A fenestrated tracheostomy tube has an additional opening that can allow more functionality than one without. But it carries additional risks.

A tracheostomy is a procedure to create an opening in your neck that connects to your trachea, or windpipe. The terms “tracheostomy” and “tracheotomy” are often used interchangeably, but we will use “tracheostomy” here.

You may need a tracheostomy for many reasons. It is usually a planned surgery and is done under general anesthesia. If it’s an emergency, a slightly different procedure called a cricothyrotomy is performed.

You might need a tracheostomy if your upper airway is damaged or blocked or if you’re unable to keep fluid out of your lungs.

A tracheostomy creates an opening, or stoma, to your trachea below your vocal cords. A tube can be inserted into the stoma so air can reach your lungs without passing through your nose or mouth.

The tube can be either fenestrated or non-fenestrated. A fenestrated tube has an additional opening that can allow more functionality but might also have certain risks.

Let’s take a deeper dive into fenestrated tracheostomy tubes.

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Fenestrated tracheostomy tube. | Medical Illustration by Bailey Mariner.

When you have a tracheostomy tube put in, it may be temporary. Other times, like if your upper airway is irreparably injured, you might need a permanent tracheostomy tube. This will largely depend on the reason for your tracheostomy and your overall health.

Whether you have a temporary or permanent tracheostomy tube, it will need regular cleaning and may also need occasional replacement.

If you have a temporary tracheostomy tube, you may be able to use a fenestrated tracheotomy tube after you’ve started to recover.

The fenestrated tracheostomy tube has an opening that allows exhaled air to flow into your throat and out of your nose or mouth. This might allow you to speak again. It may also make breathing less laborious, which could be helpful if you’re coming off a ventilator (extubation).

Around the outside of a tracheostomy tube is a small inflatable ring called a cuff. When this is inflated, it seals off your trachea so that the only pathway to and from your lungs is through the tube.

The cuff helps prevent secretions like saliva from entering your lungs. But it also prevents air from passing up over your vocal cords, leaving you unable to speak.

In some cases, you might be able to speak while the cuff is deflated, but this is often very difficult or not possible.

A fenestrated tracheostomy tube has one or more small holes, called fenestrations, which allow exhaled air to pass over your vocal cords so you can speak.

A non-fenestrated tracheostomy tube does not have these holes, meaning it’s unlikely you’ll be able to speak. Another option is a speaking valve, which is an attachment that goes on the end of the tube and can make it easier to speak, but some people may find it difficult to use.

A fenestrated tracheostomy tube does have some risks associated with it.

First, the fenestrations make it easier for secretions or food particles to enter your tracheostomy tube. Once inside the tube, this debris could partially or fully block the flow of air into your lungs. The debris could also travel down the tube and enter your lungs, causing further complications.

Additionally, cleaning a fenestrated tracheostomy tube may pose some risks. Tracheostomy tubes require occasional cleaning or clearing. A doctor will use a special type of suction device to clear the inside of the tube. If you have a fenestrated tracheostomy tube, there is a risk that the suction device can pass through the fenestration and damage the surrounding tissues in your trachea.

For these reasons, you will usually start on a non-fenestrated tube immediately following your tracheostomy. You may be able to switch to a fenestrated tube after you begin to recover.

Recovery from a tracheostomy will be different for everyone depending on your overall health and your reason for needing the procedure. The stoma itself will usually heal in about a week.

The area around the stoma will need to be kept clean. It’s possible to eat while using a tracheostomy tube if you’re in a condition to do so. You may need to limit strenuous physical activity for 1–2 months after the procedure.

You may find it helpful to speak with your doctor to discuss expectations for your tracheostomy recovery.

After having a tracheostomy, your doctor will insert a tracheostomy tube into the stoma to allow air to flow in and out of your lungs.

The tracheostomy tube can be fenestrated or non-fenestrated. A fenestrated tube has holes that make it easier to speak, but this can also introduce other risks.

If you’re going to have a tracheostomy, you may want to ask your doctor which type of tube to expect after your procedure.