Can’t talk after surgery, with a trach or on a ventilator? Apps that can help

When this happens

• On a ventilator or with a tracheostomy. With the cuff of a tracheostomy tube inflated, “you will not be able to speak”, and at first people may “need to communicate using writing and gestures”.¹
• After throat or mouth surgery, including removal of the voice box. People may use picture or typing systems “on a temporary basis in the acute postsurgical phase”, or for longer after extensive surgery.²
• On voice rest after vocal fold surgery. One NHS leaflet’s advice for the first days is to “avoid talking as much as possible. Write or text instead of using your voice.”³

For family and staff at the bedside, our guide how to communicate with nonverbal patients covers yes and no, letter boards and handover.

What the care team may try

A speech-language pathologist (in the UK, a speech and language therapist) looks at every way the person might communicate. For tracheostomy and ventilator patients, the professional guidance lists:⁴

• Ways without the voice: “writing; texting; gesturing and/or using signed language; the use of tablet or phone apps; and the use of low- and/or high-tech AAC”.
• Ways to use the voice or the mouth: mouthing words for someone to lipread, “leak speech” with the cuff partly or fully let down, an electrolarynx, or a one-way speaking valve.

Whether a speaking valve is safe is decided person by person: “candidacy for speaking valve use must be carefully established”.⁴ A speaking valve “can help make your voice stronger” for some people.¹ Even then, it helps to have a way to communicate that doesn’t need the voice, as a backup.⁴ After the voice box is removed, speech is usually rebuilt with an electrolarynx, esophageal speech or tracheoesophageal speech, and people have support to communicate after surgery.²⁵

What to look for in an app for a hospital stay

• It talks without internet. Hospital Wi-Fi can be slow, behind a sign-in page, or missing in the room you’re in.
• One-tap phrases: yes, no, pain, “I need the nurse”, “I can hear you, I just can’t speak”.
• Typing with word guesses, for everything else, if you can spell.
• Big text on screen as well as a voice: staff in masks, alarms and noise make voices hard to hear.
• A free start long enough for the stay, so you don’t pay for something you need for a week.
• A layout you can work with one hand, or with your eyes or head if your hands can’t move.

Apps to try

Apps for a while without a voice: price and offline use (October 30, 2026)

If you can type

Speech Assistant AAC is a typing app with phrase buttons; its listing says it works with no internet connection and that its extra features are a one-time payment.⁶ TypingTalk AAC is free on Google Play, with a choice of offline voices or more natural internet voices.⁷ Spoken predicts words as you type and has natural-sounding voices; the basics are free and new users get a free trial of its Premium features.⁸

If typing is hard

Tiredness, medicines, a weak hand or a stroke can make spelling hard. An app with picture buttons lets a person point instead. Tap AAC (ours) has picture pages and a typing screen, talking pages for intensive care needs and pain, and a voice that works with no internet; its 30-day free trial includes everything, so a stay of a few weeks costs nothing.¹⁴¹³ Cboard is a picture app with a free version, and also runs in a web browser.¹⁵¹⁶

If the hands can’t move

Look to Speak, a free Android app from Google, lets a person “use your eyes to select a menu of phrases and pictures and have them spoken aloud”.¹⁸ Vocable AAC, also free, uses the front camera on phones that support ARCore to follow head movements, so it can be used hands-free.¹⁹ Both need a stand to hold the phone or tablet steady in front of the person. On paper, an eye gaze board or partner-assisted scanning needs nothing but a helper.

Paper first, app second

In intensive care, a printed board is often quicker to start with than a phone: nothing to charge, unlock or set up, and anyone on the next shift can use it. Our free hospital communication board and large-print ICU board print on one page each. Many people use both: the board in bed, and the app when they can hold a phone.

More help choosing

• Make Android say what you typeLive Transcribe, call features, and text-to-speech or AAC apps, and which fits which need.
• AAC apps for adultsTyping apps for ALS, pictures and phrases for aphasia, and apps that suit autistic adults.
• Free AAC apps for AndroidWhich are free for good, which are free trials, and what the free versions leave out.
• How to communicate with nonverbal patientsYes and no, letter boards and handover, for nurses and care staff.
• AAC for adultsAfter a stroke, with ALS or MND, and in the hospital.

Sources

Read on October 30, 2026. Google Play listings are named by app ID (the “id=” in their web address).

1. NHS. Tracheostomy. NHS health information, page last reviewed 26 January 2024. Accessed October 30, 2026.
2. American Speech-Language-Hearing Association. Head and Neck Cancer (Practice Portal). Professional guidance for speech-language pathologists. Accessed October 30, 2026.
3. NHS Lothian. Voice care advice following vocal fold surgery (patient leaflet, PDF). NHS patient information, approved April 2024. Accessed October 30, 2026.
4. American Speech-Language-Hearing Association. Tracheostomy and Ventilator Dependence (Practice Portal). Professional guidance for speech-language pathologists. Accessed October 30, 2026.
5. NHS. Laryngeal (larynx) cancer: treatment. NHS health information, page last reviewed 1 September 2025. Accessed October 30, 2026.
6. Google Play. Speech Assistant AAC listing (nl.asoft.speechassistant). Price, in-app purchases, last update and listing text, United States, checked October 30, 2026.
7. Google Play. TypingTalk AAC Text-to-Speech listing (com.miyanour.speechassist). Price, in-app purchases, last update and listing text, United States, checked October 30, 2026.
8. Google Play. Spoken – Tap to Talk AAC listing (com.spoken.app). Price, in-app purchases, last update and listing text, United States, checked October 30, 2026.
9. Spoken. Does Spoken cost anything?. The maker’s help page. Accessed October 30, 2026.
10. Spoken. Spoken Premium vs. free. The maker’s help page. Accessed October 30, 2026.
11. Spoken. Do I need to be connected to the internet to use Spoken?. The maker’s help page. Accessed October 30, 2026.
12. Spoken. What is a fallback voice?. The maker’s help page. Accessed October 30, 2026.
13. Tap AAC. Everything Tap AAC does. Our own feature list for the version on Google Play.
14. Google Play. Tap AAC listing (com.tapaac.app). Price, trial and listing text, checked October 30, 2026.
15. Cboard. Cboard: free AAC web application. The maker’s website. Accessed October 30, 2026.
16. Google Play. Cboard AAC listing (com.unicef.cboard). In-app purchases, last update, listing text and the developer’s reply about the paid plan (November 3, 2023), United States, checked October 30, 2026.
17. Cboard. The app’s English text, in its published source code (en-US.json). The list of subscription features and the offline messages. Accessed October 30, 2026.
18. Google Play. Look to Speak listing (com.androidexperiments.looktospeak). Price, in-app purchases, last update and listing text, United States, checked October 30, 2026.
19. Google Play. Vocable AAC listing (com.willowtree.vocable). Price, in-app purchases, last update and listing text, United States, checked October 30, 2026.
20. WillowTree. Vocable. The maker’s website. Accessed October 30, 2026.