Tracheotomy

A Tracheotomy is one of the oldest, most shunned, and least understood procedures for Obstructive Sleep Apnea. The concept with this procedure is that any area of blockage to breathing, from the nose to the voice-box, is bypassed by a hole placed into the windpipe. The hole in the trachea is called a stoma. The stoma must be maintained both by daily cleaning and by insertion of a tube. The tracheotomy tube must be kept exquisitely clean; otherwise, painful infections of the stoma will occur, or the tube and/or windpipe could become blocked with secretions.

A tracheotomy does not mean that a patient would not be able to talk. If the tube would be plugged by a finger, then air from the lungs would pass through the voice box allowing one to talk by mouth. When the tube would be unplugged, or open, then air from the lungs would largely bypass the voice box not allowing one to talk by mouth. Some patients plug the tube closed during the day to allow normal conversation by mouth, but release the plug for night-time use when speech is not required, and OSA needs treatment. A special valve could be placed on top of the tracheotomy tube to allow "hands free" speech. Most patients eat without difficulty despite the tracheotomy tube.

Just because a tracheotomy has been placed, it does not necessarily mean that the tracheotomy would need to be permanent. It might be possible to perform some of the operations outlined in this web site and eventually have the tube removed. For example, when OSA is severe and CPAP is not tolerated or ineffective or cardio-pulmonary failure has developed then a tracheotomy may be the initial treatment of choice. This is done to reverse the severe sleep deprivation, depression and cognitive deficits of OSA and to stabilize or reverse the cardio-pulmonary problems as a result of chronic OSA. A month or two later a sequence of procedures can be initiated as indicated (and are outlined in this web site). After the indicated procedures have been performed a sleep study is done with the tracheotomy tube capped shut. If the sleep study showed resolution of the OSA then formal plans could be made to remove the tracheotomy tube and allow the stoma to be closed. Obviously, the likelihood of being able to safely remove the tracheotomy tube because of OSA resolution is dependent on multiple factors including: patient motivation/ interest, anatomical and physiological constraints, disease severity and level of physician expertise in dealing with OSA and its surgical management.