What is Tracheostomy?
BDS (Bachelor of Dental Surgery), 10 years of experience
What is the meaning of Tracheostomy?
A tracheostomy is an opening or hole made by the surgeon through the neck into the windpipe (trachea). A tracheostomy tube is placed into the hole to aid the person in breathing. A tracheostomy helps in providing an air passage for breathing when the usual route of breathing is blocked or reduced.
A tracheostomy is often required when certain health disorders require the long-term use of a machine known as a ventilator to help a person in breathing. In rare cases, an emergency tracheostomy may also be performed when the airway of a person is suddenly blocked due to a traumatic injury to the face or neck. When a tracheostomy is no longer required, it is either allowed to heal on its own and shut or closed surgically. In some people, tracheostomy is permanent.
In today’s article, we will be discussing tracheostomy in detail-
- What is the purpose of Tracheostomy?
- What are the different conditions requiring Tracheostomy?
- What is the diagnostic procedure before a Tracheostomy?
- What is the preparation for a Tracheostomy?
- What is the procedure of Tracheostomy?
- How to care after a Tracheostomy?
- What are the risks of Tracheostomy?
- What is the cost of Tracheostomy in India?
What is the purpose of Tracheostomy?
The doctor may recommend a tracheostomy in the following cases:
- Medical conditions require the use of a breathing machine (ventilator) for an extended time.
- Medical disorders that narrow or block your airways, like throat cancer or paralysis of the vocal cord.
- Preparation for a neck or head surgery in order to assist the patient’s breathing during recovery.
- Neurological (nerve-related) disorders, paralysis, or other conditions that make coughing up the secretions from the throat difficult, and require suctioning of the windpipe to clear the airway.
- Traumatic injury to the head or neck causing obstruction of breathing.
- Other emergency conditions in which the breathing is obstructed and a breathing tube cannot be put through the mouth into the trachea.
What are the different conditions requiring Tracheostomy?
Tracheostomy is done in the following conditions:
- A tumor
- Spasm of the voice box (larynx)
- Injury to the windpipe ( Know more about- What is Thyroidectomy? )
- Vocal cord paralysis
- Swelling of the mouth, tongue, or airway
- Food stuck in the airway
- Burns
- Infections ( Know more about- What is Tonsillectomy? )
- Sleep apnea (a sleep disorder in which the breathing stops and starts while sleeping)
- Other diseases which may cause breathing problems
- Surgery of the face
- Laryngectomy (removal of the larynx or voice box)
- Birth defects that may be affecting the airways
- Paralysis
- A severe allergic reaction
- A spinal cord (backbone) injury
- Coma
- Lung diseases
- Chest wall damage
- Problems with the diaphragm (muscle below the lungs that help in breathing)
- Pneumonia
- Heart attack
- Stroke (blood supply to the brain is suddenly stopped)
What is the diagnostic procedure before a Tracheostomy?
- Physical examination: The doctor will first examine the patient physically to check for the overall health status of the patient. The motion of the neck is also checked by the doctor. The patient’s symptoms, along with the medical history and family history of the patient are also noted.
- Blood tests: Blood tests may be done to check for the various blood parameters like the blood cell count, and also to check for any underlying medical conditions.
- Imaging tests: Depending on the procedure being performed, the doctor may advise imaging tests like X-rays, CT scans, MRI scans to obtain clear images of the internal organs of the body.
What is the preparation for a Tracheostomy?
- The preparation for a tracheostomy depends on the type of procedure you are going to undergo.
- You should inform your doctor about any medications, supplements, or herbs that you may be taking.
- You should inform your doctor about any pre-existing medical conditions that you may be having.
- You will most likely be advised to not eat or drink anything for eight to twelve hours before the procedure.
- The doctor may advise you to stop taking any blood-thinners like warfarin or aspirin a few days before the procedure, as these medications increase the risk of bleeding during and after the procedure.
- Quit smoking at least two weeks before the procedure.
- In case of an emergency tracheostomy procedure, you may not have time for preparation.
What is the procedure of Tracheostomy?
- A tracheostomy is usually performed under general anesthesia (the patient is put to sleep during the procedure).
- A local anesthesia (the surgical site is numbed) is used to numb the neck and throat if the surgeon is concerned about the airway getting compromised due to general anesthesia, or if the procedure is done on an emergency basis.
- The type of tracheostomy done depends on the reason for undergoing the procedure, and whether the procedure was pre-planned. Tracheostomy can be of two different types:
Surgical tracheostomy:
- The surgeon makes a horizontal incision (cut) through the skin at the lower part of the front of the neck.
- The surrounding muscles are pulled back carefully.
- A small portion of the thyroid gland is cut, exposing the trachea or windpipe.
- The surgeon then creates a tracheostomy hole at a specific spot on the windpipe near the base of the neck.
