Sleep Apnea

The Drawbacks of Tracheostomy

Posted on 22. Jan, 2010 by admin in Treatments for Obstructive and Mixed Apneas

One of the main drawbacks of tracheostomy, and one reason it has fallen out of favor so quickly with the advent of CPAP, is the impact that it has on day-to-day lifestyle.

Most people need several weeks to months to learn to deal with the frustrations of tracheostomy hygiene and to adjust to their new image with a tracheostomy opening in the throat. A bout of depression commonly accompanies this adjustment period. The severity and duration of the person’s depression (in fact, whether it occurs at all) depend on the individual, on how well the person has been prepared for the appearance and the care of the tracheostomy, and on family support. The patient, spouse, and other close family members should be counseled about the surgical procedure, the care that is necessary afterward, and the likelihood of temporary depression. Talking with other people who have tracheostomies and are attending sleep apnea support groups, both before and after surgery, helps people to adjust more easily.

Most people who have had tracheostomies report that they do just fine once the initial adjustment period is over. They lead normal, active lives and generally do not seem to be bothered by their tracheostomies. However, they will always have to be careful about hygiene around the tracheostomy opening. And they must always take care that nothing enters the windpipe through the tracheostomy opening. For example, people with tracheostomies may not swim. Because the opening in the throat leads almost directly into the lungs, people with tracheostomies are in extreme danger from drowning and therefore must avoid not only swimming but also all water-related activities (water skiing, sailing, rafting, fishing from a boat) that might require swimming.

Other drawbacks involve the cosmetics of covering the tracheostomy opening. A small plate or shield is worn over the opening and is held in place by a cord around the neck . There is nothing inherently objectionable about its appearance, but many people choose to cover the tracheostomy plate with a turtleneck or a scarf. On some people the opening is a little too high to be easily covered by clothing. One such patient recommended making a high-necked, elastic-topped dickey.

Another problem can be keeping the opening sealed during the day. Talking becomes difficult if there is air leakage. Coughing or sneezing can sometimes pop the seal and cause temporary embarrassment.

Other difficulties are problems that can arise from poor healing or erosion of the opening. To avoid such problems, it pays to find the most skillful surgeon you can (consider a plastic surgeon) and to carefully follow the postoperative instructions. Ask your doctor to answer any questions you may have and be persistent in asking for help in learning to deal with any follow-up problems.

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