Tracheostomy living

Overview

A tracheostomy is a surgical opening made in the front of your neck and into your windpipe (trachea). A thin plastic tube is placed through this opening to help you breathe. This tube is called a tracheostomy tube. The opening itself is called a stoma. A tracheostomy can be temporary, while you heal or recover from an illness, or permanent, if you need long-term breathing support.

A tracheostomy is a fairly common procedure in hospitals, especially for people who need help breathing for a long time or have a blocked airway. Many thousands of people have a tracheostomy each year across the world.

A tracheostomy can affect people of all ages – from newborn babies to older adults. It may be needed after a serious injury, major surgery, or because of a long-term illness that weakens breathing, such as a nerve or muscle condition or cancer in the throat.

Symptoms

Common symptoms

• Increased mucus or secretions from the stoma or tube
• A wet-sounding cough
• Mild soreness or irritation around the stoma
• Difficulty speaking or making sounds
• The need to occasionally clear or suction the tube

Symptoms in children

• Extra fussiness or irritability
• Difficulty feeding or swallowing
• Skin redness or breakdown around the stoma
• Frequent crying without sound
• The tube may come out more easily than in adults, so parents need extra training

Symptoms in older adults

• Higher risk of chest infections, such as pneumonia
• Dry mouth or thick secretions due to multiple medicines
• Confusion or agitation caused by low oxygen or infection
• Skin fragility around the stoma
• Needing more help with daily care and swallowing

Causes

Main causes

• Prolonged need for a breathing machine (ventilator) to support weak or failing lungs
• Blockage of the upper airway due to swelling, injury, or a growth
• Severe infection or inflammation that narrows the windpipe
• Nerve or muscle disorders that make it hard to breathe or protect the airway
• Major surgery on the head, neck, or chest that affects breathing

Risk factors

• Being on a ventilator for a long time in the hospital
• Serious injury to the neck, face, or chest
• Neurologic conditions such as spinal cord injury or stroke
• Cancer of the throat or vocal cords
• Severe weight loss or frailty that weakens breathing muscles

When to see a doctor

See a doctor urgently if:

• If you have any of the emergency signs listed above, call your local emergency number immediately.
• Contact your healthcare team the same day if your tube feels blocked, suctioning does not work, or you have signs of infection.
• If your stoma is bleeding or the skin looks badly damaged, get urgent care.

Book a routine appointment if:

• See your specialist team regularly to check the stoma and the tube.
• Attend all planned appointments with your doctor or tracheostomy nurse.
• Have your tube changed on the schedule your team recommends.
• Ask about seeing a speech and language therapist and a dietitian if you have trouble swallowing or eating.

Diagnosis

A tracheostomy is created by a surgeon, so there is no 'diagnosis' in the usual sense. However, after the procedure, you will need regular check-ups to confirm the stoma is healing well, the tube is in the right position, and your lungs are receiving enough air.

Tests that may be done

• Chest X-ray – often done after surgery to check the tube position
• Arterial blood gas – measures oxygen and carbon dioxide levels in your blood
• Stoma and skin assessment – your nurse checks for signs of infection or irritation
• Airflow checks – your team may measure breathing while you are on the ventilator or breathing on your own
• Swallowing tests – if you are eating or drinking, a speech therapist may help assess your risk

What to expect at your appointment

You will be seen by a team that may include doctors, nurses, speech and language therapists, dietitians, and physiotherapists. They will teach you and your family how to clean the stoma, suction the tube, change the dressing, and recognise signs of trouble. You may have a trial of speaking valves or other devices to help you communicate.

Treatment

There is no pill that treats a tracheostomy itself. Treatment focuses on keeping the opening clean, the tube clear, and the lungs healthy. Your care team will create a personal plan based on why you have the tracheostomy, whether it is temporary or permanent, and your overall health.

Self-care at home

• Clean the stoma area gently every day as shown by your nurse, using clean supplies.
• Use a humidifier or saline drops to keep mucus moist and prevent blockage.
• Suction the tube whenever you feel or hear mucus, but not too often – ask your team for guidance.
• Drink plenty of fluids (if safe for you) to keep secretions thin.
• Protect the stoma from water when showering – ask about special waterproof guards.
• Avoid smoke, dust, and strong fumes that can irritate your airways.

Medical treatments

Treatment may include inhaled medicines to keep the airways open or to thin mucus, given as a mist through a nebuliser. If you have an infection, your doctor may prescribe antibiotics. For people with too much saliva or mucus, there are medicines that help reduce secretions. Your team may also use a humidified breathing tube (heat and moisture exchanger) to keep the air you breathe moist. Always ask your healthcare provider before using any new medicine or device.

When is surgery considered?

If your tracheostomy was temporary, a minor surgery or procedure may be done later to remove the tube and close the stoma, allowing you to breathe normally again. If it is permanent, you may occasionally need surgery to revise the stoma or treat scar tissue that narrows the airway.

Living with this condition

Your daily routine will include cleaning the stoma area, checking the tube, and suctioning as needed. You may learn to talk using a speaking valve or by covering the tube with a finger. Showering can be done with special waterproof covers, and you can usually sleep normally after a short adjustment period. It is important to always keep emergency suction or a spare tube with you, and to tell close family and friends what to do in an emergency.

Lifestyle tips

• Wear a medical alert bracelet that says you have a tracheostomy.
• Carry a small emergency kit with a spare tube, suction catheters, scissors, and a copy of your care plan.
• Avoid swimming or being under water – even a small splash can enter the stoma.
• If you smoke, ask your healthcare team about support to quit – smoking seriously increases risks.
• When going outside, wear a loose soft collar or scarf to cover the stoma and filter the air.

Diet and exercise

You may need to adjust your diet if swallowing is affected. A speech and language therapist or dietitian can help you find safe textures and positions to eat. Regular gentle exercise, as advised by your physiotherapist, can keep your lungs and body strong. Avoid exercise that involves heavy straining or lifting that could shift the tube.

Mental health and emotional wellbeing

Living with a tracheostomy can feel isolating, frustrating, or scary at first. Changes to your voice and appearance may affect your confidence and mood. It is very common to feel anxious or depressed. It is important to talk openly with your care team, family, and friends. If you are struggling, ask your doctor or nurse about counselling or support. If you have thoughts of harming yourself, please reach out to a mental health crisis line – help is available.

Prevention

A tracheostomy itself is usually a life-saving treatment, so it cannot be 'prevented' when it is needed. However, you can prevent many complications – like infections and tube blockages – by carefully following your care plan, keeping the stoma clean and dry, and washing your hands before touching the tube.

Vaccines

It is strongly recommended to stay up to date on vaccines, especially against the flu, pneumonia, and COVID-19, because a tracheostomy increases your risk of chest infections. Ask your healthcare provider about which vaccines are right for you.

Screening programmes

Your team will regularly check the stoma and lungs for early signs of problems. If you had a tracheostomy because of throat cancer, you will have regular follow-up appointments as part of your cancer care.

Complications

If left untreated

• Serious infection of the stoma or lungs (pneumonia)
• Blockage of the tube by dried mucus, which can stop breathing
• Bleeding from small blood vessels in the windpipe
• Scar tissue or narrowing of the windpipe over time
• Damage to the skin around the stoma from constant moisture or rubbing

Long-term outlook

The outlook for people living with a tracheostomy is generally very good, especially with proper training and support. Many people go on to live full, productive lives – working, travelling, and enjoying family time. For some, the tracheostomy is temporary and can be reversed. For others, it is a permanent but manageable part of life. You are not alone, and your healthcare team will be with you every step of the way.

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