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CION Cancer Clinics
Speaking with a tracheostomy: how the speaking valve works | CION Cancer Clinics
A speaking valve is a small one-way cap on the end of the tracheostomy tube. It opens when you breathe in, so air comes through the tube. It closes when you breathe out, so the air goes around the tube, up through the voice box and out of the mouth, and that moving air makes your voice. It only works when the cuff is down and air can pass around the tube, which is why the first trial is always done with the team watching. CION Cancer Clinics’ surgical oncologists in Hyderabad can talk this through with you.
MI
Medically reviewed by Dr. Mohammed ImaduddinConsultant Surgical Oncologist · MBBS, MS (General Surgery), MCh (Surgical Oncology) · last reviewed September 2026, next review due September 2027
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On this page
- How does a speaking valve work?
- What happens when the valve is tried for the first time?
- Who can use a speaking valve, and who cannot?
- Speaking valve words, in plain language
- Four things families tell us, and what is actually true
- What this page cannot tell you
- Common questions about speaking with a tracheostomy
The short answer
How does a speaking valve work?
A speaking valve is a small one-way cap on the end of the tracheostomy tube. It opens when you breathe in, so air comes through the tube as usual. It closes when you breathe out, so the air has to go around the tube, up through the voice box and out of the mouth. That moving air is what makes your voice.
Why you lose your voice with a tracheostomy
Your voice is made by air from the lungs passing over the vocal cords in the voice box. A tracheostomy sits below the voice box, so air goes in and out through the tube and never reaches the cords. The cords themselves are usually fine. They are being bypassed.
What the valve needs to work
Air must be able to get past the outside of the tube. That means the cuff, if there is one, is fully down, the tube is small enough to leave a gap around it, and the airway above the tube is open. If any of these is not the case, the valve traps air in the lungs. That is why the first trial is always done with the team watching.
A speaking valve is never used after a total laryngectomy. In that operation the voice box is removed and the airway no longer connects to the mouth.The first time
What happens when the valve is tried for the first time?
Assessment
A speech and swallowing therapist and the tracheostomy team check that you are breathing on your own, that secretions are manageable, and that the airway above the tube is open. Sometimes a small camera is passed to look.
Cuff down and a finger test
The cuff is let fully down and the tube is suctioned. The therapist briefly covers the tube opening with a gloved finger while you breathe out. If air moves easily around the tube and you can make a sound, the valve is likely to work.
The valve goes on
It clicks onto the tube. You are asked to breathe quietly, then to say a few words. Your breathing, oxygen level and comfort are watched the whole time.
Short sessions first
Minutes at first, then longer, always with someone present. The valve comes off if breathing becomes hard, the voice sounds strained, or you feel air trapping in the chest.
A plan for home
You leave with written times for wearing it, instructions on cleaning it, and the rule that it is never worn asleep unless the team has specifically said otherwise.
Not sure whether this applies to you?
Ask an oncologistSuitability
Who can use a speaking valve, and who cannot?
The valve is safe only when air has a clear way out around the tube. The team checks this before every trial.
Usually suitable
Someone breathing on their own, awake and alert, with an uncuffed tube or a cuff that stays fully down, secretions that are thin, and an open airway above the tube.
Not yet suitable
Someone still on a ventilator, someone whose cuff must stay up because swallowing is unsafe, or someone with thick secretions that need frequent suction. Often these change with time, and the valve is tried later.
Not suitable at all
Anyone whose airway above the tube is blocked, whether by swelling, scarring or the tumour itself, and anyone who has had a total laryngectomy. For them, a valve would trap air with no way out.
Other ways to communicate
- A writing pad or phone screen
- An electrolarynx held to the neck
- Picture or word boards
Sometimes helped by a tube change
If the tube is too wide for air to pass around it, the team may change to a smaller or a fenestrated tube, one with a small window, before trying again.
!
One thing that cannot wait
If the person becomes breathless, distressed, red or blue in the face, or cannot breathe out while the valve is on, take the valve off at once. That is always the first step, before anything else. If breathing does not settle within a few breaths of the valve coming off, suction the tube and call the emergency number. A valve on a cuffed tube with the cuff still up can stop the breath out completely. Check the cuff every single time before the valve goes on.
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Words you will hear
Speaking valve words, in plain language
- One-way valve
- The valve itself. Open on the breath in, closed on the breath out.
- Cuff
- The balloon on some tubes that seals the windpipe. It must be completely down before a valve is used.
- Fenestrated tube
- A tube with a small window in its curve that lets more air reach the voice box. Used with the plain inner tube removed.
- Finger occlusion
- Covering the tube opening briefly with a finger on the breath out to test whether air passes around the tube. Only done as the team showed you.
- Capping
- Closing the tube completely with a solid cap, so all breathing goes through the nose and mouth. The step after the valve, on the way to removing the tube.
