A tracheostomy is a type of medical procedure that involves making an opening in the neck in order to place a tube into a person’s windpipe (trachea).
The tube is inserted through the opening in the neck below the vocal cords. This lets air to enter the lungs. Breathing is then done through the tube. A tracheostomy is usually referred to as a stoma. This is the name for the hole in the neck that the tube passes through.
Why a tracheostomy is performed
A tracheostomy is done for several reasons, all involving restricted airways. It may be performed during an emergency when your airway is blocked or it could be used when a disease or other problem makes normal breathing difficult.
Conditions that may require a tracheostomy include:
- birth defects of the airway
- burns of the airway from inhalation of corrosive substances
- cancer in the neck
- chronic lung disease
- diaphragm dysfunction
- facial burns or surgery
- injury to the larynx
- injury to the chest wall
- need for prolonged respiratory support
- blockage of the airway
- obstructive sleep apnea
- total paralysis of the muscles used for swallowing
- severe neck or mouth injuries
How to prepare for Tracheostomy
If your tracheostomy is planned, your doctor will tell you how to prepare for the medical procedure. This can involve fasting for up to 12 hours prior to the procedure.
If your tracheostomy is done during an emergency, there will be no time to prepare.
How a tracheostomy is performed
For most scheduled tracheostomies, you’ll be given general anesthesia. This means you’ll be unconscious and won’t feel any pain. In emergencies, you’ll be injected with local anesthesia. This numbs the area of your neck where the opening is made. The procedure will start only after the anesthesia has started working.
Your doctor will make a cut into your neck just below your Adam’s apple. The cut will go through the cartilaginous rings of the outer wall of your trachea (windpipe). The opening is then made wide enough to fit a tracheostomy tube inside.
Your doctor may connect the tube to a ventilator, in case you need a machine to breathe for you. The tube will be secured in place with a band that goes around your neck. This aids to keep the tube in place while the skin around it heals. Your doctor will tell you how to care for the wound and your tracheostomy tube.
Adapting to a tracheostomy tube
It usually takes one to three days to adapt to breathing through a tracheostomy tube. Talking and making sounds also takes some time. This is because the air you breathe no longer goes through your voice box. For certain people, covering the tube helps them talk.
Alternately, special valves can be attached to the tracheostomy tube. While still taking in air through the tube, these valves let air to exit the mouth and nose, allowing speech.
Every medical procedure where the skin is broken comes with the risk of infection and excessive bleeding. There’s also a chance of an allergic reaction to anesthesia, although it’s rare. Inform your doctor if you’ve had an allergic reaction to anesthesia in the past.
Risks specific to a tracheostomy include:
- damage to the thyroid gland in the neck
- erosion of the trachea
- lung collapse
- scar tissue in the trachea
Outlook after a tracheostomy
If your tracheostomy is temporary, there’s usually only a small scar left when the tube is removed.
Those with a permanent tracheostomy may require help getting used to the stoma. Your doctor will give you tips about cleaning and maintaining the tube.
Although people with tracheostomies have initial difficulty speaking, most can adjust and learn to speak.
Frequently Asked Questions (FAQs)
Is tracheostomy a permanent procedure?
Tracheostomy can be temporary or permanent, depending on the patient's condition. In some cases, the tracheostomy tube can be removed once the patient's breathing has improved, and they can breathe independently. However, in other cases, the tracheostomy may be needed long-term or permanently.
What is tracheostomy care?
Tracheostomy care involves regular cleaning and maintenance of the tracheostomy tube and stoma to prevent infections and ensure proper functioning. Care routines include suctioning mucus, cleaning around the stoma, and changing the inner cannula or the entire tube as needed.
How long does it take to recover from a tracheostomy?
Recovery time varies depending on the individual's health condition, the reason for tracheostomy, and whether it's temporary or permanent. Some patients may regain their ability to breathe independently relatively quickly, while others might require ongoing support and rehabilitation.
Can a person speak with a tracheostomy tube?
Speaking with a tracheostomy tube may be challenging, but various options are available to restore speech. Fenestrated tracheostomy tubes and speaking valves redirect airflow, allowing vocalization. Speech therapy can also help patients adapt to speaking effectively with a tracheostomy.
Is tracheostomy reversal possible?
Tracheostomy reversal, also known as decannulation, is possible in many cases where the patient's condition improves significantly. The decision for decannulation is made by a medical team based on the patient's respiratory function, overall health, and ability to breathe independently.
Tracheostomy is a complex medical procedure, and decisions regarding it should be made in consultation with qualified healthcare professionals who can provide personalized guidance based on the individual's medical needs and circumstances.
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