By Alan Mozes
NEW YORK, Jan 24 (Reuters Health) -- Two years after the world's first
and, to date, only laryngeal transplant, US doctors say that the patient has
almost completely recovered his vocal capabilities, according to a report
presented Saturday at the American Laryngological Voice Research and Education
Foundation's "Millennium Symposium" held in New York City.
"He has pitch... not perfect, but he absolutely speaks in a normal voice
with pitch which is almost impossible to imagine without hearing it, but it is
truly amazing -- it still gives me goosebumps," said surgeon Dr. Marshall
Strome, chairman and professor of otolaryngology at the Cleveland Clinic
Foundation in Ohio, where the surgery was performed.
The transplant patient sustained severe trauma to his larynx -- more
commonly known as the "voicebox" -- in a motorcycle accident 20 years
previously. The serious damage meant that he could speak only with the aid of a
device pressed against his throat. During the groundbreaking operation, Strome
replaced 70% of the patient's larynx with donor tissues.
At the symposium, Strome screened an 8-minute video that traced the
patient's progress over the course of 18 months postsurgery, illustrating the
slow but notable recovery of the patient's ability to speak unassisted, and with
increasing clarity and pitch control.
In an interview with Reuters Health at the symposium, Strome expressed
unbridled optimism for the future of this type of surgery in light of the
results. "I expected that he'd be able to talk but the quality of his voice is
beyond my expectations," he said. "How could you really know what will happen?
We have worked with transplants in animals, but they don't really speak."
Two years after the procedure, Strome said that "we now know that it takes
1-1/2 years for the voice to completely mature to what it's going to be after a
transplant." And he added that the surgery can now be described as "the one and
only operation of its kind in which immunosuppression has been used and remained
viable for this long a period of time."
But Strome said that within 5 to 10 years he expects the surgery to be a
much more common occurrence, noting that the potential benefit to people
suffering from similar conditions -- including the nearly 10,000 people who are
diagnosed each year with laryngeal cancer in the US alone -- is enormous.
"The next patient will be someone who is 5 to 10 years after having his or
her larynx resected," said Strome. But in the midst of his high expectations, he
also emphasized that a major obstacle exists in making this surgery available to
all those patients who need it. "The operation costs $110,000, and it's not yet
covered by insurance," Strome noted, making it prohibitively expensive for
hospitals and patients alike.
"It's really sad," said Strome. "The letters I get (from patients) would
make you cry, saying that they just want to be human again... I have patients
lined up for this operation, but they can't afford it. We've had a lot of
publicity at the time of the operation -- all over the world -- but 2 years
later, the money just isn't there yet."
