Touching Lives - March 2003
Giving throat cancer patients a voice
It is hard to imagine the frustration of suddenly being unable to form sounds and words, but it’s a problem faced by thousands of throat cancer patients every year.
As many as 50 per cent of throat cancer patients may need to have their voice box removed, which means that air can no longer pass from their lungs and into the throat and mouth to aid speech. Patients can also lose their vocal cords, used to produce speech sounds.
But thanks to a grant from Action Medical Research, scientists on Humberside are using advanced computer modelling techniques in new research that could improve the lives of patients striving to recover some form of speech after surgery.
Consultant surgeon Mr Stephen Ell and researcher Dr Michael Fagan have been awarded £68,000 to investigate ways of improving the treatment methods currently used to restore speech following laryngectomy (removal of the voice box).
Mr Ell said: “Throat cancer can be a devastating illness that may require removal of the voice box. A critical disability for these patients is the inability to speak. Our research has the potential to significantly improve the quality of life for thousands of such people.”
A permanent opening is made in the front of the neck to enable the patient to inhale and breathe. To help people regain their voice, a small silicone valve that connects the windpipe with the back of the throat allows them to talk again because air from the lungs can be diverted by the valve into the throat and formed into speech.
The technique is quite successful, but the valves used are still based on a design from the 1970s and need to be changed every three months or so. Replacement can be uncomfortable for patients and also expensive — ^there are about 12,000 valve changes in the UK each year, costing the NHS an estimated £8 million^.
Mr Ell, who is based at Hull Royal Infirmary, told us: “A reduction in the frequency of valve changes would benefit patients and the health service. Our project aims to understand the precise causes of valve failure, then use computer-aided modelling techniques to design a new valve that can operate for much longer.”
His colleague Dr Fagan is Director of the Centre for Medical Engineering at the University of Hull. His team will develop new valve prototypes using computer-generated models more often seen in the aircraft and automotive industries.
He said: “Speech restoration is an important treatment that has been neglected in the past and we are delighted that the support of Action Medical Research will help us address the problem.”
It may be two years before the team has a valve suitable for clinical trials, but the project is progressing well.
An impact on the whole family
It’s over five years since Alan Jennison of Hull had his laryngectomy, and the impact on his life has been enormous.
As a father of five, his house is usually busy with children and grandchildren, and the frustrations of having to learn to speak again after the operation were considerable, impacting not just on him, but on his whole family. As with any major surgery, it’s the attitude of other people that’s sometimes hardest to cope with.
Alan said: “It hasn’t been too bad and I manage quite well with the valve, but keeping it clean is very important. There are some frustrations, but generally I do quite well, even though it does have a big effect on your whole life.”
In the past few years Alan has been hospitalised with pneumonia — inevitably anyone not breathing through their nose or mouth loses their first line of defence when it comes to germs.
His wife Ann explained: “Colds are a real worry. The drugs do a good job but Alan is still vulnerable. Really there are many ways in which the operation has affected our lives.
“There is a lot of frustration and anger at first in not being able to communicate properly and there is certainly an impact on your social life, for example we don’t go out to eat much now because Alan can’t sit down and enjoy a big meal.
“Doing simple things are impossible for someone breathing through their neck. Alan was quite a handyman and after the operation, the first time he tried to blow some sawdust away really brought it home to him — ^he just can’t do things that he used to take for granted^.
“He has to constantly stop whatever he’s doing to be able to speak. Having to put his hand to his throat to speak can also cause problems because the attitude of other people is sometimes distressing.
“I think we all needed time to adjust when he first had the operation. In the house when the children are here it can get quite noisy; we try not to talk over Alan but sometimes it’s hard for him to make himself heard and there have been times when people have hung up the telephone, which is very annoying for him.
“The one good thing is that our grandchildren are so used to it that they think nothing of it and just accept it. They wouldn’t look twice at someone else with the same condition.”