Abstract Background Speakingvalve trials are routinely incorporated into pediatric tracheostomy care to assess upperairway patency, phonation readiness, and ventilator weaning. Beyond communication, intolerance to speakingvalve trials may signal undiagnosed airway compromise. The diagnostic value of speakingvalve trials for detecting occult airway pathology in pediatric tracheostomy patients has not been systematically evaluated. Methods We conducted a retrospective review of pediatric tracheostomy patients at Children’s Wisconsin who underwent speakingvalve trials as part of multidisciplinary airway management. Patients were categorized as Pass or Fail on initial speakingvalve trial. Airway endoscopy findings before and after trials were compared to identify previously unrecognized pathology. The primary outcome was detection of new airway lesions following the speakingvalve trial. Chisquare testing assessed associations between valve tolerance and new airway findings. Results A total of 259 children underwent speaking-valve trials. The cohort included 160 males (61.8%) and 99 females (38.2%). Most patients received tracheostomy for ventilator dependence (174/259, 67%). Speaking-valve trials occurred a median of 154 days after tracheostomy (IQR 50-406), and follow-up airway endoscopy occurred a median of 222 days after the trial (IQR 106-412). Of the 259 patients, 152 (58.3%) successfully tolerated the speaking valve on initial trial, while 107 (41.3%) did not. Previously unrecognized airway pathology was identified in 102 patients (39.4%) on subsequent endoscopy. Children who did not tolerate the speaking valve demonstrated a higher rate of new airway lesions compared with those who passed (42.0% vs 33.1%; p = 0.0088). Newly detected findings included suprastomal granulation, subglottic narrowing, and dynamic airway collapse. Airway intervention was required in 27 children (10.4%) with newly identified pathology (ongoing surgical data collection). Intervention rates did not differ between pass and fail groups (10.5% vs 10.3%; p = 1.00), suggesting that while speaking-valve intolerance is useful for detecting occult lesions, not all detected abnormalities require surgical correction. Interventions included procedures such as granulation excision, subglottic dilation, and airway reconstruction. See Table 1. Conclusion Speakingvalve tolerance provides clinically meaningful diagnostic information beyond communication assessment in pediatric tracheostomy patients. Children who fail speaking-valve trials are more likely to have previously unrecognized airway pathology, supporting the role of speaking-valve response as a useful screening tool for occult airway abnormalities and to inform tracheostomy and decannulation planning. Although many identified airway abnormalities did not necessitate immediate surgical intervention, speaking-valve intolerance served as a clinical indicator prompting airway evaluation, facilitating longitudinal surveillance and informing subsequent management decisions, including potential intervention when warranted. This abstract is funded by: None
Henningfeld et al. (Fri,) studied this question.