Speech facilitator tube and valve

Into patients intubated with an endotracheal tube for patient ventilation, a sound tube is inserted into the hypopharynx. A valve between the endotracheal tube and the ventilator can be manually actuated so that the patient's exhaled breath passes through a buzzer in the sound tube. The sound emanates from a location just above the natural vocal chords and can be articulated into intelligible speech by lips and tongue.

FIELD OF THE INVENTION 
This invention is directed to a sound tube carrying a buzzer with the 
outlet of the tube positioned at the hypopharynx so that the patient can 
articulate the sound of the buzzer into intelligible words by normal 
movement of the tongue and lips. 
BACKGROUND OF THE INVENTION 
Some post-operative patients have an endotracheal tube inserted through the 
nasal passage and terminating in the trachea. A ventilator is connected to 
the endotracheal tube and is utilized to control the patient's breathing. 
The ventilator inflates and deflates the patient's lung. The endotracheal 
tube passes through the vocal chords and thus makes them inoperative. Such 
patients cannot communicate by voice. The inability to communicate causes 
anxiety for many patients as well as frustration for the medical team and 
the patient's relatives. 
When an endotracheal tube is in one nostril and a nasogastric tube is in 
the other nostril, the patient cannot communicate by voice. Since both 
nostrils are employed, there is no opportunity to pass a voice tube down 
into the hypopharynx. In other cases, the larynx or vocal chords are 
distorted or removed so that the patient has a permanent impairment of 
vocal capability. In each case, it is desirable to provide the patient 
with a device which permits him to articulate intelligible speech. 
SUMMARY OF THE INVENTION 
In order to aid in the understanding of this invention, it can be stated in 
essentially summary form that it is directed to a speech facilitator tube 
and valve, with the tube configured for placement through the nasal 
passages to terminate above the larynx. A buzzer is provided in the tube, 
and the tube has a gas supply to actuate the buzzer so that sound is 
produced which can be articulated into intelligible speech by action of 
the lips and tongue. When the tube is employed with an endotracheal tube 
for patient ventilation, a valve is provided to permit exhaled air to 
actuate the buzzer and the speech facilitator tube. When the tube is 
employed with a nasogastric tube, it can be attached thereto to the 
hypopharynx. 
It is thus an object and advantage of this invention to provide a speech 
facilitator tube which contains a buzzer and is configured so that the 
tube can be installed with its lower end in the hypopharynx, just above 
the region of the larynx, so the buzzer in the tube delivers sound near 
the larynx from which the sound can be articulated into intelligible 
speech. 
It is another object and advantage of this invention to provide a speech 
facilitator tube which is particularly useful in connection with 
endotracheal intubation of a patient, including a valve which causes 
exhaled ventilation air to be passed through the speech facilitator tube 
to actuate a buzzer therein and deliver sound to the hypopharynx. 
It is another object and advantage of this invention to provide a speech 
facilitator tube and valve which is inexpensive so that it can be supplied 
in presterilized condition and disposed after use and provide a speech 
facilitator tube which is reliable and effective to produce intelligible 
speech. 
Other purposes and advantages of this invention will become apparent from a 
study of the following portion of the specification, the claims and the 
attached drawings.

DESCRIPTION OF THE PREFERRED EMBODIMENTS 
Endotracheal tube is placed within the trachea of a patient to assist in 
breathing. Endotracheal tube 10 is shown in FIG. 1 to be nasally inserted 
in patient 12 into the trachea, below the larynx. Cuff 14 is attached to 
the end of tube 10 and is inflated to seal endotracheal tube with respect 
to the patient's trachea. A ventilator is connected to ventilator tube 16, 
which is connected through valve 18 to endotracheal tube 10. In the normal 
position of valve 18, ventilator tube 16 is directly connected to 
endotracheal tube 10 to provide normal ventilation. Normal ventilation 
comprises cyclically delivering air or oxygen-enriched air under gentle 
pressure and predetermined cycle volume through the ventilator tube and 
endotracheal tube to inflate the patient's lungs. At the end of each 
cycle, the ventilator removes the air or the lungs are permitted to 
normally contract and expel the air delivered on the previous cycle. In 
the normal position of valve 18, shown in FIGS. 2, 3, 4, 5 and 6, the 
expelled air goes back to the ventilator and is vented to atmosphere. 
While the endotracheal tube is in place, all of the air delivered by the 
ventilator and the exhaled air passes through the endotracheal tube. 
