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How Does a Tracheotomy Work?Will Rehnquist be able to talk next week?

By Brendan I. Koerner
Posted Monday, Oct. 25, 2004, at 5:27 PM ET

The Supreme Court announced today that Chief Justice William H. Rehnquist underwent a tracheotomy on Saturday as part of his treatment for thyroid cancer. The official press release also noted that the 80-year-old jurist "is expected to be on the Bench when the Court reconvenes" next Monday. Will Rehnquist be able to speak so soon after having a tube inserted into his throat?

Perhaps, though it's unlikely that the longtime chief justice will have full command of his vocal capabilities in a week's time. Though a tracheotomy is a routine, relatively low-risk procedure that can take as little as 15 minutes to perform, there's no telling how quickly Rehnquist will recover. The first thing he'll have to adjust to is the simple act of breathing through the tube, as opposed to through the mouth and nostrils; the adjustment typically takes three days. (In thyroid cancer patients like Rehnquist, a tracheotomy is usually performed either as a prelude to surgery or because the illness has complicated breathing.) After that, he can start working on speech, perhaps with the aid of a speech therapist.

A big factor in determining Rehnquist's verbal recovery time is whether or not his vocal cords are damaged. Cancer can cause the vocal nerves to suffer, and such damage is a potential side effect of a tracheotomy—especially in a patient of Rehnquist's advanced years. But the chief justice did appear to be in good health before this weekend's hospitalization, and damaged vocal nerves can grow back, albeit not in a mere seven days.

When Rehnquist does wish to speak upon his release from the hospital, he will have to cover up the tracheotomy hole. This can be done with a finger, or with a one-way speaking valve like those manufactured by Passy-Muir. Such valves allow the intake of air but not the outflow. Instead, the air is pushed up through the vocal cords, allowing the formation of audible speech. Exhalation takes place through the mouth and nostrils.

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Brendan I. Koerner is a contributing editor at Wired and a columnist for Gizmodo. His first book, Now the Hell Will Start, is out now.
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