One-way (speaking) valves

This page from Great Ormond Street Hospital (GOSH) explains about one-way (speaking) valves, what they do and how to encourage your child to wear the valve. A one-way valve is a plastic attachment that fits on to the end of your child’s tracheostomy tube.
 The valve opens to allow your child to breathe in through the tracheostomy tube. When they breathe out the valve closes. This diverts the air up through the voice box, throat and mouth/nose as in normal speech. Not all children will be able to produce a voice immediately the valve is placed on the tracheostomy tube. Your speech and language therapist will explain your child’s particular difficulties.

Many children with a tracheostomy cannot have a speaking valve. The main reasons are:

• „„Severity of upper airway obstruction, such as a severe subglottic stenosis
• „„Large tracheostomy tube size
• „„Significant swallowing problems

These vary from child to child but some of the benefits may include:

• „„a louder voice
• „„clearer speech/voice
• „„normal passage of air through the throat and mouth
• „„ improved ability to smell and taste „„ reduced secretions
• „„easier development of babbling (early speech sounds) in young babies
• „„easier language development in small children
• „„more efficient speech that is, more words on one breath by older children.

There are very few disadvantages. However, when your child first starts to use the valve he or she may notice that there is an increase in effort is needed to breathe out. It may take your child a while to get used to it. He or she may therefore need to gradually build up the amount of time he or she wears the valve. Your speech and language therapist will advise you about this. 

Some children produce thicker secretions as the valve does not humidify the air when your child breathes in. You may need to alternate use of the speaking valve with an HME/Swedish nose.

The valve will be fitted for the first time by your child’s speech and language therapist either on the ward or in the outpatient clinic depending on what is most appropriate for your child.

Whilst it is very easy to fit the valve by simply fixing it to the end of the tube the speech and language therapist will assess that it is safe for your child to use.

If your child has a changing or fluctuating airway problem or is undergoing ENT surgery, this may impact on their speaking valve suitability and tolerance. If your child’s airway problems change, please contact your speech and language therapist to discuss.

Games that will attract your child’s attention and distract them from the speaking valve:

1. Playing with his or her favourite toys
2. Blowing bubbles
3. Reading books
4. Playing with noisy or moving toys
5. Peek-a-boo / Hide and Seek / Ready Steady Go games.