Therefore, no air passes the vocal chords of the patient while he is 
intubated, and the tube incapacitates the chords; thus the patient cannot 
speak. Voice tube 20 is nasally inserted and extends into the hypopharynx 
just above the larynx of the patient, as indicated in FIG. 1. Tube 20 is 
open at its distal end 22. Voice tube 20 carries an air-operable reed or 
buzzer therein. The buzzer 24 is located at the valve, as seen in FIG. 1, 
but alternatively the buzzer could be positioned within the length of the 
tube or at the distal end. Regardless of where the buzzer is located, the 
sound emanates at the open end 22 of the tube 20, which is close to the 
normal location of the vocal chords. The buzzer sound can be articulated 
into intelligible words by normal movement of the tongue and lips. If the 
buzzer is located at the proximal connection end of the voice tube, the 
sound is carried through the tube and the sound is delivered into the 
hypopharynx just below the uvula and just above the vocal chords, at the 
distal end of the voice tube. Whether the sound is generated at the distal 
end or delivered there, it can be articulated into intelligible words by 
normal movement of the tongue and lips, as previous described. 
In order to make the buzzing sound, gas must be delivered through voice 
tube 20 to a sufficient extent to actuate the buzzer 24. The delivery can 
simply be by connection to a pressurized source, such as compressed air or 
oxygen, or, since the patient is used to speaking as he is exhaling, it is 
preferable to employ the breath delivered by the contracting lungs to 
energize the buzzer. This is accomplished by means of valve 18. Valve 18 
has a body 26 on which are secured endotracheal tube boss 28 and voice 
tube boss 30. These bosses are tubular and are sized to connect the 
respective tubes. Fitting 11 is secured on the end of tube 10 and forms a 
standard part thereof. Fitting 11 has a tapered nose and engages securely 
within the tapered opening 32 in endotracheal tube boss 28. Voice tube 
boss 30 has a central opening 34. Buzzer 24 has a nose 25 which inserts 
into and seals with respect to the opening 34 in boss 30. Voice tube 20 is 
received in a tube fitting on the top of the buzzer, as seen in FIG. 2. 
Each of the bosses is a valve port. Slot 36 is formed through the body 
along the length of the body. Slot 36 is a parallel slot, except for guide 
pins 38 and 40 formed as part of the body and extending into the slot, and 
spring stop 42 formed as part of the body and positioned at the left end 
of the slot, as seen in FIG. 3, where it extends partway across the slot. 
Valve member 44 is of generally rectangular configuration to fit within the 
slot 36 and slide therein. Slots 46 and 48 respectively receive guide pins 
38 and 40 to limit the longitudinal sliding of the valve member in the 
valve body. The pins also facilitate aligning and assembling the parts 50 
and 26. 
Valve cover 50 has openings which locate on pins 38 and 40, as seen with 
respect to pin 40 on the right side of FIG. 4. Valve cover 50 is also 
tee-shaped to enter a short distance into the slot 36 for proper alignment 
and security with respect to the body. The cover is permanently attached by 
welding or adhesive, but valve member 44 is allowed to slide freely. This 
tee-shape is seen in FIGS. 5 and 6. Cover 50 has ventilator boss 52 
thereon for connection to ventilator tube 16. Opening 54 in boss 52 is in 
alignment with opening 32. Valve cover 50 also carries check valve boss 56 
thereon, which has its opening 58 in alignment with opening 34 in voice 
tube boss 30. Resilient check valve 60 is positioned in check valve boss 
56. The check valve 60 is in the form of a duckbill valve directed upward, 
from atmosphere toward the voice tube opening 34. Fitting 62 holds the 
resilient duckbill check valve 60 in place and has an opening therethrough 
and a hose nipple 63 thereon. 
As seen in FIG. 3, spring pocket 64 contains compression spring 66 which 
resiliently urges valve member 44 to the rightmost position seen in FIG. 
3. In this position, valve opening 68 is in alignment between ventilator 
opening 54 and endotracheal tube opening 32. In this position, there is 
continuity between the ventilator and the endotracheal tube for normal 
ventilation and allows no escape of air to voice tube through boss 30. 
Valve opening 68 has a recess 70 which is above gate 72 formed as part of 
the sliding valve member 44. When the sliding valve member 44 is moved to 
its leftmost stop position by finger pressure, against the urging of 
spring 66, the ventilator opening 54 is closed off, but endotracheal tube 
opening 32 is connected to voice tube opening 34 and valve 60, see FIG. 7. 
