HeadLines Spring 2009: Getting the Words Out

When he learned that radiation had failed to cure his laryngeal cancer, and he would need a laryngectomy, John Smith’s* first question was how soon he could undergo the surgery. But it was the next question that proved the most daunting: What if it was too late?

Heather Starmer works with a speech
pathology patient

It wasn’t. Smith arrived in the operating room in time and is cancer-free today. But after the surgery, a whole new set of challenges opened in front of him. With his voice box removed and a visible opening in his throat, the reflection he cast in the mirror no longer seemed to be his. Further still, he would have to relearn to swallow solid food and to speak. Fortunately, with his treatment at The Johns Hopkins Hospital came a multidisciplinary approach that placed him immediately in the hands of three speech pathologists in the Department of Otolaryngology: Heather Starmer, Donna Tippett and Kimberly Webster, each specializing in helping patients learn to function again after treatment for head and neck cancers.

“Saying that these people are great falls short somehow,” Smith writes in an e-mail. With treatment, rehabilitation and the assistance of a customized device made by the division’s anaplastologist, Smith has regained his speaking ability. “Between the cancer, the sense of dread that accompanies the diagnosis and the physical impairments that follow, you have the potential for a downward spiral. But when I arrived at speech pathology there, I landed in the arms of understanding, empathy and patience.”

Whether they’re treating a laryngectomy patient like Smith or a patient with a swallowing disorder because of previous radiation or chemotherapy treatments, Hopkins speech pathologists rely on a proactive approach that requires their involvement in every patient’s care from the very beginning. For laryngectomy patients, the department stocks every form of prosthesis to restore voice function and products to cover the visible hole that remains in the throat after surgery. They also design customized devices and prostheses—a service that’s only offered in a handful of places across the country. But that isn’t the speech pathology group’s only mission. They also focus heavily on creating and maintaining a high quality of life for their patients. The group is currently seeking funding to develop a clinical research program to identify methods of restoring and maintaining function in their patients and to study their quality of life.

“We see patients before they start treatment, during treatment, at the conclusion of their treatment and after their treatment,” says Starmer. “We do endoscopic evaluations that we use for evaluating swallowing and voice problems. We also have a large volume of patients and experience using a number of different modalities, like biofeedback. You won’t see that everywhere you go.”

Thomas Highley knows firsthand the importance of the speech pathology program’s hands-on, proactive approach. After a radiation treatment to cure a neck cancer damaged the muscles in his throat, he found himself unable to swallow and in Starmer’s care.

A Michigan resident who spends his winters in Southwest Florida, Highley chose Johns Hopkins because of a good experience he’d previously had under the hospital’s care. But the kind of time-intensive therapy required for treating his swallowing disorder, combined with a full-time job, made travelling back and forth from Baltimore difficult.

Starmer, however, was able to quickly determine what had gone wrong in Highley’s swallowing muscles and what kind of treatment he would need. Meanwhile, she located a physician and speech pathologist in Florida who were more convenient to Highley and willing to work with his care team in Baltimore. “She went out of her way to track down someone who could help me here so that I wouldn’t spend all of my time flying back and forth,” he says. “She’s just demonstrated such kindness and ability.” For more information please call 410-955-7895.