Val Kilmer was diagnosed with throat cancer over a decade ago, but it wasn't his cause of death

• Val Kilmer's cause of death was pneumonia, according to his daughter.
• Kilmer was diagnosed with throat cancer a decade ago and underwent a tracheotomy.
• The tracheotomy affected his ability to speak. The procedure can also increase the risk of pneumonia.

Val Kilmer died of pneumonia on Tuesday, but his history of throat cancer — an umbrella term for cancers of the throat, voice box, head, and neck — may have been a contributing factor.

Though the "Top Gun" star was diagnosed with the disease a decade ago, he initially kept it a secret. The actor, who was 65 at the time of his death, only began to speak publicly about his condition a few years later, and released a 2021 documentary "Val," in which he opened up about his health struggles, including losing his voice as a result of a tracheotomy. He used a voice box to speak in the film.

Kilmer's daughter, who confirmed his death, didn't clarify whether his pneumonia was related to his cancer. However, undergoing a tracheotomy can increase the risk of pneumonia long-term according to the American Thoracic Society.

Val Kilmer was diagnosed with throat cancer in 2014

The "Batman Forever" star received his diagnosis in 2014, but publicly disclosed it for the first time in a 2017 Reddit Ask Me Anything post. He had previously denied that he had cancer in 2016 after his "The Ghost and the Darkness" costar Michael Douglas revealed his health status during a press event. He later detailed his ongoing health struggle in a 2020 memoir called "I'm Your Huckleberry."

Kilmer confirmed he was cancer-free in a 2021 People magazine cover story promoting his documentary; in the doc, the actor said he'd been cancer-free for about four years.

Val Kilmer wasn't able to speak due to a tracheotomy

Kilmer's vocal cords were damaged after a tracheotomy, and he permanently lost his voice.

During a tracheotomy, also called a tracheostomy, a hole is made in the front of the neck and a tube is inserted into the windpipe. The procedure is performed on people with a problem that prevents air and oxygen from reaching the lungs. This can include throat injury (such as from radiation or trauma), or a physical blockage in the windpipe (such as from cancer).

The tracheotomy tube is secured to the neck with tape, and the patient breathes through it rather than through their nose and mouth.

It's common to have difficulty speaking after a tracheotomy, but not everyone loses the ability to speak permanently. However, the problem can persist in up to 25% of patients who require long-term mechanical ventilation, according to The National Tracheostomy Safety Project.

In a 2020 New York Times profile of Kilmer, the actor said his cancer treatments had included surgery, followed by chemotherapy and radiation. He suggested that damage from the chemo and radiation had resulted in his need for a tracheotomy tube. He also said that when he tried to remove the tube, he'd experience complications like a cough, cold, or fever.

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