What Is a Tracheostomy?

A tracheostomy is a hole in your windpipe that a doctor makes to help you breathe. You’re usually “asleep” when you get one, though not always, if it’s an emergency situation.

The doctor usually puts a tube, sometimes called a trach tube (pronounced “trake tube”) through the hole and into your lungs. Tracheotomy (no “s”) refers to the cut the surgeon makes into your windpipe, and a tracheostomy is the opening it forms. But some people use both terms to mean the same thing.

It’s usually a temporary solution that helps you breathe more easily while a medical issue -- swelling in your airway, for example -- clears up. Your doctor will typically remove the tube and close the hole once you can breathe normally on your own.

But if there’s serious damage to the windpipe, paralysis of the vocal cords, or a dire situation such as coma, that may call for a tracheostomy for the long term.

Reasons for Tracheostomy

The main reason is not being able to get enough air into your lungs. This could be because something in your upper airway blocks the flow of air. The doctor cuts below the injured or blocked part of the airway to get air to the lungs. This may be due to:

  • A tumor
  • Seizing vocal cords
  • Spasm of your larynx (your voice box)
  • Injury to your windpipe or airway
  • Swelling of your tongue, mouth, or airway
  • Food or something else stuck in your airway
  • Severe sleep apnea

Sometimes, doctors use a tracheostomy because of burns, an infection, or other illnesses that cause breathing problems.

Or it may be that nothing blocks the airway, but you simply can’t draw a breath well enough because of a serious illness. If so, treatment usually starts with a tube that goes down into the airway through your nose or mouth (intubation). But this can be uncomfortable and may cause injury, ulcers, and infection if left in for too long. So if you’re going to need long-term help with breathing, your doctor may suggest a tracheostomy. This can happen with:

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What to Expect

If a tracheostomy might help, your doctor will first consider whether you have any health problems that could complicate the surgery. They’ll examine you, check how well your neck moves, and consider your health history.

If there are no issues, the doctor will explain the surgery to you and talk with you about the pros and cons. The hospital may ask you to sign a document that says you agree to the procedure.

You will be face up for the operation. A nurse will clean your chest and neck with a germ-killing antiseptic. The anesthesiologist will give you general anesthesia, so you’ll be asleep and unable to feel pain. Once you’re unconscious, the surgeon will cut into the skin on the lower half of your neck between your voice box (also called your larynx) and the top of your chest. They will part the muscle underneath and may need to move or cut the thyroid gland to get to your windpipe. Once there, the surgeon will cut a hole into the windpipe and insert the tube. Stitches, surgical tape, or a Velcro strap will hold it in place.

In a less-invasive version of the operation, the doctor threads a special lens through your mouth to see inside your throat to make a hole in your windpipe with a needle. This is called a percutaneous tracheotomy.

If it’s an emergency, like when you suddenly can’t breathe at all, you may be awake during the procedure. A doctor or other medical professional may do the surgery at your hospital bedside after injecting drugs to numb your neck.

After Surgery

Expect to stay at least a few days in the hospital after a tracheostomy and maybe longer. Specialized health care professionals will help you manage:

Your trach tube. You’ll need to know how to clean and change it to avoid problems such as irritation and infection. You may also learn to use a special machine that vacuums away material from your windpipe or throat.

Speech. You probably won’t be able to speak normally or possibly at all after your tracheostomy. A speech therapist or other health care worker may be able to give you certain devices or techniques to help you communicate, and, as soon as possible, to talk.

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Food. As your tracheostomy heals, it will be very hard to swallow. You’ll probably get your nutrients by IV or through a feeding tube that goes into your stomach.

Lung irritation. The air that gets to your lungs may be drier because it won’t pass through your moist nose or mouth. That can irritate the tissue inside and cause extra mucus and coughing. Nurses can teach you how to use saline solution, humidifiers, and other techniques to help lessen the irritation and loosen the mucus so it’s easier to cough up.

WebMD Medical Reference Reviewed by Paul Boyce, MD on January 10, 2020

Sources

SOURCES:

American Thoracic Society: “Tracheostomy in Adults.”

Department of Health & Human Services, State Government of Victoria, Australia: “Tracheostomy.”

Johns Hopkins Medicine: “Tracheostomy Service.”

Mayo Clinic: “Tracheostomy.”

Medscape: “Tracheostomy.”

National Heart, Lung, and Blood Institute: “Tracheostomy.”

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