Drilling speaking valves: a modification to improve vocalization in tracheostomy dependent children

Pediatric tracheostomy dependence is associated with a variety of sequelae. Vocalization delay is commonplace and may result in long-term communication disability. Passy-Muir speaking valves are routinely used to allow such children to vocalize. Unfortunately, not all tracheostomy dependent children can tolerate the placement of a speaking valve. Elevated transtracheal pressures are often associated with failure. We describe a method of modifying a standard Passy-Muir valve to decrease transtracheal pressures and thus improve tolerance of the valve. In our practice, the modification allows a broader range of children experience the benefit of speaking valve placement.