An endotracheal tube (ETT) system and methods are provided. In at least one example, an ETT system may comprise, a tube, inflatable cuff coupled to the tube, and a restrictor. In at least one example the restrictor may comprise one more cavities. In a further example, a restrictor drainage assembly may be coupled to the restrictor, the restrictor drainage assembly configured to drain secretions that may be collected at a collection point formed by the restrictor when the ETT system is positioned in an airway of a patient and in an inflated state.