Unaided speech in long-term tube-free tracheostomy

Objectives/Hypothesis: Objectives of the current study were as follows: 1) to determine whether a self-sustaining, tube-free tracheostomy with unaided speech capability can be achieved, 2) to propose new surgical techniques t o enhance voluntary constriction of a tube-free tracheostoma to improve cou gh and speech production, and 3) to explain the mechanism involved in unaid ed speech after long-term tracheostomy. The hypotheses were that long-term, tube-free tracheostomy could minimize the unwanted effects of conventional tube dependent tracheotomy; that surgical shunting of the trachea to the s kin surface can be established through a short, skin-lined, self-supporting , nostril-like opening; and that patients could generate speech and cough w ithout the need to occlude the stoma or use stents and/or one-way valves if such a long-term tube-free tracheostoma were established. Study Design: A prospective study of tube-free tracheostomy intended to establish unaided c ough and speech, Methods: Thirty-five patients who underwent long-term nap tracheostomies between 1992 and 1999 with the prospective intent of establi shing a self-sustaining stoma without the need for tubes or stents were rev iewed. The patients were trained to intentionally constrict the stoma for p roduction of unaided speech and cough, The pertinent techniques developed f or successful achievement of these characteristics are presented and review ed, A new surgical technique using a local tendinous muscular sling was des igned to further improve the efficacy of stomal constriction, Results: A tu be-free stoma was successfully established in all 35 patients, Eighteen pat ients achieved effective intentional constriction of the stoma and thereby were capable of unaided speech production, Four patients required an additi onal new surgical sling procedure to optimize unaided cough and speech prod uction, Thirteen patients achieved only limited unaided speech production, but were satisfied to do nothing further. Conclusions: New surgical techniq ues and postoperative management to create a modified tube-free tracheostom y with self-constricting capabilities can enable production of effective co ugh and near-normal generation of unaided speech, In this manner, the airwa y can be secured with little or no voice compromise.