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When a tracheostomy tube is introduced, the functions of the airway can be dramatically changed. Some tracheostomy tubes have a cuff to assure that all air moves in and out through the tracheostomy tube during mechanical ventilation. Proper cuff inflation should be maintained at all times. Over inflation of the cuff can cause many complications including necrosis and trauma to the delicate tracheal tissues as well as esophageal impingement with possible swallowing difficulty and reflux. Proper cuff inflation is best achieved by measuring the pressure in the cuff with a manometer. Even with proper cuff inflation, complications arise when airflow bypasses the upper airway, mouth, and nose. Normal sensation and airway pressures are lost. As a result, tracheostomized patients have diminished or absent functions of the aerodigestive tract. Absence of airflow through the vocal folds leaves patients without the ability to speak, causing docHub frustration an