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Tracheostomy
Tracheostomy is a vital ENT surgical procedure that creates a direct opening in the neck into the trachea (windpipe), providing a safe and reliable airway for patients who require prolonged ventilation, have upper airway obstruction, or need lung protection from aspiration.
Overview
Tracheostomy establishes a direct airway through an incision in the front of the neck into the trachea, bypassing the upper airway when it is blocked, compromised, or unable to function safely. A curved tube is placed through the opening to maintain the airway and connect to a ventilator if needed, providing a safe, secure breathing route that can be maintained for days to months. Modern techniques including percutaneous bedside approaches have made this procedure safer and more accessible for critically ill patients.
Types of Tracheostomy
Tracheostomy is performed through several techniques, each suited to different clinical situations and patient needs. Your ENT specialist and intensive care team will determine the most appropriate approach.
- Surgical Tracheostomy (open technique — performed in the operating theatre)
- Percutaneous Dilatational Tracheostomy (bedside procedure in the ICU)
- Mini-Tracheostomy (small-bore tube for secretion clearance without full ventilatory support)
- Emergency Cricothyroidotomy (emergency airway when standard tracheostomy is impossible)
- Paediatric Tracheostomy (specially sized tubes and modified technique for children)
Risk Factors Requiring Tracheostomy
Tracheostomy is indicated across a wide range of clinical situations where the natural upper airway cannot safely maintain breathing. These conditions require experienced ENT surgeon expertise for safe airway management.
- Prolonged mechanical ventilation in ICU requiring transition from endotracheal tube
- Upper airway obstruction from tumour, trauma, or infection
- Severe head and neck cancer causing progressive airway compromise
- Neurological conditions impairing swallowing and increasing aspiration risk
- Major facial and head and neck trauma requiring definitive airway management
- Obstructive sleep apnoea unresponsive to conservative treatment
Tracheostomy Indications and Symptoms
Patients requiring tracheostomy typically present with life-threatening airway compromise or prolonged ventilatory dependency. These clinical situations require prompt expert ENT evaluation.
- Acute stridor indicating critical upper airway narrowing
- Respiratory failure requiring prolonged mechanical ventilatory support
- Failure to wean from endotracheal tube ventilation in ICU patients
- Recurrent aspiration pneumonia from neurological swallowing dysfunction
- Bilateral vocal cord paralysis causing airway obstruction
- Post-surgical or post-radiation laryngeal oedema
- Progressive dysphagia with high aspiration risk in head and neck cancer
- Subglottic stenosis causing progressive airway narrowing
Key Benefits
Discover the advantages of choosing our tracheostomy services.
Provides a safe, reliable airway immediately eliminating the risk of acute upper airway obstruction
Allows ventilator-dependent patients to be safely managed in lower-acuity care settings
Enables speech with a speaking valve when clinically appropriate improving patient communication
Reduces the need for ongoing sedation in ICU patients allowing faster cognitive recovery
Improves secretion clearance in patients with poor cough and swallowing function
Clinical Features
The technology, techniques and clinical approach behind our tracheostomy.
Establishes a safe, direct, and stable airway bypassing the upper airway completely
Available as elective open surgery or as a percutaneous bedside procedure in the ICU
Multiple tube types and sizes available to match each patient's anatomy and clinical needs
Specialist tracheostomy nursing and speech therapy support from the day of the procedure
Humidification systems provided to replace the natural airway humidifying function
Preparation Instructions
- Complete airway imaging (CT neck and chest) and laryngoscopy before elective tracheostomy
- Blood tests including CBC, coagulation, and blood group are required
- Stop anticoagulants 5 to 7 days before elective procedures as directed
- Fast for 6 to 8 hours before elective surgery
- Obtain informed consent from patient or family regarding the procedure and communication changes
- Ensure speech therapy and tracheostomy nursing teams are briefed for post-operative care
- Arrange tracheostomy care training for the patient's family before discharge if long-term use is anticipated
- Emergency tracheostomy requires no specific preparation — performed immediately to save life
The Procedure
Step-by-step guide to what you can expect during your tracheostomy procedure.
Clinical Airway Evaluation
Your ENT specialist carefully assesses your airway patency, breathing capacity, and the underlying condition requiring tracheostomy — whether prolonged ventilation, upper airway obstruction, or protection from aspiration — to plan the safest and most appropriate surgical approach for your specific situation.
Sterile Preparation and Anaesthesia
The neck area is cleaned, draped in a sterile manner, and local anaesthesia with sedation (or general anaesthesia for elective cases) is administered. Our airway team ensures the existing airway is secured before any surgical step begins, maintaining your safety throughout the transition.
Surgical Incision and Tracheal Access
A precise horizontal incision is made in the lower neck overlying the trachea, and the tissue layers are carefully separated to expose the front wall of the trachea directly. The procedure is performed under direct vision with excellent lighting to ensure accurate anatomical identification.
Tracheal Opening and Tube Placement
A controlled opening is made in the tracheal wall between the second and fourth tracheal rings, and the appropriately sized tracheostomy tube is gently but securely inserted through the opening into the airway. Correct placement is confirmed immediately by the easy passage of breath through the tube.
Securing the Tracheostomy Tube
The tracheostomy tube is secured with neck ties and may be sutured to the skin to prevent accidental dislodgement during the early post-operative period when the stoma has not yet matured. The cuff is inflated to the appropriate pressure to seal the airway.
Stoma Care and Team Education
Our specialist tracheostomy nursing and speech therapy teams begin stoma care education immediately — teaching the patient, family, and ward nursing team everything needed for safe, confident tracheostomy management before the first tube change at day 5 to 7.
What to Expect
Tracheostomy is performed under general anaesthesia (elective) or local anaesthesia in emergencies, taking 30 to 45 minutes. A small horizontal incision is made in the lower neck, the trachea is opened, and the tracheostomy tube placed and secured. You will not speak normally while the tube is in place but the care team will provide communication aids. The first tube change is at 5 to 7 days when the stoma has matured.
Recovery
Tracheostomy tube care requires daily cleaning of the inner cannula, regular suctioning, and keeping the stoma site clean and dry. Humidification of inspired air is essential as the natural humidifying function of the nose is bypassed — always use prescribed humidification devices. Begin speech therapy as directed to work towards safe speech and eventual decannulation when appropriate. Contact your medical team immediately if the tube becomes blocked, dislodged, or if you experience increased difficulty breathing.
Frequently Asked Questions
Common questions about tracheostomy.
Related Services
Explore other services in our E N T department.
Adenoidectomy
Adenotonsillectomy
Bilateral Modified Neck Dissection
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