- Speech and swallowing therapist
- The specialist who assesses the voice and the swallow and runs the valve trials. Written as SLP or SLT in the notes.
Commonly believed
Four things families tell us, and what is actually true
"He has a tracheostomy, so he will never speak again."
Most people with a tracheostomy who still have their voice box can speak with a valve once they are off the ventilator and the cuff is down. The voice may sound weaker or breathier than before. It is still their own voice.
"We can buy a valve online and try it ourselves."
The first trial has to be done with the team watching, because a valve on the wrong tube, or with the cuff up, traps air in the lungs. Once you have been cleared and taught, you use it at home. Not before.
"If she can speak with it, she can sleep with it."
Asleep, secretions build and nobody is watching. A valve that becomes blocked overnight has no way to let the breath out. The valve comes off for sleep, and for any time the person is drowsy, unless the team has specifically said otherwise.
"A speaking valve is the same as a laryngectomy voice prosthesis."
They are different devices for different operations. A speaking valve sits on a tracheostomy tube and sends air up to an intact voice box. A voice prosthesis after laryngectomy sits between the windpipe and the gullet.
Being straight with you
What this page cannot tell you
This page cannot tell you whether your relative is ready for a valve, or how their voice will sound. Readiness depends on the swallow, the secretions and the airway above the tube, and only the team can assess those.
What the valve does not do
It does not make swallowing safe on its own, although for some people it helps. It does not mean the tube is about to come out, although it is usually a step on that road. And it does not restore a voice changed by surgery to the cords themselves.
What to ask
Is the cuff down, and is the tube the right size for a valve. Who runs the trial, and when. How long can it be worn each day, and what are the signs to take it off. How is it cleaned, and how often is it replaced. Ask for the wearing plan in writing and keep it with the valve.
If the voice suddenly changes, or the valve becomes hard to breathe through, stop using it and ring the team the same day.Questions we are asked
Common questions about speaking with a tracheostomy
How soon after the tracheostomy can he try to speak?
Once he is off the ventilator, awake, coping with the cuff down and not needing frequent suction. For some people that is within days, for others weeks. The team decides on what they see, not on a calendar.
Will her voice sound the same as before?
Often quieter or breathier, because less air reaches the cords than through a normal airway, and because the throat may be sore or swollen after surgery. Many people find it improves with practice. If the cords were touched by the operation or radiotherapy, the therapist will explain what to expect.
Can the valve be worn all day?
Many people build up to wearing it all their waking hours. It comes off for sleep, for suction, for nebulised treatments, and whenever breathing feels harder. Follow the wearing plan you were given and increase only as the team advises.
Does it help with eating and drinking?
For some people it does, because breathing out through the mouth and nose restores the sense of smell and some of the pressure that helps a swallow. It does not make an unsafe swallow safe. Eating with a tracheostomy is assessed separately.
How do I clean the valve?
Rinse it in warm, not hot, water with a little mild soap, rinse again, and leave it to air-dry on a clean cloth. Do not boil it, scrub it, or use spirit or bleach. Follow the maker's instructions for how long it lasts before it is replaced.
Why does he cough so much when it goes on?
Air passing up through the throat for the first time in days or weeks moves secretions that were sitting there, and the throat is sensitive. Coughing in the first minutes is expected. Coughing that does not settle, or comes with breathlessness, means the valve comes off and the team is told.
Is the valve covered by Aarogyasri or insurance?
It is often included when it is part of the hospital plan, and less often as a replacement bought later. Ask the team's counsellor to check your scheme or insurer before you buy.
What if the valve does not work for her?
The team looks at why. A tube change, more cuff-down time, or treatment of swelling above the tube may make a later trial work. If a valve is never going to be safe, an electrolarynx, a writing pad and phone apps all give a voice back in a different way.
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Sources
- NHS — Tracheostomy
- National Cancer Institute — Tracheostomy (NCI Dictionary of Cancer Terms)
- American Cancer Society — Surgery for laryngeal and hypopharyngeal cancer
- Cancer Research UK — Laryngeal cancer
- Macmillan Cancer Support — Head and neck cancer
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Cuffed vs Uncuffed TubesWhy the cuff has to be down before a valve goes onTracheostomy vs Laryngectomy Stoma: Not the Same ThingWhy a speaking valve is never used after laryngectomyEating and Swallowing With a TracheostomyThe swallow is assessed separately from the voiceDecannulation: Getting the Tube OutThe valve is usually a step on the way to capping and removalThe Emotional Side of Cancer SurgeryLosing your voice, even for a while, is hard
Talk to us
Wondering whether your relative is ready for a speaking valve?
Call the helpline. A surgical oncologist or speech and swallowing therapist will explain what the team checks first and what to ask on the ward. One helpline serves every CION centre.