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Physiological Changes associated with Tracheostomies The formation of a tracheostomy tube alters or bypasses certain upper and lower airway functions. Most of these normal functions assist to combat infection therefore tracheostomy patients have a higher risk of developing respiratory infections. Normally the cavities of the nose warm and filter inhaled air. The pharynx then transmits air into the larynx, vocal cords and trachea. During inspiration and expiration air passes through the larynx, the vocal cords open and air moves to and from the trachea. As air is re-routed from the upper airway after tracheostomy formation, the following changes occur temporarily: • Loss of nasal filtering functions • Loss of humidification by the nose Loss of warming of inhaled air • Loss of voice • Altered sensation and cough reflex. • Altered taste and smell Potential swallowing dysfunction As a result of the above actions cold, dry air reaches the lower airways. The normal tracheobronchial tree requires a relative humidity of >90% for the muco-ciliary mechanism to function normally. This humidity comes from the warming and humidification of inspired gases in the nasopharynx. Ciliary action in the trachea is also affected and patients are unable to effectively clear secretions and foreign matter. The tracheostomy tube is also perceived by the body as a foreign object and the body increases mucous secretions as a protective mechanism.