3. All of the steps in question 2 have been checked, the PMV was put back on the tracheostomy tube and it was still harder to breathe. What could be causing this?

• If you are not able to tolerate the PMV you may need to be evaluated by your doctor or a specialist such as an Ear, Nose and Throat Doctor (ENT or Otolaryngologist) or Lung Doctor (Pulmonologist). The doctor will look for a narrowing or softening of the walls of the trachea (windpipe) that might make it collapse, a build-up of scar tissue, or problems with the vocal cords. Any of these things can make it difficult or impossible to use the PMV until the problem is corrected.
• Sometimes a tracheostomy tube is too big to allow the air to travel around the tube and into the upper airway through the vocal cords and out the mouth and nose to allow sufficient exhalation. The doctor may need to put in a smaller tracheostomy tube or a tracheostomy tube without a cuff in order for you to be able to use the PMV.
• Tracheostomy tube changes sometimes create swelling of the surrounding tissues in your airway. When you have your tracheostomy tube changed, you might find it helpful to wait a day or so before wearing the PMV again to allow any swelling to go down.

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