Objective <p>This prospective study aims to explore the effect of combining speaking valves with swallowing training on early decannulation in tracheostomy patients with dysphagia.</p> Method <p>A total of 43 tracheostomy patients with dysphagia were randomized to a trial group (<i>n</i>=21, speaking valves plus swallowing training) or a control group (<i>n</i>=22, swallowing training alone) alongside routine care. Outcomes including decannulation rate, alveolar-arterial oxygen gradient [P(A-a)O2], nutritional/inflammatory markers, Penetration-Aspiration Scale (PAS) scores, and suctioning requirements were evaluated over a one-month intervention period.</p> Result <p>After the one-month intervention, the decannulation rate was significantly higher in the trial group (57.1%, 12/21) than in the control group (0%, 0/22) (<i>P</i>&lt;0.05). Both groups showed post-treatment improvements, but the trial group demonstrated significantly greater reductions in P(A-a)O2, PAS scores, suctioning frequency, and suction volume compared to controls (all <i>P</i>&lt;0.05). Furthermore, while both groups exhibited increased albumin and prealbumin alongside decreased neutrophils and C-reactive protein (CRP) levels, these improvements in nutritional and inflammatory markers were significantly more pronounced in the trial group (<i>P</i>&lt;0.05).</p> Conclusion <p>Combining speaking valves with swallowing training facilitates early decannulation, improves oxygenation, enhances swallowing safety, and reduces airway secretions. The observed favorable trends in nutritional and inflammatory markers are likely multifactorial, reflecting the broader benefits of this multimodal rehabilitation approach.</p>