The goals of the study were 1) to investigate the relationship between tracheal air pressure and the tracheostoma valve seal in patients with laryngectomy and tracheoesophageal puncture (TEP) and 2) to assess whether tracheal pressure contributes to the duration of the valve seal. Ten patients with TEP after laryngectomy underwent training with an outer Blom-Singer tracheostoma valve and a 30-day trial with this “hands-free” speaking valve. We found that tracheal pressure was not a significant predictor variable in assessing the duration of the outer tracheostoma valve seal achieved by the patients with TEP. Factors other than tracheal pressure appeared to affect the duration of the tracheostoma valve seal. Mastery of use of the tracheostoma valve, the subject's neck anatomy, and the amount of time, training, and experience that was given to each subject were significant predictors of the valve seal. Tracheal pressure measurements might be of use in deciding between a standard or a low-pressure outer tracheostoma valve for an individual patient.