scar is raised or uncomfortable
• you have pain or discomfort around the area of the tracheostomy, particularly when swallowing
• your voice is hoarse or weak for more than a week

You may be referred to a specialist so they can investigate these problems further.

Immediate action required: Call 999 if:

You've had a tracheostomy and:

• you're having difficulty breathing

Page last reviewed: 26 January 2024 Next review due: 26 January 2027

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Tracheostomy tube - 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).

At the time of your surgery, the first trach tube will 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 should be able to make sounds. However, most of the time the trach tube is changed after 5 to 7 days to a smaller, cuffless trach. This makes speaking much easier.

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.
• Close off the trach tube opening with your finger and then speak.
• 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.

In order to speak, it is important that you place a clean finger over the trach to prevent air from exiting through the trach. This will help the air go out through your mouth to make your voice.

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 without needing to use your finger to block your trach each time you talk.

Some patients may not be able to use these valves. The speech therapist will work with you to ensure you are a good candidate. 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
• Airway damage from factors that created the need for the tracheostomy

Alternative Names

Trach - speaking

Dobkin BH. Neurological rehabilitation. In: Jankovic J, Mazziotta JC, Pomeroy SL, Newman NJ, eds. Bradley and Daroff's Neurology in Clinical Practice . 8th ed. Philadelphia, PA: Elsevier; 2022:chap 55.

Greenwood JC, Winters ME. Tracheostomy care. In: Roberts JR, Custalow CB, Thomsen TW, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine and Acute Care . 7th ed. Philadelphia, PA: Elsevier; 2019:chap 7.

Review Date 12/31/2023

Updated by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

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• Tracheal Disorders

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SpaceX Starship rocket prototypes inside the Starbase Launch Center - the precursors to ships ... [+] destined to transform the Moon. (Marie D. De Jesús/Houston Chronicle via Getty Images)

Squads of American explorers are counting down to rocketing to the Moon, armed with leading-edge technologies that set the stage for a new branch of civilization to bring life to its ancient craters.

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Rapid advances in creating “swarms” of interlinked AI-enhanced robots, and in global “cloud robotics” networks that allow them to learn from each other, are remaking the realm of space robotics and its future, Hodges tells me in a series of interviews.

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“Starship is designed to do that better than any competing vehicle at this point.”

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While now constructing virtual looking glass worlds of Moon sites surveyed by orbiting satellites, he says the ultimate goal is to rapidly build simulations from imagery captured by robotic photographers before and during the early stages of Artemis landing missions.

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Radical success with this troupe of robot-democrats and their mapmaking odyssey , he adds in a press release, “could change how we do exploration in the future.”

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