8. No voice or very little voice is being produced while the PMV is being worn. What do I do?

Airflow through the vocal cords is responsible for producing speech and sound. The vocal cords may be weak from not using them if the tracheostomy tube has been in place for a while. In addition, there may be weakness of the diaphragm which can reduce the amount of breath support you have when you speak which can make your voice sound soft and weak. If this is the first time the PMV is being used, remember that sometimes it takes time and practice to coordinate breathing with voicing. The following exercises may be helpful to get you started:

• Take a breath in through the tracheostomy tube while your PMV is on and then open your mouth and say "ahhhh" while you exhale. Try this a few times.
• Count slowly from one to five, taking a breath before saying each number. Try this a few times.If no voice can be produced, an evaluation of the vocal cords by an Ear, Nose and Throat Doctor may be needed to rule out vocal cord damage and/or to assess the tracheostomy tube size to consider putting a smaller tube in the airway to allow more air to reach the vocal cords. A speech-language pathologist is often consulted to help improve voice and speech production. Young children should be encouraged to play games that help them practice blowing air through the mouth (e.g., blowing bubbles, whistles, horns, etc.). You can also encourage them to imitate sounds that you make while they are wearing the PMV.

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