A permanent tracheostoma is often necessary in patients with respiratory diseases such as severe bronchial asthma or chronic bronchitis in order to reduce dead space. Another group of patients who require a permanent tracheostoma are those with laryngeal stenosis or bilateral vocal cord pareses whose general condition makes them unsuitable candidates for more advanced surgical procedures. This has usually been achieved by a conventional tracheostomy tube which, however, carries many problems; the ability to cough is greatly reduced when a sufficient intra-abdominal pressure cannot be acquired, speech is impaired, the tube has to be changed regularly, it must be fixed by bands around the neck, etc. These problems can be significantly reduced by using a short, straight tube placed in the stoma and kept securely in position by an outer flange and four flaps on the tracheal side. To this tube is attached a special two-way valve adjustable for either inspiration and expiration or for inspiration only in which case it also serves as a speech valve. Up to now this construction has been used in 16 patients with excellent results, one patient has had this device continuously since 1970 without any complications.