Minimally invasive tracheostomy (percutaneous tracheostomy):
- The doctor will make a small incision near the base of the front of the neck.
- A special lens is then fed through the mouth so that the surgeon can view the inside of the throat.
- The surgeon then guides a needle into the windpipe for creating a tracheostomy hole and then expands this hole to an appropriate size for the tracheostomy tube.
- In both procedures, the surgeon will then insert a tracheostomy tube into the hole.
- A neck strap is attached to the faceplate of the tracheostomy tube. This prevents the tube from slipping out of the hole.
- Temporary sutures (stitches) may be given for securing the faceplate to the skin of the neck.
How to care after a Tracheostomy?
You will most likely stay in the hospital for many days after the procedure. During this time, you will be learning the various skills required for coping and maintaining the tracheostomy.
Taking care of the tracheostomy tube:
- The nurse will teach you how to clean and change the tracheostomy tube to help in preventing infection and reducing the chances of complications.
- This needs to be continued for as long as you have a tracheostomy.
Eating:
- During the healing period, swallowing will be difficult.
- The nutrients are usually injected into a vein (intravenously) in the body, a tube inserted directly into the stomach, or a feeding tube that passes through the mouth or nose.
- Once you are able to eat again, you may need to work with a speech therapist, who will help you in regaining the muscle strength and coordination that is required for swallowing.
Speaking:
- Tracheostomy causes the exhaled air to go out of the tracheostomy hole rather than up through the voice box. This prevents speaking.
- There are a few techniques and devices available to redirect the airflow enough for producing speech.
- Depending on the type of tracheostomy tube used, the width of the trachea, and the condition of the voice box, one may be able to speak with the tracheostomy tube in place.
- A speech therapist may help you in communication and speech.
Copying with dry air inhalation:
- The air that is inhaled is drier than normal as it no longer passes through the moist nose and throat before reaching the lungs.
- This can lead to coughing, irritation, and excess mucus secretion from the tracheostomy.
- Small amounts of saline can directly be put into the tracheostomy tube to loosen the secretions, or a saline nebulizer treatment can also be useful.
- A device known as a heat and moisture exchanger can help in capturing the moisture from the air that you exhale and humidification of the air that you inhale.
- A vaporizer or humidifier helps in adding moisture to the air present in a room.
Management of other effects:
- The healthcare team will guide you to take care of the other common effects that may be related to a tracheostomy, like using the suction machine to help in clearing the secretions from the airway or throat.
What are the risks of Tracheostomy?
The immediate risks of tracheostomy include:
- Bleeding
- Displaced or misplaced tracheostomy tube
- Damage to the thyroid gland, windpipe, or nerves in the neck ( Know more about- What is Thyroid Disorders? )
- Pneumothorax (air buildup between the lungs and the chest wall) causing pain, breathing problems, or lung collapse
- Subcutaneous emphysema (air trapped in the tissue under the skin of the neck) causing problems in breathing, and damage to the food pipe (esophagus) or windpipe (trachea)
- Hematoma (collection of blood) in the neck causing breathing difficulties
The long-term risks of tracheostomy include:
- Displaced tracheostomy tube from the trachea
- Scarring, narrowing, or damage of the trachea
- Tracheostomy tube obstruction
- Tracheoesophageal fistula formation (an abnormal passage between the trachea and esophagus) which can cause food or fluids to enter into the lungs
- Tracheoinnominate fistula formation (abnormal passage between the trachea and the large artery supplying blood to the right side of the head, neck, and right arm) which can cause a life-threatening bleeding condition
- Tracheobronchitis (infection in the trachea and bronchial tubes, which are the tubes from which the air goes in or comes out from the lungs)
- Infection around the tracheostomy area
- Pneumonia (due to infection in the lungs) ( Know more about- What is Lung Transplant? )
Call your doctor immediately if you have:
- Bleeding from the trachea or tracheostomy site
- Difficulty in breathing ( Know more about- What is Pulmonary Embolism? )
- Extreme pain or discomfort
- Swelling or redness around the tracheostomy
- The position of the tracheostomy tube changes
What is the cost of Tracheostomy in India?
The total cost of tracheostomy in India can range from around INR 25,000 to INR 85,000. However, many prominent hospital doctors in India specialize in tracheostomy. But the cost varies across different hospitals.
If you are coming from abroad, apart from the cost of tracheostomy, there will be an additional cost of living in a hotel and the cost of local travel. So, the total cost of tracheostomy in India comes from a total of INR 35,000 to INR 1,20,000.
We hope that we could answer all your questions regarding Tracheostomy through this article.
If you need more information related to Tracheostomy, then you can contact an ENT Surgeon.
We only aim to provide you with information through this article. We do not recommend any medicine or treatment. Only a doctor can give you good advice because no one else is better than them.
