A tracheotomy tube apparatus includes an outer cannula having first and second ends, a fenestration along the length of the outer cannula between the first and second ends, and a first inner cannula sized for insertion into the outer cannula. The first inner cannula includes a resilient region which lies adjacent the fenestration when the first inner cannula is properly oriented within the outer cannula, and a valve operatively associated with the first inner cannula. A region between the resilient region and the valve provides a passageway between the first inner cannula and the outer cannula when the first inner cannula is properly oriented within the outer cannula.