This portion of the blog describes basic airway anatomy and the functions that are inhibited when a tracheostomy is placed.
These two photos display a cross section of our body's airway system. There are three basic functions that are inhibited when a tracheostomy is put in place. They are: speaking, air humidification, and the filtering of air. As displayed in the picture on the left, the "nares," more commonly known as nostrils, have small hairs that serve to filter the air. The picture on the right depicts the "nasal turbinates." These serve to warm the air and keep secretions moist. The third function that is bypassed by a tracheostomy is speaking. Speaking is performed when air moves past the vocal chords and causes vibrations of the vocal chords to occur which result in speech. When a tracheotomy is performed, the incision is made below the vocal chords, causing air to escape before it reaches the vocal chords. Because these are important functions of the airway system, it's important to make proper adaptations to allow your child's airway to continue to function normally.
Adapting to the tracheostomy
Speaking. There is a device that has been developed called a Passy-Muir valve to help children speak with a trach tube. It is a one-way valve which allows air to enter the airway, but does not allow it to exit. This allows the air to flow upwards, toward the vocal chords and promote vocalization. Because this facilitates a different kind of breathing, the child may need to put it on and take it off throughout the day.
Here is a photo of several Passy-Muir valves:
Here is a video depicting how a Passy-Muir valve works:
Air humidification. The second function which is inhibited when a tracheostomy tube is placed is air humidification. When a trach tube is placed, the nasal turbinates (shown in picture above) are bypassed which serve to warm and moisten the air. Because the air is not warmed, it can cause the secretions to be more thick and much more difficult to cough up. By providing an external humidifier, the air can be warmed and moistened in that way. If the child is placed on a ventilator, an external humidifier will be a part of the closed circuit.
The following is a picture of an external humidifier:
Filtering the air. The last function that is inhibited is filtering the air. The filtering of the air is normally done through the nostrils. Because the nostrils are bypassed, it is important to keep your child away from debris-filled air, smoke, and anything that might be given entrance to the airway via the tracheostomy tube.
References
http://cdn.rsvlts.com/wp-content/uploads/2012/09/s_a30_0RTR2G42-707x1024.jpeg
https://www.youtube.com/watch?v=9yn5ekGJ0Qw
http://www.airoswiss.net/assets/item/regular/AOS7135.jpg
http://emptynosesyndrome.org/wp-content/uploads/2013/02/turbinates-tutorial-6-5.gif
http://www.patient.co.uk/doctor/tracheostomy-pro
http://www.passy-muir.com/sites/default/files/valves_labels.jpg