Friday, April 19, 2019
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Jill speaks about Buttons

Buttons/Stents aren't for everyone and it seems the most common use are for folks with OSA who want their trach plugged during the day and open at night for sleeping.

Personally I wouldn't want a speaking valve or HME built into a button or a trach tube/cannula.  Why?  Cleaning issues, if you are sick it is much easier to clean a tube that is open than one with a speaking valve or HME built in.  Plus you have to be extra careful not to damage the speaking valve or HME when you clean it.  OSA folks (and others) need air more at night and the bigger the inner diameter without anything on or inside the button or tube the better and easier it is to breath.  You will probably need humidification at night and it easier to breath with less in/on the tube opening.

With the Hood (or other buttons) you decide when you need the extra air (leaving the speaking valve off or unplugged) you can't do that with a product that is built in.

Make sure your doctor knows about the Hood Stoma Stent and KNOWS how to do the surgery so it fits right.  If your surgeons does surgery for a tube you will have nothing but issues if you try to switch to a button.  You have to make sure when your surgeon makes the hole for a button that it is straight as opposed to curved for a tube or you will have problems getting a button to fit correctly (Hood has a curved button for those that have had the curved tube surgery).  If you want the Hood, go see Dr. Isaac Eliachar (he invented the Hood) at the Cleveland Clinic Foundation  in Ohio, he would be able to tell you if you are a candidate for Hood Stoma Stent, or his new procedure (see link) or the standard trach tube.  Hood Speaking valve

 If you can't see Dr. Eliachar:

Your doctor will need to help decide if the goal is a button or a tube.  Dr. Eliachar might talk with your doctor and provide help for him/her over the phone.

Problem with most buttons is getting a correct fit (long enough to not allow sides of stoma wall to close in and push button out) and one that will stay in place and not come out when you cough/sneeze or while sleeping (then your hole will start to close up), one that doesn't stick into the windpipe and stays just in stoma opening. 

Buttons in general seem not to be made for people with a very long stoma.  Unless when they put your trach in they make the hole for a button (straight as opposed to curved for a tube) you will have problems getting one to fit correctly.

The KEY DIFFERENCE between tubes/cannulas and buttons is a tube/cannula sits in your windpipe and MOST not all buttons have flanges that are placed against the inside windpipe wall.  Some of these buttons require a topical anesthetic and some say they should be switched for a tube/cannula while sleeping.   Buttons with the flanges can cause other issues such as granulomas, inflammation, swelling, building up scar tissue and other issues.  Sometime the flanges can tear down tracheal rings by putting them in and out so often. 

Tubes/cannulas can also cause granulomas (most common).  Depending on how your surgery went the tube can also tear down the tracheal rings.

So be sure and discuss the pros and cons with your doctor.

 Note- Since writing this article Dr. Isaac Eliachar has retired.  Dr. Robert Lorenz has taken over Dr. Eliachar's patients.



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