A tracheostomy is a medical procedure—either temporary or permanent—in which a tube is surgically implanted into a person’s windpipe so that he or she can breathe.
The tube is inserted through a cut in the neck below the vocal cords, allowing air to enter the lungs. Breathing is then done through the tube, bypassing the mouth, nose, and throat.
A tracheostomy is commonly referred to as a stoma, which is the name for the hole in the neck that the tube passes through.
A tracheostomy is performed for several reasons, all of which involve restricted airways that prevent air from reaching the lungs. It could be employed during an emergency situation when the airway is blocked, or due to a disease or another problem that makes normal breathing impossible.
Conditions that may require a tracheostomy include:
- anaphylaxis (a severe, full-body allergic reaction in which the airways narrow and blood pressure quickly drops)
- birth defects of the airway
- burns of the airway from inhalation of corrosive material (including steam and smoke)
- cancer in the neck
- chronic lung disease
- diaphragm dysfunction
- facial burns or surgery
- injury to the larynx or laryngectomy
- injury to the chest wall
- obstructive sleep apnea (a condition in which there are pauses or decreases in airflow into the lungs while asleep)
- obstruction by a foreign body
- paralysis of the muscles used in swallowing
- severe neck or mouth injuries
- vocal cord paralysis
Every medical procedure where the skin is broken carries the risk of infection and excessive bleeding. There is also a chance of an allergic reaction to anesthesia, although it is rare. Tell 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 (i.e. the windpipe), which is rare
- lung puncture and lung collapse
- scar tissue in the trachea
If a tracheostomy is performed during an emergency—such as a foreign object obstructing the airway—there will be no time to prepare.
However, if your tracheostomy is planned, your doctor will give you complete instructions about how to best prepare for the procedure. This may involve fasting for up to 12 hours before the procedure, removing all jewelry, and changing into a hospital gown before the surgery.
The doctor will begin by putting you under general anesthesia, which means that you’ll be in a painless sleep. In emergencies, local anesthesia to the neck will have to suffice. When the anesthesia has kicked in, the procedure will begin.
A surgeon will make a cut into your neck, just below your Adam’s apple. The cut will go through the tough cartilage rings of the outer wall of your trachea. This hole is then opened wide enough that a tracheostomy tube can fit inside.
There are several types of tracheostomy tubes. Your doctor will choose the one that bests suits your needs. All can be hooked up to a ventilator, in case your condition requires that a machine breathe for you. When you wake up from surgery, you may be hooked up to a ventilator.
The tube will be secured in place with a band that goes around the neck. This helps keep the tube in place while the skin around it heals. Your surgical team will instruct you about how to care for the wound and your tracheostomy tube.
It typically takes a patient one to three days to adapt to breathing through a tracheostomy tube. Talking and making sounds also takes some practice because the air you breathe no longer passes through your voice box. For some people, covering the tube allows them to talk relatively easily.
Alternately, there are special valves that can be attached to the tracheostomy tube that, while still taking in air through the tube, allow air to exit the mouth and nose, permitting speech.
If your tracheostomy is temporary, there is typically only a small scar left when the tube is removed.
Those with a permanent tracheostomy may need assistance to get used to the stoma. Your doctor’s office will give you tips about cleaning and maintaining the tube.
Though people with tracheostomies have initial difficulty speaking, most can adjust and learn to speak.