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In his own voice

For Pradeep Lahiri, speaking again after losing his voicebox to cancer, has been the greatest challenge, reports Dhamini Ratnam.
Hindustan Times | By Dhamini Ratnam, Mumbai
UPDATED ON JUN 03, 2008 07:20 PM IST

At 49, Pradeep Lahiri had to relearn speech, vowel by vowel, after his voice box (medically called the larynx) was surgically removed because of cancer.

This was in 1992, and Lahiri, a civil engineer by profession, was working at the Bhabha Atomic Research Centre, Trombay as a scientific officer.

Married, with two young children, he recounts how, after learning that he was to undergo an operation that would render him speechless, he would shut himself in the bathroom and turn on the tap so that no one could hear him cry.

Once his vocal chords were removed, a hole was made in his neck to allow him to breathe. The hole, called the stoma, is made in the trachea or air pipe for the air to go directly into the lungs. Losing his speech was a big set back for Lahiri; from being able to shout out to his assistants from the top of his office building easily, he was now breathing through a hole.

However, all hope was not lost. Dr Ashak Mehta, Lahiri's surgeon at the Tata Memorial Hospital, Parel, told him that as long as he could belch, he would be able to talk.

He was referring to esophageal speech (see box), a way of speaking in which Lahiri was shown how to take in air from his mouth to the throat and expel to produce sound. Lahiri practiced at home, moving his mouth and tongue to form vowels and consonants. It took several months before he could get the words out. It took even longer to be heard and understood.

"I may sound hoarse, and I certainly cannot sing, but I'm talking without a voice box or any aid," says Lahiri with pride. Perfecting the technique In 1998, Lahiri met the people who had started the Cancer Rehabilitation Clinic in Prince Aly Khan Hospital at the world congress for cancer patients being held in Worli, and agreed to join them as an esophageal speech therapist.

The next year, he went to Tokyo for an Advanced Instructor's training programme on Esophageal Speech conducted by the Asian Federation of Laryngectomees' Association (AFLA). The programme lasted a month, and Lahiri benefitted tremendously from it.

He not only learnt how to train other survivors in this form of speech, he also perfected his own. He was taught how to use his nose for short breaths in order to speak continuously, instead of short bursts.

"They taught me how taking in air through the nose helped improve my speech," says Lahiri who can now shout loud enough to be heard through a closed door. Not an easy feat seeing how much air has to be inhaled and expelled forcefully to achieve that without the help of the nose.

The importance of being heard Although technically, every laryngectomee is capable of esophageal speech, "only one out of 10 is capable of doing it" according to Dr Sultan Pradhan, the chairman at the department of oncology and chief of surgical oncology at the Prince Aly Khan hospital. "It's a question of knack. For instance, some people can whistle, some can't. Similarly, some laryngectomees just aren't capable of belching out air."

"Many don't want to make the effort even though this method costs nothing and returns the survivor's self confidence," he adds. Dr Pradhan, who helped start the CRC points out that cancer of the larynx is the most common after oral and throat cancer. There are devices such as the electro larynx, available to help a survivor vocalise, but the voice quality is robotic, and not all can afford them.

Today, Lahiri teaches other survivors how to speak. "Losing the voice can leave one feeling frustrated and dependent. In such cases a supportive family helps," says Lahiri. Having a larger support group of other survivors - success stories - can truly lift the laryngectomee out of depression. Lahiri's story is a case in point.

What is laryngeal cancer?
Cancer of any of the three parts of the larynx (the supraglottis, glottis and the subglottis) is called laryngeal cancer. The larynx itself is located in the wind pipe (or trachea) which extends from the nasal cavity to the lungs.

Tobacco products and alcohol can affect the development of laryngeal cancer.

Symptoms: A sore throat or cough that does not go away; Trouble when swallowing; Ear pain; A lump in the neck or throat; Hoarseness in the voice.

Cure: According to Dr Pradhan, every effort is made to preserve the organ up till the third stage of cancer. Often radiation is enough, if the cancer is detected early. Another method is the carbon dioxide laser treatment where a laser beam is directed at the cancerous growth magnified through a microscope.

"This method is effective and precise," says Dr Pradhan. "It costs far lesser as the patient can return home the very same day," he added. Up till an early stage 3, an open partial laryngectomy can also be performed, which allows for the preservation of the main functions of the larynx, namely swallowing, respiration and speech.

By a late stage 3, a combination of radiation and chemotherapy called Chemoradiation can be performed. Complete laryngectomy, which involves the removal of the entire voice box, with the vocal cords, occurs only in stage 4 cancer. This is when the patient loses his/her voice.

"Even here, in one out of five cases, the voice can be preserved, but the stoma would still have to be made in the neck," said Dr Pradhan. What then: Devices like the tracheoesophageal prosthesis and the electronic larynx can be used to generate the voice. Then there is esophageal speech.

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