Dr Kamakshi Memorial Hospitals, Pallikaranai, Chennai restores voice in a larynx tumour patient

Investigation and Diagnosis

According to hospital sources, one Krishnamoorthi aged 49 years employed at the Airport Authority of India, presented with complaints of 'voice change' (hoarse nature) that had lasted for two months along with Intermittent cough. When evaluated via endoscopy to visualise the throat and voice box (larynx), a mass of tissues was discovered in the vocal folds, which was disturbing the voice production, resulting in sudden hoarseness. The biopsy of the mass provided a cancer diagnosis - squamous cell carcinoma.

The Plan of Action - Cancer Treatment

The Doctors at Dr Kamakshi Memorial Hospitals soon swung into action headed by their Consultant, Head and Neck Surgical Oncology Dr Major G Vasanth Kumar (MS ENT, DNB ENT, Fellow Head & Neck Surg Onco). Dr Vasanth Kumar, who is specially trained in Endolaryngeal & Microlaryngeal laser surgeries, voice restoration surgeries, reconstruction surgeries and upper airway surgeries planned and supervised the entire treatment assisted by his able team.

Dr Vasanth Kumar explained, "Our next step was to quickly analyse the spread of cancer. Staging of the disease was done with imaging (CT scan) and it suggested Stage 4A, which meant cancer had grown large and involved the laryngeal framework (muscles and cartilages of the throat). A thorough metastatic workup and evaluation to check if cancer had spread to other parts of the body was conducted. This was followed by a discussion within the multidisciplinary comprehensive cancer clinic to plan the course of treatment."

After much consideration of what was at stake, it was decided to surgically remove cancer as the primary treatment. This would be followed by radiotherapy in the postoperative period. The same was conveyed to the patient who was then counselled about the complications, consequences, alternate treatment options and post-surgery rehabilitation. Once the patient consented to the treatment, the surgery was performed and the voice box was removed. 4 weeks later radiotherapy sessions were administered for a duration of 7 weeks. The cancer treatment was a great success.

The most worrying concern from the patient's side was whether he would be able to speak after the surgery because it involved the removal of the voice box. The surgery is called Total Laryngectomy (larynx = throat, ectomy = removal), and it takes away the ability to speak using one's vocal cords. However, speech can be restored with adequate training after surgery."

Speech Restoration

There are three options after surgery for restoration of speech.

Option 1:

The first option is to use an Electrolarynx which is a small, battery-powered device. It makes a humming sound like the vocal cords, and the patient can move his lips to form words. Some models are used in the mouth, while other models are placed on the neck but the voice is robotic in nature.

Option 2:

The second option is Esophageal speech. For this approach, the speech-language pathologist teaches the patient how to swallow and then how to release air like a burp from the walls of the throat. The patient learns how to form words from the released air with his lips, tongue, and teeth.

Option 3:

The last option is TEP (Tracheoesophageal puncture). This surgery is done either at the same time the larynx is removed or as a separate surgery later. The surgeon makes a small hole between the trachea and oesophagus and places a small device in the opening. With practice, one can learn to speak by covering the hole and forcing air through the device. The air makes sound by vibrating the walls of the throat. This method is considered the best option. Nevertheless, motivation and practice are required to master it.Tep & Speech Rehab

Dr Vasanth Kumar further added, "In the current case, Krishnamoorti had consented to undergo TEP at the time of the laryngectomy. When he had recovered from the surgery and radiotherapy, he underwent intensive training to speak. Currently, he is able to speak only a few words, but with more practice, he will improve and his speech will become as normal as possible. Voice rehabilitation after laryngectomy is an integral part of treatment and many patients who have advanced throat cancer which needs surgery can enjoy a better quality of life through TEP. Not only did our team at Dr Kamakshi Memorial Hospitals (for full details on the facilities visit www.drkmh.com) intervene and remove cancer at the right moment, but we also ensured that the patient would regain his ability to speak and function normally in spite of the laryngectomy. Below is a testimonial from the patient himself in his own words."

"I am grateful to the Doctor's team at Dr Kamakshi Memorial Hospitals, Pallikaranai, Chennai who were involved in treating me. I was leading a normal life in Mumbai and then got transferred to Chennai a few years back. For 4 months I was having some change in my voice which was not responding to any home remedies. Since I had the habit of chewing tobacco and Paan, I was inquisitive in checking what is wrong with my throat. After the consultation with the doctor, and undergoing endoscopy, I was diagnosed with a mass in my vocal cords. The tissue in my vocal cards was taken and tested and confirmed as cancer. This was heartbreaking for me as I am the breadwinner of the family. The cancer was also in the advanced stage. The doctor's team suggested me to undergo surgery which involved the removal of voice box and part of the throat. I was very much concerned about my voice after the surgery because it is the only way of communication for me as I'm not so fluent in writing. The doctor told that a small valve can be placed during the surgery and through which I can speak after adequate training. After 4 months of treatment with surgery and radiotherapy now I am leaving a near-normal life with voicing to communicate. I have to practice hard so that one day I will speak as normal as you. I joined my work again and leading a happy normal life as a cancer survivor. Thank you."

Dr Kamakshi Memorial Hospital was established in 2005 by Dr TG Govindarajan, Founder and Chairman. A 75000 square feet 300 bedded multi-speciality hospital at Pallikaranai, Chennai, it is fully equipped with state-of-art facilities and expert doctors in every department besides 24/7 emergency services, pharmacy, online consultation, high-tech diagnostic and imaging facilities, fully sanitised premises and a support staff that does not hesitate to go the extra mile. The Hospital has one of the most advanced Cancer Treatment centres with Expert Doctors and the latest equipment for diagnosis and treatment of cancer. Dr Kamakshi Memorial Hospital is also at Medavakkam, Pallavaram (LK Hospitals) and now at Shastri Nagar, Adyar in Chennai. It is also a sought-after centre for Medical Tourism from across the world. The mission of the hospital is to provide quality health care to everyone and it strongly stands by the same true to its spirit.

For more details, please visit www.drkmh.com.

This story is provided by NewsVoir. ANI will not be responsible in any way for the content of this article. (ANI/NewsVoir)