# Ferrer Adjustable Speaking Valve for Early Phonation in a Deconditioned Patient

## TL;DR

A new adjustable speaking valve helped a patient with a long-term tracheostomy to speak and breathe more effectively.

## Contribution

The introduction of the Ferrer adjustable speaking valve allows for earlier phonation and diaphragm exercise in deconditioned patients.

## Key findings

- The patient tolerated the Ferrer valve at 20% closure and progressed to 50% closure with partial phonation.
- The valve was used safely for 23 days, suggesting its potential for early communication and respiratory function improvement.

## Abstract

A patient with multiple comorbidities and an eight-year history of tracheostomy was being treated for tracheitis. At this point, she became incapable of using regular speaking valves, and multiple attempts to reintroduce the speaking valve failed. A Ferrer adjustable speaking valve (FASV) was designed with gradations of outflow closure, allowing air to go through the vocal cords for phonation. The FASV was offered to her through the compassionate use program at the FDA. At 20% initial closure, the patient was able to tolerate the valve and was advanced to 50% closure, at which point she could phonate partially. The use of the valve was terminated at the time of her transfer, 23 days after the initiation of use. This suggests the safety and possible efficacy of using an adjustable speaking valve earlier than regular valves, allowing patients to communicate earlier and further exercise their diaphragms.