A Simple Modification to the New Shiley™ Tracheotomy Inner Cannula Improves Phonation With Finger Occlusion

Several options exist allowing for phonation with a tracheotomy tube including use of a one-way speaking valve and finger occlusion. In 2021, new Shiley™ tracheotomy tubes were introduced including a redesigned inner cannula with a "duckbill" configuration that locks into place. When using this model, the discontinuity of the inner cannula at 12 and 6 o'clock positions results in air leak during attempted phonation with finger occlusion. We aim to discuss a method of overcoming this challenge.

We present a technique that has been developed by one of our patients to continue using finger occlusion for phonation with the new Shiley™ tracheotomy tube. One to two layers of 1/4 in. wide paper surgical tape is wrapped circumferentially around the outer edge of the inner cannula to recreate a complete circle.

With this modification, air no longer escapes through the sides of the inner cannula during finger occlusion with the new Shiley™ tracheotomy tube. This is an inexpensive and simple modification that improves patient communication, safety, and quality of life. Often patients who prefer finger occlusion phonation have opted to clean and reuse the discontinued model of Shiley™ tracheotomy tubes or they simply leave out the inner cannula entirely. The former action increases risk of infection by encouraging biofilm formation over time while the latter risks complete obstruction of the tracheotomy tube which can be life threatening.

Phonation with finger occlusion using the new Shiley™ inner cannulas is challenging for the patient. Applying the 1/4 in. paper surgical tape wrapping technique offers a solution to this problem that is easy to adopt by patients and clinicians alike. We would like to share this simple modification with the tracheotomy community and to propose consideration for a redesign of the inner cannulas with the new Shiley™ tracheotomy tubes.

Level 5.