What is tracheostomy
The word tracheostomy is commonly used to mean a hole in the trachea. In the medical context, it means the actual procedure of making the hole; the actual hole is called a stoma. On this page, tracheostomy and stoma mean the same thing.
Tracheostomy is made in the trachea, the windpipe, through the skin of the neck (B in the picture). In emergencies the hole is usually made a bit higher, just under the thyroid cartilage, Adam's apple (A). Both possible places are below the vocal cords. The hole itself is generally quite small, 5 to 15 millimeters. The procedure is done under general or local anesthesia either by making a hole with a scalpel or helping the creation from the inside. When the hole has desired size, a tube called a cannula is put in. Without it, the tracheostomy might grow shut. If this happens, there will be some scar tissue left and a new hole might be more difficult to do.
Tracheostomies can be done on newborns, and people can live with them for decades. Tracheostomy might affect speaking or swallowing. You always have to be ready remove mucus from lungs with a tracheostomy, either by suctioning with a machine or by coughing. Dirt can be dangerous with tracheostomies, as everything that goes inside it goes straight to the lungs. Dirt can include, for example, dust, hair, bacteria from hands or strong scents. Water can cause drowning even in small amounts and cold air causes lung infections.
Why tracheostomies are done
The basic reason is that tracheostomies make breathing easier. The upper airways - nose, mouth and throat - might be blocked for example due to a tumour or allergic reaction. Another reason is that it might be needed to assist breathing, like the use of a respirator. This is a common reason among people with muscular disorders. A rarer reason for tracheostomies in general is too much mucus in the lungs. It's very easy to remove it through the tracheostomy. For me this is the primary reason and making breathing easier is secondary. I don't use any kind of assistive machines for breathing.
Most of the time, tracheostomy is only the second choice of treatment. For example, with breathing difficulties, doctors like to use pressurisation and masks first.
What is a cannula
The tube put in the tracheostomy is called a cannula. Most of the time they are plastic and they are curved to fit in the trachea. Most cannulas have two tubes, one inside another, to help with hygiene. The inner tube is easy to take out and clean. Cannulas come in different sizes; some are designed more for hospital use and some work better with respirators. Nearly all cannulas can be attached to different sorts of equipment, such as valves and respirators.
Cannulas don't stay in the tracheostomy on their own, so they are secured with collars. Some cannulas have cuffs, small balloons, to keep them in place. Cuffs are also designed to keep food and secretions from reaching the lungs. It also stops air from going up to the mouth. It is very difficult or impossible to speak with a cuff. A fenestrated cannula has one or more holes in it to help air go up, making speaking easier.
If there is no respirator or other equipment attached to it, it is generally plugged with something. Many of these plugs are simply stuck on to the cannula. The "nose" is a piece of plastic with a filter inside to filter and humidify air. It doesn't affect breathing much and speaking with it is just as difficult (or easy) as with just a cannula. The plug can also be a cork, which stops any air from going in or out. A speaking valve is somewhere in between a full cork and a nose. It lets air in through the cannula but lets very little air out. With a speaking valve, speech is nearly normal. Some speaking valve models have a similar filter to noses. I use a speaking valve with a filter during the day and a nose during the night so I can breathe easier.
How to take care of a tracheostomy
Tracheostomies are easy to take care of at home. You just have to make sure the room isn't dirty or dusty, and single use gloves should be used at all times.
The cannula is generally changed once a month, unless it gets dirty before that. The change can be done either by a doctor or some other trained person. The inner cannula should be rinsed once a day or more often. The actual hole is cleaned only during the cannula change, but the hole surroundings are cleaned once a day (or less often, if the hole is healthy). The cleaning is done with cotton swabs or gauzes, both from pharmacies, and saline. The surroundings of the hole are protected by sterile gauzes or special pads specifically made for the purpose. The protection should gather everything that comes through the hole. Tracheostomies are basically the same as any piercings, so some discharge is expect. Blood can also come out, but if there is a lot of blood or discharge then medical attention is needed. If mucus is coming out from the hole, it means the hole is too big compared to the cannula.
How tracheostomy affects my life
I always have to have a chance to remove mucus from my lungs. This means I always have to have a suction machine with me and someone to use it. The person is either an assistant or a friend. In theory I should never be alone, but in practice I can be alone more than an hour if needed and I'm not coughing.
With the machine I always have gloves and, if I'm away from home more than a day, I take with me a spare cannula, a spare speaking valve and everything required for cleaning.
Outside home, I always wear a scarf to protect my neck. During the winter, cold is a big issue; during summer, it's all the dust. In unfamiliar places, it's difficult to tell if there is a lot of dust. The scarf also helps to keep the speaking valve in place, because it has a tendency to fall out on its own.
During showers I have to be extra careful not to get any water in my lungs. I can go to sauna if I wish, and swimming is also allowed - if I can keep the water out.
I can speak nearly the same as before tracheostomy. My cannula has no cuff or holes, and I use a speaking valve. Yelling is slightly more difficult, because some air is always let out through the hole.
My tracheostomy doesn't hurt. It may ache a bit if the protective gauze is wrinkled. Mucus suctioning doesn't hurt either - and doesn't feel as bad as it looks.
I try to keep my home clean from dust. I also ask my visitors to avoid strong scents and tobacco smoke. Animals are welcome, if they don't stay long.