Post-Tracheostomy Care: Managing Coughing and Voice Changes

Q: Post-Tracheostomy Care: Managing Coughing and Voice Changes

Hello： 1. <br>After extubation, if there is hoarseness, please consult an otolaryngologist to check for any issues with the vocal cords. <br>2. <br>The cough issue is not significantly related to the removal of the tracheostomy tube, unless there is excessive sputum. <br>The airw

Care after tracheostomy tube removal?

It has been about four months since my elderly family member had their tracheostomy tube removed, and they still experience frequent coughing.
Are there any care methods available, or should we just learn to adapt to the frequent coughing? Their voice has been hoarse since the tube was removed; will it recover? I would appreciate your assistance, thank you.

Irene, 40~49 year old female. Ask Date: 2021/05/22

Dr. Yang Wenda reply Pulmonology

Hello: 1.
After extubation, if there is hoarseness, please consult an otolaryngologist to check for any issues with the vocal cords.
2.
The cough issue is not significantly related to the removal of the tracheostomy tube, unless there is excessive sputum.
The airway at the original tracheostomy site is narrower, making it more difficult to clear secretions, which may prolong the coughing duration.
It is recommended to consult a pulmonologist for medication adjustment.

Reply Date: 2021/05/22

More Info

Post-tracheostomy care is a critical aspect of recovery for patients who have undergone a tracheostomy procedure. It is common for patients to experience persistent coughing and voice changes after the removal of the tracheostomy tube. Here, I will address your concerns regarding coughing management and voice recovery, as well as provide some general care tips.

Coughing Management
Coughing after a tracheostomy can be attributed to several factors, including the presence of secretions, airway sensitivity, and changes in lung function. Here are some strategies to help manage coughing:
1. Hydration: Ensure that the patient stays well-hydrated. Adequate fluid intake helps to thin mucus secretions, making them easier to expel. Encourage the patient to drink water or other fluids unless contraindicated by their medical condition.

2. Humidification: Using a humidifier in the patient's room can help keep the air moist, which may ease coughing and help with mucus clearance. If the patient is using supplemental oxygen, ensure that the oxygen is humidified as well.

3. Chest Physiotherapy: Techniques such as postural drainage, percussion, and vibration can help mobilize secretions in the lungs. This can be performed by a trained caregiver or respiratory therapist.

4. Coughing Techniques: Teach the patient effective coughing techniques, such as "huff coughing," which can be less taxing than traditional coughing. This involves taking a deep breath and then exhaling forcefully while keeping the mouth open, which can help clear secretions without causing excessive strain.

5. Medication: Consult with the healthcare provider about the possibility of using expectorants or mucolytics to help manage mucus production. These medications can assist in thinning mucus, making it easier to cough up.

Voice Recovery
Voice changes, such as hoarseness or loss of vocal strength, are common after tracheostomy tube removal. Here are some considerations for voice recovery:
1. Speech Therapy: Referral to a speech-language pathologist (SLP) can be beneficial. An SLP can assess the patient's vocal function and provide tailored exercises to strengthen the voice and improve clarity.

2. Vocal Rest: Encourage the patient to practice vocal rest, especially if they experience discomfort while speaking. Overuse of the voice can lead to further strain and prolong recovery.

3. Hydration and Humidity: Just as with coughing, staying hydrated and using humidification can help maintain vocal cord health. Dry vocal cords can lead to hoarseness and discomfort.

4. Avoid Irritants: Advise the patient to avoid smoking, secondhand smoke, and other environmental irritants that can exacerbate voice issues.

5. Gradual Return to Normal Speech: Encourage the patient to gradually increase their speaking time as they feel more comfortable. This can help rebuild vocal strength without causing excessive strain.

Conclusion
While it is normal for patients to experience persistent coughing and voice changes after a tracheostomy, there are effective strategies to manage these symptoms. It is essential to work closely with healthcare providers, including respiratory therapists and speech-language pathologists, to develop a comprehensive care plan tailored to the patient's needs. With appropriate care and time, many patients can experience significant improvements in both coughing and voice quality. If symptoms persist or worsen, it is crucial to seek further medical evaluation to rule out any underlying issues.

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