Purpose: Tracheostomy patients face many adversities including loss of phonation and essential airway functions including air filtering, warming, and humidification. Heat and moisture exchangers (HMEs) facilitate humidification and filtering of inspired air. The Shikani HME (S-HME) is a novel turbulent airflow HME that may be used in-line with the Shikani Speaking Valve (SSV), allowing for uniquely preserved phonation during humidification. The aims of this study were to (a) compare the airflow resistance (R[subscript airflow]) and humidification efficiency of the S-HME and the Mallinckrodt Tracheolife II tracheostomy HME (M-HME) when dry (time zero) and wet (after 24 hr) and (b) determine if in-line application of the S-HME with a tracheostomy speaking valve significantly increases R[subscript airflow] over a tracheostomy speaking valve alone (whether SSV or Passy Muir Valve [PMV]). Method: A prospective observational ex vivo study was conducted using a pneumotachometer lung simulation unit to measure airflow (Q) amplitude and R[subscript airflow], as indicated by a pressure drop (P[subscript Drop]) across the device (S-HME, M-HME, SSV + S-HME, and PMV). Additionally, P[subscript Drop] was studied for the S-HME and M-HME when dry at time zero (T[subscript 0]) and after 24 hr of moisture testing (T[subscript 24]) at Q of 0.5, 1, and 1.5 L/s. Results: Rairflow was significantly less for the S-HME than M-HME (T[subscript 0] and T[subscript 24]). R[subscript airflow] of the SSV + S-HME in series did not significant increase R[subscript airflow] over the SSV or PMV alone. Moisture loss efficiency trended toward greater efficiency for the S-HME; however, the difference was not statistically significant. Conclusions: The turbulent flow S-HME provides heat and moisture exchange with similar or greater efficacy than the widely used laminar airflow M-HME, but with significantly lower resistance. The S-HME also allows the innovative advantage of in-line use with the SSV, hence allowing concurrent humidification and phonation during application, without having to manipulate either device.