From twanging to talking
For most patients with advanced laryngeal cancer, removing the larynx completely offers a high cure rate, and patients typically live out normal life spans after treatment.
“The obvious downside to total laryngectomies is no more sound source for patients’ voices,” says speech language pathologist Kim Webster, whose caseload is filled with head and neck cancer patients dealing with this issue.
Most patients have one of two options for replacing their natural voice: either the hand-held, battery-operated electrolarynx or a tracheoesophageal prosthesis (also known as a TEP). A third method, used less commonly today, is esophageal speech, a technique in which patients learn to “burp” their words by swallowing air and forcing it out of the esophagus.
Though these methods do offer patients ways to talk, each has its drawbacks, says head and neck surgeon Joe Califano. Electrolarynxes and TEPs can cost thousands of dollars over patients’ lifetimes for care and upkeep, and esophageal speech can be extraordinarily difficult to learn. None of these options is a good fit for patients in developing countries, where resources such as equipment and batteries—and even education—are scarce.
But a chance flip of the radio dial five years ago is now offering total laryngectomy patients another way to replace speech: the jaw harp, an instrument also known as a mouth harp or trump.
In December 2007, musician Wayne Hankin heard a radio segment featuring Califano, who spoke about the challenges for patients with total laryngectomies. Hankin, who plays the jaw harp professionally and uses it to generate twangy, buzzy-sounding speech for fun, wondered whether his instrument might offer an alternative for patients who couldn’t access other options.
When Hankin called Califano with his idea, the doctor was initially skeptical. “I thought it sounded like a nutty idea,” Califano says. “But when Wayne started talking on the phone with his jaw harp, I could see that it really works.”
Califano invited Hankin to Hopkins to present his idea to himself and Webster in person. Within a couple of short lessons, both were speaking with the instrument—suggesting that it might be a viable option for patients, too.
Within months, Webster and Hankin had started a small pilot study to teach jaw harp-generated speech to a dozen total laryngectomy patients. Though results were mixed—not every patient was a fast learner—the majority were able to pick up the technique quickly and with relative ease. With further practice, Hankin says, talking with the jaw harp can be nearly as easy as speaking naturally.
Even so, jaw harps probably won’t overtake electrolarynxes or TEPs anytime soon, Webster says. Most insurance plans cover the majority of costs for these devices, which most patients find easy to use. However, she adds, the jaw harp holds decided advantages. With no special equipment or batteries necessary and a small learning curve, it could be a great option for patients in resource-poor settings. It also has an extremely minimal cost, Hankin adds.
“If you take care of your instrument and make an effort to learn it, the total charge for patients could be just a few dollars over the course of a lifetime,” he says.
Hankin and Webster presented their work at the American Speech-Language and Hearing Association annual meeting in New Orleans in 2009 and at a Baltimore Adult Communications Disorders Interest Group in 2011. They’re also preparing a manuscript on their pilot trial for publication.
“This may not change the current state of affairs,” Hankin adds, “but it adds another real option to the limited set of tools that cancer patients can use to get their lives back.”