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HomeHealth TopicRespiratory Diseases

Tracheostomy: Why Some People Have a Hole in Their Neck to Breathe

Frank Schwalbe, MDKarla Robinson, MD
Written by Frank Schwalbe, MD | Reviewed by Karla Robinson, MD
Published on September 27, 2023

Key takeaways:

  • A tracheostomy is a small hole in the front of the neck that bypasses the upper airway to allow someone to breathe.

  • It’s used when there is damage or a blockage to the upper airway that prevents air from reaching the lungs.

  • Even though the procedure is considered safe, the rate of complications and death can be high.

Close-up of tracheostomy on a patient.
PongMoji/iStock via Getty Images Plus

If you’ve ever wondered why some people have a hole in their neck to breathe, you’re not alone. Chances are, they’ve had an injury or blockage to their airway above the chest. This prevents air from reaching the lungs. When this happens, a person needs a tracheostomy to breathe. 

Let’s take a closer look at situations when a tracheostomy may be used and how it works to help you breathe.

What is a tracheostomy?

A tracheostomy (trach) is a small hole in the front of the neck. It allows air to move into the lower part of the windpipe and lungs without passing through the nose or mouth. A surgeon creates a tracheostomy by cutting through the skin of the neck into the front part of the windpipe. They will then place a “trach tube” in the hole to keep it open so that air can flow through.

The procedure is usually done while someone is asleep under general anesthesia, unless it’s an emergency. When someone needs airway access urgently, local anesthesia may be used to quickly numb the area before the procedure.

Why would someone need a tracheostomy?

There are many reasons a tracheostomy might be necessary. They can include emergency and elective (planned) reasons.

Emergency tracheostomy

A person’s airway might suddenly become blocked, preventing air from getting into the lungs. In these cases, a tracheostomy may be a lifesaving measure. Medical emergencies that might require a tracheostomy include:

  • A sudden swelling of the airway that prevents a breathing tube from being placed in the throat by intubation, like from severe cases of allergic reaction (anaphylaxis) or swelling under the skin (angioedema)

  • Severe head or neck trauma

  • Choking on something stuck in your windpipe (foreign body aspiration)

Elective tracheostomy

Sometimes a person or their family might plan a tracheostomy to improve their quality of life or make caring for the person easier. Some of the reasons for an elective tracheostomy include:

  • Needing to be on a ventilator for a long time

  • Expecting upper airway damage to happen (after radiation for certain types of head and neck cancer)

  • Severe sleep apnea, when routine treatments aren’t working

  • Chronic aspiration, which is when someone regularly inhales food, drink, or saliva into their windpipe

  • A narrowing of the windpipe (subglottic stenosis)

  • Neuromuscular disease, like amyotrophic lateral sclerosis (ALS)

How does a tracheostomy work?

In a tracheostomy, a tube is placed through the tracheostomy incision, directly into the windpipe. It is held in place inside the windpipe, or trachea, with an inflated balloon. The tube outside the body is taped in place.

A tracheostomy allows air to move into the lungs without going through the mouth or nose. If needed, the tracheostomy tube can be connected to a ventilator to help with breathing. If the person can breathe on their own, air will be pulled into the lungs every time they take a breath, bypassing the upper airway.

What is the success rate of a tracheostomy?

Tracheotomy is considered a safe and effective procedure with a low rate of serious complications. And in emergency situations, a tracheostomy can mean the difference between life and death. 

With trained providers performing the procedure, tracheostomy is almost always successful. The risk of death is as high as 2% in adults, but it can be higher in small children and critically ill people.

What are the risks of having a tracheostomy?

Complications of tracheostomies can happen immediately during the procedure. Or they can happen anytime after the tube is placed. They can be minor or life-threatening.

Immediate complications of a tracheostomy may involve:

  • Bleeding

  • Lung collapse (pneumothorax)

  • Air underneath the skin (subcutaneous emphysema)

  • Nerve damage

  • The tracheostomy tube becoming blocked or accidentally displaced

Complications of a tracheostomy that may develop later include:

  • Infection (skin infection, pneumonia) 

  • Scarring of the windpipe

  • Excess mucus production 

  • Changes in voice, taste, or smell

  • Difficulty swallowing 

There is also a risk of a breakdown of the tissues around the tracheostomy tube, causing a fistula to form. This can cause an abnormal connection between the tracheostomy and nearby structures like the esophagus.

How long can someone live with a tracheostomy?

In general, people who need to have a tracheostomy have very serious medical conditions. But the life expectancy of someone with a tracheostomy will depend on the underlying reason it was needed. For example, if a tracheostomy was placed because of a severe allergic reaction or choking, they can make a full recovery quickly. And the tracheostomy can be removed as soon as the airway is clear.

The outcome is less certain, though, if someone needs a tracheostomy for long-term conditions. Some people can live many years with a tracheostomy. But one large study found the risk of death 1 year after a tracheostomy was about 35% for people under 65 years old. For people over 65, the risk was greater than 50%. Most people over age 65 lived 6 months after the procedure.

How long does it take to heal from a tracheostomy?

After having a tracheostomy placed, most people will need to stay in the hospital for at least a few days. If there are no complications from the tracheostomy placement, it will take about a week for the incision to heal.

It can take a couple of weeks to get used to living with a tracheostomy. Speech and occupational therapists may be able to help with feeling more comfortable with speech, swallowing, and breathing.

For some people, a tracheostomy is permanent. For others, once the reason for the tracheostomy resolves, the tube can be removed. The tracheostomy site will need to be covered with sterile dressings until it closes and is airtight.

Depending on how long the tube was in place, it can take up to 3 weeks for the site to close. Pressure will need to be applied to the bandage to cough and speak until the wound is completely healed.

The bottom line

A tracheostomy can be a life-saving procedure. It allows someone to breathe when they have a condition affecting the upper airway that prevents air from reaching the lungs. It is considered safe and has a high success rate, especially in an emergency. Some people have to learn how to live with a tracheostomy long term, while others can eventually have it removed. If someone you know has had a tracheostomy, speak with their healthcare team about recovery options. 

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Why trust our experts?

Frank Schwalbe, MD
Frank Schwalbe, MD, is an assistant professor of anesthesiology at the Yale School of Medicine. He has practiced anesthesiology for 30 years.
Karla Robinson, MD
Karla Robinson, MD, is a medical editor for GoodRx. She is a licensed, board-certified family physician with almost 20 years of experience in health through varied clinical, administrative, and educational roles.

References

Christiansen, K. J., et al. (2022). Tracheostomy healing time after decannulation. Multidisciplinary Respiratory Medicine

Costa, L., et al. (2016). Urgent tracheostomy: Four-year experience in a tertiary hospital. World Journal of Emergency Medicine

View All References (5)

MedlinePlus. (2023). Tracheostomy.

Mehta, A. B., et al. (2019). One-year outcomes following tracheostomy for acute respiratory failure. Critical Care Medicine

National Health Service. (2022). Overview: Tracheostomy.

Raimonde, A. J., et al. (2023). Tracheostomy. StatPearls.

Zouk, A. N., et al. (2021). Managing complications of percutaneous tracheostomy and gastrostomy. Journal of Thoracic Disease.

GoodRx Health has strict sourcing policies and relies on primary sources such as medical organizations, governmental agencies, academic institutions, and peer-reviewed scientific journals. Learn more about how we ensure our content is accurate, thorough, and unbiased by reading our editorial guidelines.

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