The patient requiring mechanical ventilatory support: use of the cuffed tracheostomy "talk" tube to establish phonation.

Many patients requiring mechanical ventilatory support via a cuffed tracheostomy tube possess a normal larynx and intact linguistic and cognitive abilities yet are unable to communicate normally because of the interruption of airflow through the intact larynx. The usual alternative means of communication such as writing, gesturing, or the use of an electrolarynx have obvious limitations and are often impossible when there is neurologic motor impairment. Frustration, depression, and compromised medical care are frequent side effects of the patient's inability to communicate. An adapted speaking-aid tracheostomy tube has been available since 1975 for the patient requiring mechanical ventilatory support. However, acceptance and satisfaction with this aid to phonation have not been uniform and there have been few claims of consistent acquisition of phonation. Reasons for success or failure have been unclear. We wish to report experience with the single-cuffed tracheostomy "talk" tube in 19 patients, 14 of whom acquired satisfactory functional laryngeal phonation. Indications for its use, technical aspects of the tube, solutions of common problems, and potential reasons for failure are discussed.