In this position, the exhaling patient breathes out through tube 10, 
through opening 32 and boss 28, through the recess 70 and valve opening 68 
back into voice tube opening 34 and into the voice tube 20 itself. This 
exhalation energizes buzzer 24. The sound is in the area of the patient's 
larynx so that by normal movement of the tongue and lips, the patient can 
articulate the buzzing sound into intelligible words. The patient does 
this for one exhalation, and thereupon releases the sliding valve member 
so that the next lung inflation can be accomplished by the ventilator. 
The ventilation system is often used on patients who have some breathing 
capability to create sufficient breathing volume on the correct breathing 
cycle. Such patients may try to inhale while the valve member 44 is in the 
speaking position illustrated in FIG. 7. With the valve member in that 
position, he cannot inhale air from the ventilator. In this circumstance, 
check valve 60 opens to permit entry of room air, to prevent the patient 
from feeling deprived of air. If the patient desires, he can hold the 
valve member 44 in the active position shown in FIG. 7, inhale through 
check valve 60, and exhale through voice tube 20 to provide the buzzing 
sound which he can articulate into words. The employment of the check 
valve 60 prevents situations in which the patient tries to inhale but 
cannot. When the patient releases the sliding valve member 44 from his 
fingers, the spring returns it to the normal position. 
In those cases where the patient relies upon the ventilator for exhalation, 
he cannot use the sliding valve member 44 during exhalation to supply air 
through the voice tube. To supply the gas necessary to energize the buzzer 
in these circumstances, an oxygen or air line can be connected to 
connection nipple 63. A valve in such a line would control the delivery of 
air to the buzzer, and in turn, control the generation and delivery of 
sound at the distal end 22 of voice tube 20. The connection of a 
pressurized gas supply to the nipple 63 does not require the translation 
of sliding member 44 for actuation of the buzzer. 
The speech facilitator tube and valve described with respect to FIGS. 1 
through 7 permits the insertion of the voice tube through one nostril when 
the other is occupied by the endotracheal tube 10. Sometimes it is 
medically helpful or required to employ a nasogastric tube together with 
the endotracheal tube. Since both nostrils are occupied, a separate voice 
tube cannot be used. Patient 74, shown in FIG. 8, has a nasally inserted 
endotracheal tube 10 and also has a nasogastric tube 76 inserted through 
his nasal passages, through his hypopharynx, into his stomach. The 
nasogastric tube 76 has three lumens therein. Lumen 78 is a gastric lumen 
which passes into the stomach. At its upper end, it is connected to a 
suction source. Lavage or air bleed lumen 80 also passes into the stomach 
and is separately connected at its upper end to deliver lavage fluids to 
the stomach, as required or to permit air to enter the stomach. Voice tube 
lumen 82 terminates partway along the length of the nasogastric tube and 
has one or more ports 84 at its lower end 85. When the nasogastric tube is 
properly positioned, the ports 84 are in the hypopharynx. Buzzer 86 is 
positioned in voice tube 82. It may be at either end of the voice tube or 
along its length. In FIG. 10, it is illustrated as being adjacent the 
upper end of the voice tube, exterior to the patient. The voice tube and 
buzzer are supplied with gas under pressure. Alternatively, a valve 18 
could be connected to the nasogastric tube 10, ventilator tube 16, and 
voice tube 82 so as to use the patient's exhaled breath. In the present 
case, valve 88 controls the flow of gas under pressure from pressure line 
90. The pressure line 90 may be an humidified oxygen or a compressed air 
line, or other convenient source. Valve 88 can conveniently be a 
spring-loaded pushbutton valve, where the valve is normally closed and 
when pressed, it is opened. When the patient wants to speak, the valve 88 
is opened so that gas under pressure is delivered to buzzer 86. The buzzer 
sounds, and the vibrations are delivered by means of the voice tube 82 to 
the hypopharynx. Once the vibrations are acoustically delivered in this 
area, the vibrations can be articulated into intelligible sounds by means 
of the mouth and tongue. In this way, a nasogastrically intubated patient 
can vocally communicate with those around him. 
This invention has been described in its presently contemplated best modes, 
and it is clear that it is susceptible to numerous modifications, modes and 
embodiments within the ability of those skilled in the art and without the 
exercise of the inventive faculty. Accordingly, the scope of this 
invention is defined by the scope of the following claims.