A tracheostomy is a medical procedure — either temporary or permanent — that involves creating an opening in the neck in order to place a tube into a person’s windpipe.
The tube is inserted through a cut in the neck below the vocal cords. This allows 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. This is the name for the hole in the neck that the tube passes through.
A tracheostomy is performed for several reasons, all involving restricted airways. It may be done during an emergency when your airway is blocked. Or it could be used when a disease or other problem makes normal breathing impossible.
Conditions that may require a tracheostomy include:
- birth defects of the airway
- burns of the airway from inhalation of corrosive material
- cancer in the neck
- chronic lung disease
- diaphragm dysfunction
- facial burns or surgery
- injury to the larynx or laryngectomy
- injury to the chest wall
- need for prolonged respiratory or ventilator support
- obstruction of the airway by a foreign body
- obstructive sleep apnea
- paralysis of the muscles used in swallowing
- severe neck or mouth injuries
- vocal cord paralysis
If your tracheostomy is planned, your doctor will tell you how to prepare for the procedure. This may involve fasting for up to 12 hours before the procedure.
If your tracheostomy is performed during an emergency, there will be no time to prepare.
For most scheduled tracheostomies, you’ll be given general anesthesia. This means you’ll fall asleep and won’t feel any pain. In emergencies, you’ll be injected with local anesthesia. This numbs the area of your neck where the hole is made. The procedure will begin only after the anesthesia has started working.
Your surgeon will make a cut into your neck just below your Adam’s apple. The cut will go through the cartilage rings of the outer wall of your trachea, also known as your windpipe. The hole is then opened wide enough to fit a tracheostomy tube inside.
Your doctor may hook up 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 helps keep the tube in place while the skin around it heals. Your surgical team will tell you how to care for the wound and your tracheostomy tube.
Adapting to a tracheostomy tube
It typically takes one to three days to adapt to breathing through a tracheostomy tube. Talking and making sounds also takes some practice. This is because the air you breathe no longer passes through your voice box. For some 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 allow air to exit the mouth and nose, permitting speech.
Every medical procedure where the skin is broken carries the risk of infection and excessive bleeding. There’s also a chance of an allergic reaction to anesthesia, although it’s 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, which is rare
- lung puncture and lung collapse
- scar tissue in the trachea
If your tracheostomy is temporary, there’s 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 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.