The Speaking Valve Part 3: Why isn’t it called a swallowing valve?
By George Barnes MS CCC-SLP
Patients with trachs are MUCH more likely to aspirate (Pannuzio, 1996). It’s interesting how a little piece of plastic meant to produce voice has had the unintended benefits of swallow (Gross et al., 2003; Elpern et al., 2000; Suiter et al., 2003). To be fair, much of the research is mixed (Suiter, 2005) and we need more to make sense of the whirlwind of data. But standard practice and clinical trends tell us that using the speaking valve makes for a better swallow. And why wouldn’t it? For effective swallowing, we need sensation, strength, and coordination. The speaking valve does it all:
Sensation: In theory, with increased upper airflow, the sensation of the upper airway improves. This helps us smell and clear secretions. (Johnson et al., 2009; Lichtman et al., 1995; O’Connor et al., 2019). More research is needed on this topic, but physiologically speaking, valves make “sense” for swallowing (puns intended).
Strength: With a 10x increase in subglottic pressure, the patient may have a more productive cough, stronger bolus propulsion, and improved airway protection (Gross et al., 1994).
Coordination: Breathing/swallowing coordination is restored; giving the patient back the body’s patented inhale, exhale, swallow, exhale routine (Prigent et al., 2012). This physiological pattern isn’t just for show, it’s been developed from millions of years of evolution to protect that wrong pipe.
So while I wait for my speaking valve royalties to start rolling in I’ll leave you with some food for thought. The question is not IF we will try a speaking valve but WHEN. The answer? RIGHT NOW. But not always (see prior post on initial assessment). But often, the earlier the better. My motto? As soon as they are stable. Because as important as speaking and swallowing are, life in itself always wins. But that begs the question: What is life, without food?
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References:
Eibling, D. E., & Gross, R. D. (1996). Subglottic Air Pressure: A Key Component of Swallowing Efficiency. Annals of Otology, Rhinology & Laryngology, 105(4), 253–258. https://doi.org/10.1177/000348949610500401
Elpern EH, Borkgren M, Bacon M, Gerstung C, Skrzynski M. Effect of the Passy- Muir tracheosotomy speaking valve on pulmonary aspiration in adults. Heart and Lung: The Journal of Acute and Critical Care. 2000;29:4287-293.
Gross RD, Mahlmann J, Grayhack, JP. Physiologic effects of open and closed tracheostomy tubes on the pharyngeal swallow. Annals of Otology, Rhinology & Laryngology. 2003;112(2):143-152.
Johnson, D. C., Campbell, S. L., & Rabkin, J. D. (2009). Tracheostomy tube manometry: evaluation of speaking valves, capping and need for downsizing. The Clinical Respiratory Journal, 3(1), 8–14. https://doi.org/10.1111/j.1752-699x.2008.00100.x
Lichtman, S. W., Birnbaum, I. L., Sanfilippo, M. R., Pellicone, J. T., Damon, W. J., & King, M. L. (1995). Effect of a Tracheostomy Speaking Valve on Secretions, Arterial Oxygenation, and Olfaction: A Quantitative Evaluation. Journal of Speech, Language, and Hearing Research, 38(3), 549–555. https://doi.org/10.1044/jshr.3803.549
O’Connor, L. R., Morris, N. R., & Paratz, J. (2019). Physiological and clinical outcomes associated with use of one-way speaking valves on tracheostomised patients: A systematic review. Heart & Lung, 48(4), 356–364. https://doi.org/10.1016/j.hrtlng.2018.11.006
Pannunzio, T. G. (1996). Aspiration of Oral Feedings in Patients With Tracheostomies. AACN Clinical Issues: Advanced Practice in Acute and Critical Care, 7(4), 560–569. https://doi.org/10.1097/00044067-199611000-00010
Prigent, H., Lejaille, M., Terzi, N., Annane, D., Figere, M., Orlikowski, D., & Lofaso, F. (2011). Effect of a tracheostomy speaking valve on breathing–swallowing interaction. Intensive Care Medicine, 38(1), 85–90. https://doi.org/10.1007/s00134-011-2417-8
Suiter DM, McCullough GH, Powell PW. Effects of cuff deflation and one-way tracheostomy speaking valve placement on swallow physiology. Dysphgia. 2003;18(4): 284-292.
Suiter, D. M. (2005). Speaking Valves and Swallowing. Perspectives on Swallowing and Swallowing Disorders (Dysphagia), 14(4), 14–18. https://doi.org/10.1044/sasd14.4.14
