When a person has a trach, nearly everything changes. They have to relearn many things that before the trach, just came naturally. One of these things is speech. With a trach, just by itself, it is extremely difficult to talk. This is because the trach tube is put in below the vocal chords. Since air no longer passes through the vocal chords, it is difficult to make sound or speak. Typically, as a person inhales, the vocal chords open, allowing air to flow past the vocal chords into the trachea, and into the lungs. When a person exhales, the vocal chords close. As air flows over them it is possible to make sound and speech. Since the trach tube is put into the trachea, below the vocal chords, air no longer passes through the vocal chords for speech. Air that is exhaled, goes out the trach tube, thus never reaching the vocal chords. This makes speaking very difficult. It can be done with a speaking valve, or if you occlude the trach with your finger, but without the aid of anything it is very difficult.
When the trach was initially put in, I was unable to speak at all. As much as I would try, I was unable to make sound. Part of this was due to the size of the trach put in. I was unable to use the speaking valve because the trach was too big. The trach was changed to a smaller size so that I could use the passy-muir speaking valve. The passy-muir valve is a small circular valve that is placed over the trach tube. The way that it's supposed to work is that you are able to breathe in through the trach, but when you exhale, instead of it coming out your trach, as it would if the valve wasn't on, it is exhaled either through the mouth or nose. Since it is exhaled through your mouth instead of the trach, the air passes through the vocal chords during exhalation. As air passes over the vocal chords, it is possible to make sound and thus speak. Finger occlusion works in a similar manner. In finger occlusion, you breathe in through the trach through, but as you go to talk, you cover the opening of the trach with your finger. This prevents air from going out the trach and forces it over the vocal chords to be exhaled out of the mouth, enabling speech.
Since the 3rd trach surgery, I have been able to speak without the use of anything. I speak around the trach. Somehow I force the air over my vocal chords instead of having it all be released through my trach. In fact, for awhile this was my only form of communicating. The problem - it took a lot of effort and was quite exhausting. I could only say a few words at a time. My voice was quiet and breathy and difficult to understand at times. However, I could speak and communicate effectively. I tried the occlusion technique and while it allowed me to say a few more words at a time and my voice was stronger, it took coordination. You have to time breathing in and speaking. You obviously can't inhale while your trach is occluded with your finger. So, you have to gauge the timing correctly. It is also quite annoying to carry on a lengthy conversation by occluding your trach. For me there was another element too. This is that no matter what, your hands cannot be perfectly clean. With a trach there is always added risk for infection. It is direct access to your lungs. Anyone with a trach has to be careful, but a person that is immunocompromised, such as I am, must be beyond careful. Other than the inconvenience finger occlusion presents, the infection risk is more of a concern in my opinion.
That leaves the passy-muir valve or PMV. For most people with trachs, the PMV is their life. With the PMV they are able to speak fairly normally. For some, it may take a short time to get used to it and adjust to it. For some reason I couldn't tolerate it. They'd put it on and I'd feel like I was suffocating. I couldn't get air in. My sats would drop and my heart rate would shoot up. I just couldn't tolerate it. Everyone here couldn't understand it. Why couldn't I tolerate it? They'd never had someone who truly couldn't tolerate it. On one particular session where I was having difficulty and telling the speech therapist again that I feel like I'm suffocating and can't get air in. She told me this wasn'tt possible because the PMV is made as a flap. It is secure at the middle, but not around the edges. As you breathe in, the flap opens to let air in. When we looked at my PMV, the flap was secure all the way around; it didn't open. Well, this would explain why I felt like I was suffocating - because I was. Give it to me to get a defective PMV. Really?... What are the odds? Well of course we switched PMVs, and lo and behold, it was okay. I could use it without difficulty. It still took time to get used to it but I didn't have the problems I had been having.
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