Phonation remains a vital goal for patients living with a tracheostomy. Recently, the 2021 update to Shiley™ tracheotomy tubes introduced a redesigned inner cannula featuring a duckbill configuration. While this design locks securely, it creates a problematic discontinuity at the 12 and 6 o'clock positions. Consequently, many patients struggle with Shiley tracheotomy tube phonation because air leaks through these gaps during finger occlusion. This issue often forces patients to resort to unsafe practices, such as reusing discontinued models or removing the inner cannula entirely.

Improving Shiley Tracheotomy Tube Phonation with Surgical Tape

Clinicians and patients have discovered a remarkably simple and inexpensive solution to this mechanical challenge. By wrapping one to two layers of 1/4 inch wide paper surgical tape circumferentially around the outer edge of the inner cannula, you can effectively recreate a complete circle. This modification creates a proper seal that prevents air from escaping through the sides of the tube. Therefore, the patient can achieve clearer speech and more reliable phonation when using finger occlusion.

Furthermore, this technique addresses significant safety concerns. Patients who omit the inner cannula to improve speech risk life-threatening tube obstructions from mucus plugging. Similarly, cleaning and reusing old, discontinued models increases the risk of infection due to biofilm formation. This tape modification provides a safer alternative that enhances the patient's quality of life without compromising airway security. Clinicians should consider this easy-to-adopt method as a standard troubleshooting step for phonation difficulties.

Why does the new Shiley inner cannula cause air leaks during phonation?

The redesigned inner cannula has a duckbill configuration that does not form a complete circle at the 12 and 6 o'clock positions. This discontinuity allows air to escape during exhalation, making finger occlusion ineffective for speech.

Is it safe to use a tracheotomy tube without the inner cannula?

No, leaving out the inner cannula is dangerous. It increases the risk of the outer cannula becoming completely obstructed by secretions, which can be life-threatening. The inner cannula is essential for maintaining a clear airway.

How does the paper tape modification help with speech?

The tape fills the gaps in the duckbill design, creating a complete seal around the inner cannula's edge. This ensures that the seal directs air upward through the vocal cords during finger occlusion rather than allowing it to leak out of the tube's hub.

Disclaimer: This content is for informational and educational purposes only. It does not constitute medical advice or substitute for professional consultation. Refer to the latest local and national guidelines for clinical practice.

References

1. Freeman CG et al. A Simple Modification to the New Shiley™ Tracheotomy Inner Cannula Improves Phonation With Finger Occlusion. J Voice. 2026 Mar 20. doi: undefined. PMID: 41862291.

2. Medtronic. Shiley™ Flexible Adult Tracheostomy Tube Clinical Enhancements. [Online] Available at medtronic.com.

3. Passy-Muir. Clinical Toolbox: Managing Voice, Swallowing, and Respiratory Changes. [Online] Available at passy-muir.com.