Tommy is wearing a Passy-Muir valve. It allows air into the trach, then it closes and he has to breathe out through his mouth and nose. This moves the vocal cords causing sound. I have not heard Tommy's voice since he was born. He was a quiet little preemie and then intubated for heart surgery. He needed the trach to come off the ventilator and other than his birth, I've not heard his sweet voice until today.