April 15, 2005

MGH Voice Center saves voices, changes lives

For MGH patient John Ward, his voice is his livelihood. As a professor of Business Management at Northwestern University in Chicago and a consultant for a leading business school in Switzerland, Ward must speak clearly and project his voice so that his students can hear his sought-after lectures. He also has many public speaking engagements, requiring him to use his voice three to six hours a day. In 2000, his ability to teach and lecture was threatened when his normal speaking voice turned into a raspy whisper. He sought medical care from several well-known specialists in Chicago, but after several years of trying different kinds of therapies and treatments, his voice grew worse. His doctors were baffled. As a last resort, Ward was even teaching his classes in silence — using hand gestures, giving his students handouts and writing on chalkboards. Above, from left, Hillman, Ward and Zeitels

Finally in the fall of 2002, a colleague of Ward's suggested that he see a renowned voice specialist in Boston — Steven Zeitels, MD, FACS. It was after meeting with Zeitels and undergoing a surgical biopsy that Ward finally learned the cause of his voice problem — he was diagnosed with squamous cell carcinoma or vocal cord cancer. In fact, he had two independent cancers invading each of his vocal cords. This diagnosis was particularly unusual because Ward isn't a smoker. According to Zeitels, this kind of cancer is usually found in vocal cords that are exposed to years of smoking.

Ward was faced with an important decision. He could take the traditional course of treatment for this kind of cancer — which is to undergo radiation therapy. Or, under Zeitels' care, he could try a different course of treatment — a type of surgery that combines two techniques. One cancer would be removed by a traditional technique using a super-pulse carbon dioxide (CO2) laser as a light scalpel. To preserve more vocal tissue, the second cancer would be treated by means of a pulsed-dye laser (PDL), which usually is used to treat premalignant and vascular laryngeal lesions but had never been used to treat cancer before.

By using the PDL, the blood supply to the cancer is blocked with non-ionizing radiation but without cauterizing, burning or removing the delicate vocal membranes that vibrate to produce the voice. Using the PDL to treat laryngeal lesions had been developed and perfected through a collaboration between Zeitels and Rox Anderson, MD, director of the Wellman Center of Photomedicine.

After seeking numerous other opinions — at Zeitels' insistence — and thoroughly researching his options, Ward opted for the surgery. "I felt that I was making the right decision," he says. "While there was risk involved with choosing this path, I had complete faith in Dr. Zeitels. This surgery gave me the most promise for my future."
Ward underwent three microsurgeries in the course of several months. Using both techniques, Zeitels and his team were able to successfully remove one cancer with the CO2 laser and shrink the other cancer with the PDL.

An important factor for Ward is that he was able to recover the quality of his voice, and return to teaching his classes and international consulting. Since his last surgery in February 2003, Ward flies to Boston every two months for followup, and he continues to be cancer-free.

Ward's recovery is an example of the work of Zeitels and his colleague Robert E. Hillman, PhD, CCC-SLP, who have brought their expertise to the MGH to establish the MGH Center for Laryngeal Surgery and Voice Rehabilitation. Under the direction of MGH Surgery, the center provides state-of-the-art surgical and medical management of throat disorders that affect the larynx and voice. These conditions include vocal cord cancer, such as Ward's case, vocal cord lesions (dysplasia, polyps, nodules, papilloma), neurological disorders (paralysis) and vocal dysfunction resulting from behavioral causes. With a team of surgeons, speech pathologists and research scientists who have been working together for more than a decade, the center brings to the MGH some of the leading innovations and approaches to medical and surgical management, voice therapy services as well as education in voice science.

"Our group is very pleased to have joined the MGH, and we look forward to sharing our knowledge and expertise in laryngeal and voice disorders," says Zeitels.