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Charles Cummings
Charles Cummings, who developed the new laryngeal implant, tested it for 10 years on more than 250 patients.


How a Whisper Becomes a Voice

ven the fish are amazed at my new voice!” announces a postcard that otolaryngology director Charles Cummings, M.D., got from a patient snorkeling in the West Indies. Cummings says it typifies the joyful response he hears regularly from people who have received a newly FDA-approved laryngeal prosthesis that he developed with fellow otolaryngologist Paul Flint, M.D.

The voice-saving operation, a type of thyroplasty, helps patients whose paralyzed vocal folds fail to come together tightly due to loss of one or both of the laryngeal nerves that stimulate them. The condition can follow stroke, traumatic injury to the nerves, an impinging tumor or neurologic diseases like ALS or Parkinson’s. Alternately, the paralysis may arise from no known cause. “And if you can’t close your glottis because of it,” says Cummings, “you can’t use air effectively. Patients can’t project their voices. They find it difficult to exercise or even walk upstairs because air normally held in their lungs leaks out.”

What Cummings’ prosthesis does is provide bulk to a vocal fold, pushing it outward so it’s able to rest snugly against its counterpart. In a half-hour operation, with a local anesthetic, Cummings makes an inch-long incision in the neck and opens a small window in the thyroid cartilage. Using instruments he’s designed, he then inserts dummy prostheses of varying size—they’re about as big as half a sugar cube and look like tiny rock hammers—into the cartilage, adjacent to the vocal fold. With each of these “sizers,” he has the patient speak, in order to see which most closely returns the patient’s voice to normal. When he’s found the right size, Cummings exchanges the sizer for the permanent prosthesis. Then he snaps a 1-centimeter-long “shim” onto the end of the prosthesis, locking the whole thing into place. Patients’ voices typically recover fully within six weeks. “The correction,” says Cummings, “is apparently permanent.”

Cummings has been testing the laryngeal implants and the sizing system for about 10 years, on more than 250 patients, “with few, if any, complications.” The system, he says, is an improvement over earlier implants, which had to be hand-carved to fit during the operation. This not only doubled patient time in surgery, but also resulted in undesirable tissue swelling. In addition, says Cummings, the new implants, made of natural, bone-compatible hydroxyapatite, are assimilated into patients’ tissues more readily than earlier synthetic ones, providing a solid anchor. The implants received FDA approval this past spring. Formerly whispering patients, who could only count to six or seven before they had to gasp for breath, now give their high opinion of the implants in a loud, firm voice.