Living with a tracheostomy

If you or a loved one suddenly needs a tracheostomy, you may have questions.

A tracheostomy is an opening created in the neck so that a tube can be placed in the trachea, often called the windpipe, to aid breathing. A tracheostomy, or “trach,” may be needed if you have a blockage in your airway or severe lung disease, or for other reasons. Living with a tracheostomy can take some time to adapt to, but you can still enjoy a good quality of life. And in some cases, a tracheostomy may only be needed temporarily during a recovery period.

“We’re one of the highest volume airway centers in the country that specializes in disorders of the voice box and the trachea,” explained Alexander Gelbard, M.D., an otolaryngologist with Vanderbilt Center for Complex Airway Reconstruction. “And we really take a team approach that can provide a high level of personalized care to improve people’s recovery from severe illness.”

Reasons for a tracheostomy

To breathe, air must pass your vocal cords and move down your windpipe. Then it moves into your lungs, where it hops across a thin membrane in your alveoli to get into your bloodstream, Gelbard explained. If you have problems along the way at any one of those points, he added, you can feel like you’re not getting enough air.

“People who develop scarring on their vocal cords or trachea after having a breathing tube,” Gelbard said, “can feel like they’re short of breath. And they need a tracheostomy to bypass the blockage.”

Additionally, some people with advanced lung disease may also need a tracheostomy to help supply extra pressure and oxygen at night to support breathing if their lungs are weakened.

Tracheostomy care at home

Your care team will teach you and any caregivers how to maintain the tracheostomy. Tracheostomy care will include regularly cleaning the skin at the tracheostomy site and the stoma, which is the hole where the tube inserts into your neck. Cleaning is crucial to prevent irritation and infection and to keep your tracheostomy functioning properly. Another task is suctioning. Suctioning helps remove mucus plugs that you’re unable to cough up.

Living with a tracheostomy

Some aspects of living with a trach will take some time to get used to. One consideration is that you may have difficulty smelling and tasting your food. “If there’s not a lot of air passing your nose,” Gelbard explained, “it can be tough to smell. And a lot of times when you don’t smell well, your sense of taste is off.” Some people with a tracheostomy will require a feeding tube for nutrition, however.

“There’s also a psychologic impact of having to live with this airway prosthesis,” Gelbard added. “It can affect body image for some people. And that can take a lot of adjustment.” He said he spends a lot of time in the office talking with his tracheostomy patients about this aspect if it’s affecting them.

Although some people may need a tracheostomy long term or permanently, others may only require one for a short time as part of recovery after an illness like COVID-19.

“Decisions about tracheostomy often occur when you’re battling severe illness,” Gelbard said. “A tracheostomy can be really necessary to help you recover and move out of the hospital.” But once someone has moved out of the hospital and has gone through rehab and started to recover, their situation may change. “They should seek out an otolaryngologist to talk about if they still need to have their tracheostomy,” Gelbard explained. Even if you do need a tracheostomy long term, see a specialist who sees a lot of patients with tracheostomies. “This can be of benefit,” he said, “to help find an airway prosthesis that fits best and functions the highest to really keep you breathing, talking and swallowing optimally.”