Patients who have tumors within the airway, paralyzed vocal cords, swelling, stricture, or unusual airway anatomy are another category for tracheostomy because of airway obstruction that compromises normal respiration. A third category includes patients who cannot protect their airway and patients with an inefficient swallow and/or cough mechanism, common situations in patients who have a high spinal cord injury, cerebrovascular accident, or traumatic brain injury. Last, patients who cannot mobilize or manage their secretions may also require a tracheostomy.