A speaking valve for management of a patient's airway comprising a body rotatably and removably attachable to a tracheotomy tube, the body having a first end communicable with the tracheotomy tube and a second end distal from the first end, an offset opening formed in the second end, a ramp disposed within the body, a ball having a diameter disposed within the chamber, the ball being adapted to be guided up and down the ramp and able to partially close the opening in the second end of the body, and the body and hence the chamber therein, at the option and control of the patient, wherein the ball is adapted to move up and down the ramp opening and partially closing the opening in the second end of the body and, as selected, exhalation by the patient proceeds through the patient's upper respiratory system and facilitates speaking by the patient.