Sarah Lewis, PharmD

What is a tracheostomy?

A tracheostomy is the surgical creation of a stoma (hole) in the front of the neck and through the trachea (windpipe). A tube is usually placed in the opening. The tube provides an airway and access to remove lung secretions and excess mucus. Once the tube is in place, you will breathe through the tube instead of your nose or mouth. A tracheostomy can be temporary or permanent, depending on the condition for which it is needed.

The word tracheostomy is often used interchangeably with tracheotomy. However, tracheotomy is the term for the surgical incision or cut, while tracheostomy is the term for the opening that the incision creates.

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A tracheostomy is a common but major surgery with significant risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all your treatment choices before having a tracheostomy.

Other procedures that may be performed

An emergency medicine doctor or general surgeon may perform a cricoidotomy in an emergency. A cricoidotomy creates a hole in the trachea above the spot that may be later used for a tracheostomy. A cricoidotomy is a temporary treatment used to save your life until you are stable or a more permanent tracheostomy can be done. 

Why is a tracheostomy performed? 

Your doctor may recommend a tracheostomy when air is not getting to your lungs. Your doctor may only consider a tracheostomy for you if other treatment options with less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion if time allows. 

Your doctor may recommend a tracheostomy for the following conditions: 

  • Blocked airway

  • Congenital (present at birth) airway defects

  • Injuries, such as airway burns from smoke, steam, gases or chemicals

  • Long-term coma

  • Long-term need for a mechanical ventilator because you cannot breathe on your own. This is the most common reason for a tracheostomy.

  • Need for removal of excess lung secretions or mucus due to a chronic lung disease 

  • Paralysis

  • Severe allergic reactions or infections

  • Spinal cord injuries

  • Surgery around or removal of the larynx (voice box). This may be necessary for diseases such as neck or throat cancer.

  • Surgery of the head, neck or trachea

  • Swallowing problems, which may be due to conditions such as a stroke

Who performs a tracheostomy?

The following specialists perform a tracheostomy:

  • Otolaryngologists (ENTs) specialize in the treatment of diseases and conditions of the ears, nose and throat. 

  • General surgeons specialize in the surgical treatment of a wide variety of diseases, disorders and conditions. 

  • Critical care surgeons manage patients with life-threatening injuries or emergent surgical problems.

  • Emergency medicine and trauma doctors specialize in rapidly diagnosing and treating acute illnesses, conditions, injuries, and complications of chronic diseases.

  • Pediatric otolaryngologists (pediatric ENTs) specialize in the treatment of diseases and conditions of the ears, nose and throat in infants, children and adolescents.

  • Pediatric surgeons specialize in surgery for infants, children and adolescents.

How is a tracheostomy performed?

Your tracheostomy will be performed in a hospital. A tracheostomy is an open surgery. An open surgery incision allows your doctor to directly view and access the surgical area. Your surgeon will make cuts to expose your trachea (windpipe) and cut through the rings of cartilage that make up your trachea. Once your surgeon creates the stoma (hole), he or she will place a tracheostomy tube in the opening. 

Your surgical team will confirm the position and placement of the tracheostomy tube using a bronchoscope. A bronchoscope is a thin, lighted instrument with a small camera that transmits pictures of the inside of your body to a computer screen. Your doctor sees the surgical area on the video screen during the surgery. When the positioning is confirmed, your team will secure the tracheostomy tube in place using tape or ties or straps that go around your neck.

Your doctor will advise you on how long you need to stay in the hospital or surgical center based on your diagnosis, age, medical history, general health, and possibly your personal preference.

Types of anesthesia that may be used

Your surgeon will perform your tracheostomy using general anesthesia, unless the situation is an emergency or critical in nature. Your care team will use local anesthesia in an emergency. 

  • General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and will not feel any pain.

  • Local anesthesia involves injecting an anesthetic medication around the area in your neck so you do not feel anything. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.

What to expect the day of your tracheostomy