Verbal communication with the Blom low profile and Passy-Muir one-way tracheotomy tube speaking valves
Introduction
Once a tracheotomy tube is required for airway maintenance normal verbal communication ability is lost with resultant concomitant negative impact on social interactions, care giver discussions, and overall-all quality-of-life (Levine et al., 1987, Parker, 1984, Safar and Grenvik, 1975, Sparker et al., 1987). The inability to speak increases psychological distress, depression, and malaise (Baskin et al., 2004, Hashmi et al., 2010). Alternatively, nonverbal communication techniques, e.g., lip reading, communication boards, writing or typing, and computerized augmentative communication systems, are imprecise, cumbersome, costly, and prone to breakage (Hashmi et al., 2010).
One-way tracheotomy tube speaking valves have been shown to be reliable and valuable devices to restore verbal communication (Leder, 1994). The one-way valve opens to allow inspiration through the tracheotomy tube but then closes blocking expiration via the tube and thereby diverting expired air up through the larynx, upper airway, and mouth for speech production. Criteria for use of a one-way tracheotomy tube speaking valve are adequate cognition and ability to tolerate either full cuff deflation or a cuff less tube (Passy, 1986). A one-way valve eliminates both the need for finger occlusion and intolerance of permanent capping due to upper airway obstruction. Voice intensity associated with a successful one-way speaking valve must be greater than ambient room noise to allow for audible and intelligible speech production (Leder, 1990, Leder and Traquina, 1989).
The Passy-Muir one-way valve attaches to the external 15 mm universal hub of any tracheotomy tube and uses a bias-closed valve, i.e., only opens during inspiration (Fig. 1A). Exhaled air is directly caudally between the tracheal wall and non-fenestrated tracheotomy tube. The Blom low profile one-way valve can only be used with the Blom fenestrated tracheotomy tube and is the inner cannula with a flap-valve at the distal tip just above the fenestration (Fig. 1B). Exhaled air is directed both up through the tracheotomy tube exiting via the fenestration and between the tracheal wall and tracheotomy tube.
The purpose of this study was to compare the new Blom low profile voice inner cannula and the established Passy-Muir (Passy, 1986) one-way speaking valves. It was hypothesized that there would be no differences in physiologic parameters, voice production abilities, and functional verbal communication ratings between the two valves.
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Participants
The study was approved by the Human Investigation Committee of Yale School of Medicine. A total of 30 consecutive inpatients from a large, urban, tertiary care teaching hospital requiring a tracheotomy tube for upper airway maintenance voluntarily participated (Table 1). Inclusion criteria for participants were older than 18 years, spoke standard American English, did not exhibit reading difficulties, had never used a one-way tracheotomy speaking valve prior to current use, and had adequate
Results
Participant (N = 30) demographics, diagnoses, and tracheotomy tube type, size, and duration of use are reported (Table 1). A heterogeneous sample consistent with a large, urban, tertiary care teaching hospital with respect to age, gender, and tracheotomy tube type, size, and duration of use was obtained. All 30 (100%) participants tolerated the Blom low profile valve while 28 of 30 (93%) tolerated the Passy-Muir valve.
No significant differences (p > 0.05) were observed for the physiologic
Discussion
Functional verbal communication was rated the same by native English speaking listeners following use of either the Blom tracheotomy tube with low profile voice inner cannula or the Passy-Muir valve with both standard and fenestrated inner cannulas. Since no significant differences were observed between valves for either the physiologic parameters of oxygen saturation, respiration rate, and heart rate (p > 0.05) or voice production abilities of maximum intensity and duration of the vowel/a/ (p >
Study strengths and limitations
Major strengths of this study allowing for generalizability of results included a heterogeneous sample with respect to age, gender, and tracheotomy tube type, size, and duration of use, prospective and consecutive participant accrual, randomized and blinded methodology, and equivalent product comparisons. Limitations of this study were use of a referral-based population sample but participant accrual could not have been achieved with a randomized controlled research design
Conclusions
Functional verbal communication was rated as equivalent between the Blom tracheotomy tube with low profile voice inner cannula and the Passy-Muir one-way valve with use of both fenestrated and non-fenestrated inner cannulas. Both the Blom and Passy-Muir one-way tracheotomy tube speaking valves had similar physiologic parameters for safe use and allowed for successful phonation greater than ambient room noise.
Author contributions
Stewart I. Adam, conception and design, acquisition of data, analysis and interpretation of data, drafting and revising, final approval; Prateet Srinet, acquisition of data, revising, and final approval Ryan M. Aronberg analysis and interpretation of data, revising, and final approval; Graeme Rosenberg analysis and interpretation of data and final approval; Steven B. Leder, conception and design, acquisition of data, analysis and interpretation of data, drafting and revising, final approval.
Competing interests
None.
Sponsorships
Department of Surgery, Section of Otolaryngology.
Funding source
Ohse Research Fund, Yale School of Medicine, New Haven, CT 06520, USA.
Acknowledgement
We thank Wade Vantrease for his audio-engineering expertise in creating the functional verbal communication recordings.
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